Forget the awkward hospital gowns, frequent disruptions, lack of privacy, strict visiting hours and groans from other patients which are typical for many stays in hospital.
South Africans, who ordinarily would be admitted to hospital for acute-level care, are opting to have the same services in the comfort of their home, thanks to the hospital-at-home concept, which grew in popularity during the Covid-19 pandemic.
Though this delivery model is not for everyone, medics and medical schemes see it as not only affordable and eliminating the inconvenience of going to hospital, but it has been proven to speed up the healing process and reduce the risk of in-hospital infections.
Using sophisticated remote monitoring technology, medics are able to track even the slightest change in patients’ health.
SA’s biggest medical scheme, Discovery Health, which launched the hospital-at-home initiative in January, has seen significant growth in demand from patients and doctors since then. To date more than 160 patients have been admitted to the programme, while Bonitas has funded 1,154 members.
We have seen a significant shift and greater adoption among the younger population in addition to the uptake among the elderly.
— Dr Abongile Qamata, from AfroCentric Group
Patients are provided a range of ancillary services including home oxygen therapy, intravenous infusions, fluid management and advanced wound care.
Those eligible for admission are mostly patients who could be cared for in a general hospital ward. Some conditions funded by medical schemes so far are uncomplicated respiratory, gastrointestinal, urinary tract and skin infections, including those who’ve had surgery and qualify for early discharge.
Some patients with Covid-19, chronic heart failure, hypertension, diabetes pulmonary embolism, renal failure and strokes had also opted for home treatment.
Once admitted, patients are looked after by dedicated clinical teams which include doctors, nurses and other healthcare practitioners such as physiotherapists and psychologists.
Discovery Health CEO Ryan Noach said the programme provides attractive alternative care for a range of medical and post-surgical conditions that would otherwise require hospital admission. “Importantly, the evidence shows that outcomes are as good, if not better, than in the case of in-hospital care.”
“Hospital at home demonstrates the power of merging traditional healthcare delivery with cutting edge medical technology and innovation, resulting in the patient receiving the best possible care in the comfort and dignity of their own home.”
While globally, hospital-at-home programmes have existed for several years, in the wake of Covid-19 many leading medical institutions across the world such as the Mayo Clinic, Cleveland Clinic and Brigham and Harvard University’s Women’s Hospital revived the concept.
“Ultimately, the pandemic accelerated the adoption of digital healthcare technologies, particularly remote-monitoring technologies that enable hospital-at-home care delivery. Along with this, substantial clinical research has now been conducted on hospital-at-home models, conclusively demonstrating that these models often achieve superior patient experience and better clinical outcomes than traditional hospitals.”
Even though traditionally home-based care appealed to older patients, Dr Abongile Qamata, who leads the non-hospital alternatives programme for AfroCentric Group that administers about 17 medical schemes in SA, said: “We have seen a significant shift and greater adoption among the younger population in addition to the uptake among the elderly.”
The group had seen a “double-digit growth year-on-year since 2020”. Qamata said treatment in the home rather than at hospital saved costs by more than 40% for a single admission. “It is worth noting that brick and mortar or hospital fees, and not healthcare professional fees, drive admission costs.”
Apart from fear of hospital infections, including Covid-19, Qamata attributed the popularity of home-based care to the fact that it is funded from the hospital benefit and not day-to-day savings.
“The model introduces much-needed efficiencies and value to our healthcare system. Similar to a general ward setting, these patients don’t require round-the-clock in-person nursing care. They need close monitoring, unlike in-hospital where monitoring is intermittent with occasional in-person interventions.”
Bonitas head of operations Morgan Mkhatshwa said even with 24-hour professional care at home the costs were far less.
“Hospital-at-home is up to three times more affordable. If an average hospital stay costs R45,000, the hospital-at-home costs are about R15,000.” It also reduced the length of stay by up to 40% and improved patient satisfaction.
Not only is the home environment comfortable, “it improves patient and family participation in the treatment plan”.
“Having family members and loved ones participating in the care of a loved one — such as helping with bathing, feeding — makes a significant difference in the outcome.
“Hospitals have advantages of operational efficiency, emanating from treating more people in one place, aggregated expertise for clinical excellence and a well-established system for patient care, but hospitals are not the only environments for patient care and in some situations, not the most optimal.”
Though Bonitas introduced the concept late in 2020 its popularity grew rapidly and more than 1,000 patients had used it, averting 770 hospital bed days.
Mkhatshwa said the home option was “indispensable and would play a key role” in the future of health care given the cost of hospital care, shortages of beds and healthcare staff such as nurses.
“Nursing carers come to the home for a few hours a day or full time when the need arises. There are no visiting hours and the patient is the primary focus of the caregiver, so needs are met faster and more time is spent with patients. This also means a faster recovery, and the chances of picking up an infection, which can happen in hospital when they are exposed to germs, is reduced.”
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