Home hospitalization, which is still not widely practiced in France, has many advantages for the patient, their loved ones and the health system when possible. We explain how it works.
Since the creation in 1957 of the first home hospitalization structures (HAD) , this alternative to intra muros care has continued to develop. Advances in medicine and technology (more efficient and smaller devices) have played a large part in this. But the digital revolution, which paved the way for files shared in real time, has also promoted its growth by allowing better coordination of the various stakeholders, and therefore more effective monitoring of patients. And all this, for a daily cost three times lower than that of the hospital. However, underlines Mathurin Laurin, national delegate of the National Federation of Home Hospitalization Establishments , “ the target rate of recourse to HAD, set at 35 patients per 100,000 inhabitants in 2013, has still not been reached. We are currently at 27-28 patients per 100,000 inhabitants ”, or 160,000 people last year. Why? Mainly due to lack of knowledge of the system, both on the part of patients and doctors. An opportunity to take stock.
Heavy and complex care can be provided in home hospitalization
HAD provides intensive and complex hospital care in the patient's home, whether it is a house, an apartment, a room in a nursing home for dependent elderly people ( Ehpad ), or for disabled people. As in a hospital, healthcare professionals take turns with the patient to provide the prescribed care , and a nursing and medical service is available 7 days a week, 24 hours a day. Finally, depending on how the patient's condition evolves, the prescribing doctor adapts the treatments, up to the point of deciding on traditional Home hospitalization if he or she deems it necessary.
Serious, acute or chronic pathologies too
All people receiving hospital care that does not require a technical platform (operating room, medical imaging room , etc.) or 24-hour monitoring (intensive care) are eligible for HAD. In short, " we take patients of all ages, suffering from serious, acute or chronic illnesses , often multiple ," summarizes the specialist. In fact, a third of HAD activity concerns palliative care and another third concerns complex dressings (wounds that heal poorly or require more than 30 minutes of treatment). In the remaining third, neurodegenerative pathologies ( Charcot's disease , multiple sclerosis, etc.) occupy a significant part. But the scope of HAD continues to expand : " Among the care provided, there is also post-stroke neurological rehabilitation, blood transfusion, parenteral nutrition, complex post-surgical monitoring, monitoring of high-risk pregnancies, pathological postpartum, heavy respiratory assistance, injectable chemotherapy..." lists Mathurin Laurin.
A prescribing physician and a dedicated care team are part of the protocol
HAD can be proposed by the treating or hospital physician , or even requested by the person themselves during their hospital stay. If the principle is accepted, the patient's file is sent to one of the 286 HAD structures closest to their home. " The first step for the designated team is to assess the feasibility of home care: what is the condition of the accommodation; if necessary, can a medical bed be installed; what is the patient's level of dependency; is a caregiver present …" says Mathurin Laurin. If validated, admission is pronounced within 24 to 48 hours. The HAD team then develops the care protocol and coordinates the various professionals called upon to intervene: nurse, psychologist, dietician, physiotherapist, giving priority, when possible, to those who are already following the patient. The prescribing physician remains the pivot of the care. If all goes well, it is he who ends the HAD, maintaining if necessary simple care that no longer requires home hospitalization.