Abstract
Background: Catalonia's hospital-at-home (HaH) services have expanded significantly over the past decade, marking a shift towards home-centered care. The aging demographic—particularly those over 65 with frailty, cognitive decline, or disability—requires a more specialized and collaborative approach, as conventional hospitals often struggle to meet these complex needs. Intermediate care (IC) units facilitate the transition from hospital to home, providing a holistic model that minimizes complications such as delirium, reduces hospital stays, and lowers nursing home admission rates. In 2017, Catalonia pioneered an intermediate care hospital-at-home (IC-HaH) unit in Barcelona. Based on comprehensive geriatric assessment (CGA) and supported by a multidisciplinary team, this IC-HaH model aims to offer intermediate care within the home setting. This study aims to detail the admission case-mix of HaH in Catalonia from 2017 to 2023, highlighting the significance, growth, and role of the IC-HaH model within the Catalan health system as an innovative approach to geriatric home care.
Approach: We analyzed data from all HaH admissions across Catalonia from 2017 to 2023, including both acute and IC units, using the Data Analysis Programme for Health Research and Innovation (PADRIS). We focused on patient characteristics and care outcomes, especially within the IC-HaH cohort, to evaluate how this model enables holistic, integrated care for older adults. The IC-HaH model is supported by a multidisciplinary team—comprising geriatricians, nurses, physiotherapists, occupational therapists, pharmacists, and social workers—who deliver tailored interventions that meet each patient's unique needs.
Results: Overall, 48.2% of all HaH admissions in Catalonia involved patients over 65 [mean age (SD) 62.6 (22.3)], with 53.7% female. Among these patients, 11.4% had a history of falls, 11.8% experienced cognitive issues, and 40.3% were classified as frail. In contrast, the IC-HaH pilot unit served a more geriatric-focused population of 1,180 patients (mean age (SD) 82.7 (10.0)), where 93.7% were over 65 years, 55.8% were female, 63.5% had disabilities, 33.5% had a history of falls, 29.5% had cognitive impairments, and 83.3% showed varying degrees of frailty.
Implications: The IC-HaH model provides an effective alternative to hospital care for frail older adults with complex needs. Its personalized, multidisciplinary approach addresses various aspects of health, including physical, cognitive, and social functions, within the familiar home environment. This can improve outcomes by reducing hospital-related complications, such as delirium and functional decline, and supports recovery without the risks associated with extended hospital stays. The approach also enhances the patient and family experience by minimizing disruptions to daily life.
From a healthcare services perspective, the successful implementation of this IC-HaH pilot highlights its potential for wider regional adoption to meet the growing need for comprehensive care for older adults. Expanding IC-HaH units across Catalonia could relieve pressure on acute hospitals, decrease the length of hospital stays, and provide a more sustainable, cost-effective alternative. The model also enables more continuous, patient-centered care by reallocating healthcare resources towards community services.
Catalonia's IC-HaH model provides specialized, home-based care for frail older adults, improving outcomes, reducing hospital complications, and supporting seamless transitions. Its expansion offers a sustainable, patient-centered alternative to geriatric care.