The benefits of complex care at home

Exploring the benefits of complex care at home

Complex care can be carried out effectively in a number of locations, however many people and their loved ones prefer to organise this type of care at home due to the benefits this setting provides. Here, we are looking at the differences between complex care carried out in hospital, in a nursing home, or at home, as well as exploring why complex care at home could offer more health benefits and a more person-centred approach, as well as being the preferred choice for those who need ongoing complex care. At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about complex care at home, we can help. 

Where can complex care take place?

For some people with serious health issues, care requires moving into a nursing home or a hospital setting, and the location of care will depend on the intensity of the needs of the person, as well as the length of time they are likely to require this for. While a nursing home or hospital may be more appropriate for some, it is possible to receive complex care at home if you would prefer to stay there, and this is likely to be arranged if you require complex care on a long-term or ongoing basis. Below, you will find the benefits and downsides of each of these complex care locations so you can make an informed decision about where is the right place for your needs, or the needs of your loved one. 

Complex care in hospital

Benefits

• Complex care may require a lot of medical intervention from doctors and nurses, and in hospital this can mean the doctors in charge of care could specialise in the particular health condition the person has. In addition, there may be more specialised equipment and technologies on hand to offer more comprehensive treatment options. 
• Those with a serious long-term illness may feel more secure with the continuous monitoring a hospital can provide, prompting appropriate interventions when needed. 
• Hospitals are equipped to offer immediate access to resources such as diagnostic tests, medications, surgical procedures and more, so depending on the condition the person has, this could provide benefits that other settings do not have. 

Downsides

• Time in hospital can lead to further hospitalisations. Research found during winter 2022/23 in the UK, 1 in 6 patients aged 75+ were readmitted within 30 days of being discharged, creating a potential cycle of being in and out of hospital and never getting into a routine of home care that could provide more comfort. 
• In the UK, research has highlighted a potential shortage of hospital beds, so relying on complex care to be carried out in hospital long-term may not always be possible. 
• Hospitals can provide a feeling of safety for people with serious illnesses, however studies have found little difference in the amount of patients who pass away in hospital (17.7%) compared to the number of patients who pass away during Hospital at Home care (16.9%).
• Hospitals can be stressful and impersonal environments, which can have a potentially negative impact on a patient’s emotional wellbeing, particularly if they need to spend a long time there. 
• Hospital-acquired infections can be a concern for those in need of complex care due to the high volume of patients they may come into contact with. One study of over 200,000 patients across 947 hospitals found around 19.5% of patients in intensive care had at least one hospital-acquired infection. 
• When spending long amounts of time in hospital, a person’s autonomy can be impacted as they have less control over their daily routine, instead having to fit in with set mealtimes, restricted family visiting hours, and more. 

When people receive complex care in hospital, the aim is usually to eventually move them from hospital into either another facility like a nursing home, or ideally to their own home.

Complex care in a nursing home

Benefits

• Nursing homes benefit from having qualified medical professionals and other staff trained in providing the complex care a person requires, which means they may be able to administer medical treatments if needed. 
• Nursing homes can feel like a safer environment due to the 24/7 care and monitoring offered, and could have the infrastructure for care that could reduce risk of accidents.
• Nursing homes can provide or organise a combination of services to help the person, utilising clinical nurses, care managers, dietitians, physiotherapists, and more – anything that could help with the wellbeing of the patient may be arranged. 

Downsides

• • When a person enters a nursing home, they may start to lose their sense of independence while fitting into the structured nature of nursing home care, which can negatively impact their quality of life. 
  • Nursing homes come with limited privacy in a communal setting, and less choice when it comes to when and how often family members and friends may visit. 
  • Staffing challenges – such as shortages or high turnover rates – can lead to inconsistent care quality and limited attention to each person’s individual needs.
  • Nursing homes can be incredibly expensive, which can place financial strain on residents and their loved ones. According to Age UK, nursing homes could cost as much as £800 to £1,078 per week on average, however this depends on where you live in the country and other factors. 

• People in nursing homes may have a lower life expectancy than other people. According to the Office for NationalStatistics, life expectancy for care home residents between 2021 and 2022 ranged from 2.9 to 7 years for female residents, and 2.2 to 6.3 years for male residents, which is a significantly lower life expectancy than non-care home residents.
• There may be an increased risk of hospitalisation when living in a nursing home, with studies finding residents are more likely to experience acute hospitalisations, adverse events, and an increased risk of infections. 

You may find more useful information in our guide to the benefits of home care vs a care home.

Complex care at home

Benefits

• The outcome of care at home could be the same as outcomes of care in hospital settings. In one study, those who received Hospital at Home care had a similar outcome 6 months later as those who went to hospital.
• Studies have found those who undergo care at home, including complex care, found greater levels of patient satisfaction than they did when in hospital. 
• At home, those in need of complex care can benefit from more specialist, bespoke care that takes into account their individual circumstances, which could improve both the person’s health and their wellbeing. 
• Live-in care is an option for those who need (or prefer to have) 24/7 care and feel more safe and secure in the knowledge that someone is always around to help. 
• Home-based care allows patients to maintain a higher level of independence, and be part of the decision-making on daily activities, including family visits to the home. 
• Person-centred care is at the heart of home care, meaning care plans are tailored to the specific needs and preferences of the individual, promoting a more personalised approach to treatment and support. 
• Having complex care at home means a potentially reduced risk of infections due to spending less time in hospital.

Downsides

• At home, there may be less immediate access to medical resources needed, such as specialised medical equipment, diagnostic testing, and emergency services. However, with long-term complex care at home, anything required for the person’s health needs and comfort can be arranged within the home. 
• Family members may experience increased stress and burnout (or carer’s burnout) when providing complex care at home without respite care. 
• There may be fewer socialisation opportunities when living at home than there would be in a nursing home, which can lead to loneliness. With forward planning and a care plan acknowledging the need for socialising, this can be easily rectified at home.

Are there any health benefits to having complex care at home?

As well as the aforementioned benefits of receiving complex care at home, there could also be further health benefits, including:

• Enhanced comfort, which can positively impact stress levels and quality of life 
• A reduced risk of infections from hospitals 
• More effective one-on-one monitoring
• More personalised care that recognises potentially harmful symptoms early
• A reduced risk of developing acute confusion – studies have found that after one month people receiving Hospital at Home care were less likely to develop delirium, which could be helpful for those with conditions such as dementia

Another study found home-based care seemed to have a positive impact on the person’s adherence to their medication schedule, their patient satisfaction scores, and their health-related quality of life, so depending on the condition the person has, there could be multiple health benefits to choosing home care over other settings. 

Why do so many people prefer complex care at home?

Research carried out for a 2022 report found that only 20% of people aged over 45 believed they would be happy to go into a residential care home later in life, so it appears to be widely understood that receiving care at home is better. Studies find home healthcare interventions are likely to be just as effective – but less expensive – than hospital care interventions, so for many people receiving complex care in the comfort of their own home is the preferred choice. In addition, local councils tend to align with the view of the World Health Organization, which recommends older adults (who are arguably more likely to require complex care) be cared for in their own homes for as long as possible in order to maintain their wellbeing and independence.While the health benefits and other positives of complex care at home are undoubtedly important, it seems many people simply prefer the idea of remaining in the environment that is familiar to them, and that they are comfortable in. Staying in their own home may enable them to, for example:

• Continue spending time with others in their community
• Use their own belongings
• Take part in any hobbies they enjoy and may not be able to do elsewhere
• Enjoy more flexibility in how they spend their time and their routine
• Keep any beloved pets
• Spend quality, uninterrupted time with friends and family without restrictions

If home-based complex care seems like the best option for you or your loved one, and you would like to learn more about how this could fit into your life, our award-winning home care at Home Instead could offer you the bespoke, person-centred complex care you need. You can reach out to the Home Instead team to discuss your needs and allow us to create a personalised package to support you.