Hospital-at-home care model may address hospital admission constraints.A study conducted by researchers in Singapore shows that a hospital-at-home (HaH) care model is on par with ward-based acute care in clinical outcomes but outperforms it in cost.
In this study, the costs per bed day and per episode were lower (–42 percent and –24 percent, respectively) in the HaH than in the ward group. “However, there were no significant differences in mortality, 30-day readmission, emergency department (ED) visits, or improvement in patient-reported quality of life,” the investigators said.
Compared with the ward group, the HaH group had lower weighted median costs per bed day (S$935 vs S$1,611; p<0.001) and per episode (S$5,186 vs S$6,851; p<0.001). [BMC Health Serv Res 2026;26:242]
The cost of staffing was also lower in the HaH than in the ward group (S$2,292 vs S$2,867), as were the overhead costs (S$1,487 vs S$2,207; p<0.001 for both). The investigators attributed these to caregivers’ ability to provide basic care and remote monitoring, which could reduce the need for overnight nursing staff. Moreover, patients at home typically self-manage, and HaH staff do not necessarily require a big ‘office space’ in the HaH setting.
The weighted median total length of stay was longer in the HaH than in the ward group (5 vs 4 days; p=0.02). Looking at the total unweighted HaH bed days, 682 bed days were saved.
The HaH and ward groups had similar 30-day readmission rates (9.3 percent vs 7.9 percent; weighted relative risk [RR], 1.2; p=0.65) and ED re-attendance (4 percent vs 2.6 percent; weighted RR, 1.9; p=0.33), as well as weighted mean changes in EQ-5D* utility value (0.23 vs 0.21; p=0.54) and EQ-VAS** from baseline (14.9 vs 13.9; p=0.69).
In the HaH group, one frail elderly patient died after returning to the hospital for pneumonia; another died within 30 days after being discharged from HaH to home hospice care with a preference to die at home. No deaths were reported in the ward group.
Three safety events were reported in the HaH group (two falls and one thrombophlebitis). In the ward group, only one was reported (venous thromboembolism).
Over 95 percent of patients and caregivers expressed willingness to use the HaH again. The researchers attributed this to the intangible benefits, such as improved communication and more convenient visitation. [Cochrane Database Syst Rev 2016;9:CD007491]
Over 70 percent of HaH patients with a preceding ward stay reported better sleep quality, more time walking around, and less time lying in bed than those warded in the hospital.
Despite some reports of patients and family members being inconvenienced by the HaH setup, most patients (97.5 percent) and caregivers (83.9 percent) felt more comfortable having the patient at home. “Patients in the HaH group generally had positive experiences with home visits,” the researchers said.
“Asian health systems are facing significant bed capacity issues, with countries like SG (2.1 beds per 1,000) and South Korea (12.7 beds per 1,000 in Seoul) experiencing hospital inflow exceeding outflow,” the researchers noted.
SG’s ageing population and the rising healthcare costs underline the urgency to explore alternative care models. [Lancet 2021;398:1091-104; https://www.population.gov.sg/files/media-centre/publications/population-in-brief-2023.pdf; https://www.moh.gov.sg/others/resources-and-statistics/government-health-expenditure-and-healthcare-financing, accessed March 16, 2026]
The study included 302 participants (151 in each group) recruited from two SG hospitals that had an active HaH service during the study. The HaH group included clinically stable patients who were able to self-care or manage with caregivers, lived within the programme’s catchment area, and agreed to HaH admission. The ward group included patients clinically eligible for HaH but lived outside the catchment area or were excluded from the programme due to full capacity.
“Our findings support the recognition of HaH care as part of an inpatient admission, a shift that is already underway in Australia and Europe, and currently being evaluated in the US,” the researchers said. “In SG, since April 2024, HaH financing has been similar to standard in-hospital admission, ensuring lower out-of-pocket charges compared to ward-based care.”
“Such health financing reform is critical to HaH sustainability and expansion beyond pilot phases and to incentivizing adoption in health systems that rely on out-of-pocket hospitalization costs,” they continued.
The results also challenge the assumption that new hospitals are the only solution to address constraints, the researchers noted. “A balanced approach should thus prioritize timely hospitalization while minimizing hospital-acquired complications.”