Extending Hospital-at-Home to nursing homes: findings from a novel care model in Singapore.

BACKGROUND

We implemented a Hospital-at-Nursing Home (HaNH) pilot program in a nursing home to reduce acute hospital bed utilization and allow residents to receive right-sited care in familiar environments.

METHODS

A prospective data collection of the Hospital-at-Home (HaH) program was conducted from November 2023 to December 2024 in a regional general hospital.

RESULT: 16 HaNH enrollments were completed, comprising three admission avoidance cases and thirteen early supported discharges. Pneumonia (56.3%) and urinary tract infections (18.8%) were the most common diagnoses. The median length of stay was three days (range 1-12, IQR 4). One mortality occurred within the program in the HaNH in alignment with the patient's preferred place of care and death, supported by palliative care. Comparisons with a non-institutionalized HaH cohort (n = 349) had a higher risk of escalation to the actual hospital facility (RR = 5.45, 95% CI: 1.71-17.42, p = 0.0025; aRR = 1.32, 95% CI: 0.35-4.96). HaNH patients had increased vulnerability, with higher post-discharge mortality (RR = 10.9, 95% CI: 2.16-55.21, p = 0.004; aRR = 3.38, 95% CI: 0.83-13.71) and emergency visits (RR = 3.18, 95% CI: 1.72-5.88, p = 0.0002; aRR = 2.00, 95% CI: 1.18-3.36), though readmission risk was non-significant.

CONCLUSION

These preliminary findings suggest that while HaNH may alleviate hospital bed shortages, patients in nursing homes are at increased risk of deterioration and require careful selection and support.