Politicians, hospitals resist at-home care

Hospital in the home is entirely doable, but it needs political courage and a transition plan.

---

Caring for patients in their home rather than a traditional hospital setting is far from a new idea in Australia – but policymakers and bureaucrats are proving to be major roadblock.

The benefits for eligible patients who are offered well-resourced and supporting in-home care have been well-documented, including reduced infection risk, improved recovery time, and better family and social support.

And when it comes to the cost, the case for in-home care becomes even more convincing, with research showing it can be up to 10 times cheaper than in-hospital treatment.

In home care is not for all patients, but for those who meet the criteria it has a frustrating level of untapped potential, as delegates at panel discussion at the Wild Health Summit in Canberra heard.

Toby Hall, former St Vincent’s Hospital CEO, said that the solution was “not rocket science”.

“We’ve talked about [at-home care frameworks] for the last 30 years,” he said.

“There is nothing new in this. What is difficult is making the transition. We have to address the current system, and fund transition to a new model at the same time. That costs a lot of money. And everyone’s scared to do that.”

Mr Hall used the example of past mental health policy to demonstrate why transitional funding was important.

“We had this brilliant idea of taking everybody out of institutions (and) put them into community services,” he said.

“That is the way to go. And it’s logical from a health point of view. We all agreed with that but we didn’t fund it.

“What has actually happened by default – we (now) fund mental health services and care institutionally through our prison system, largely. That might sound horrendous but that’s the truth.”

Mr Hall said that transition funding needed to come with strong political will.

“We need brave leadership from state politicians to say, ‘instead of developing the big hospitals, were going to develop ambulatory care centres’,” he said.

Hospital funding models also needed to change if at-home care was to become a widespread reality, he said.

“The reason hospitals don’t want to do something different is because if they take money and spend it on someone being (treated) at home, the way the system works (means that) that money is taken away from them in the future,” Mr Hall said.

“These are fundamental flaws. We need to look for an answer.”

Hospitals in Denmark have also impeded the widespread roll out of at-home care, said Hans Erik Henriksen, former chief executive of Health Denmark.

This was despite, Mr Henriksen said, at-home care costing Danish tax payers 10 times less that care in a bricks and mortar hospital. He added, however, that there had been a recent change that opened new possibilities.

Mr Eriksen said the Danish Minister of Health stepped in to forge a regional agreement – a common strategy between hospitals and local municipalities to provide care jointly.

“That is the reason why even though there’s resistance with the hospital, we are now (able to deliver at-home care). But we could do it faster,” he said.

Quality Care Coach managing director Sarah Barter has helped aged care organisations design person-centred models of care.

In the panel’s discussion about policy and funding, she said it was critical to remember the person at the centre of the care. She said the new in-home care model for aged care was “very concerning”.

“It’s basically a fee for service model that has a stripped back care management and has a separate assessment function,” she said.

“You actually are not enabling conversations at all between people living at home and the people that are supporting them in that home.”

Ms Barter said the absence of the customer voice was also evident in digital strategy underpinning at-home care.

She said the market was not building technology around supporting person-to-person interactions which were at the core of at-home aged care.

“We’re just tinkering in the edges – implementing a new client management system, or a new incident management system or a new billing system,” Ms Barter said.

“Rather (we should be) looking at what technology is needed to allow humans to do what humans do well – connecting with each other, caring for each other, and designing services that meet those individual needs.”

Panellists also spoke about the five advantages to at-home care in Denmark, Australia’s technical dependencies, and how clinical governance fits in.

Watch the video for the full discussion.