COVID-19 Hospital at Home : another piece of the armoury against COVID-19

Authors: consultant in geriatrics and general medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; service lead for @Home service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; integrated care fellow, Guy’s and St Thomas’ NHS Foundation Trust, London, UK including intravenous treatments, oxygen and nebulisers, but not single organ support such as renal haemofiltration or mechanical ventilation. They reduce the demand on hospital beds by offering an alternative place of care to people who otherwise would either need to be admitted to hospital for treatment or would need to stay longer in hospital to complete their treatment. In healthcare systems with @Home, these services fill the gap between primary and secondary care acute services. @Homes exist throughout the world but are predominantly found in higher-income countries. Some are specific to a single disease entity (such as oncology and stroke), whereas many others manage a mixture of medical conditions. These services are particularly helpful for older adults living with frailty for whom hospital admission might lead to hospital-associated secondary issues, such as nosocomial infections, worsening mobility, delirium and institutionalisation. Outcomes are similar whether care is delivered by @Home or in hospital, and there is evidence of a reduction in subsequent admission to long-term institutional care for those who receive @Home care. The COVID-19 pandemic has led to two surges in demand for hospital care. Hospitals have a finite capacity, so alternatives to hospital care were vital to ensure patients received evidencebased treatment in the right place at the right time. Many systems for remote support and monitoring of patients in their own homes with COVID-19 were set up to cope with the surge in demand but for frailer adults and those with more complex needs, face-to-face support was needed. Here, we describe how a well-established @Home service supported pathways of care for patients with COVID-19, particularly older adults living with frailty, including a unique severe COVID-19 treatment pathway.