“Care@home will be a cornerstone of the healthcare system”

Care@home is a term that leaves room for interpretation. Can you give us a one-sentence definition?

It stands for patients receiving in-home treatment of an equivalent standard to in-hospital treatment, administered by specialists supported by technical applications.

A competence centre for Care@home in the canton of Bern is currently in planning. How did the idea come about?

The Council of the Canton of Bern has set up a medical task force, the objective of which is to successfully position Bern as a leading location for medical services.

This task force has commissioned BFH to work with partner organisations to draft models to further the development of healthcare towards a system that combines outpatient and inpatient services into a continuous treatment chain.

The models of what is known as integrated healthcare should be not just efficient, but also cost-effective and quality-conscious. This gave rise to the idea of a Care@home competence centre.

What goals are you hoping to accomplish with the competence centre?

The competence centre is tasked with developing, testing and evaluating models for new decentralised care concepts in the healthcare sector. These models should incorporate the patient’s perspective and needs, but they must also be efficient, of high quality, and safe. Another priority for the canton of Bern is that the competence centre should also consider the medical care of the population in peripheral regions.

The centre is far more than just a single practical application of Care@home: rather, it is a broad-based initiative and a significant driver of innovation in the healthcare sector – not just in the canton of Bern, but nationwide. It is characterised by close collaboration between politics, science, industry and practice, resulting in a strong innovative spirit. The network now comprises 50 partner organisations from all areas of the healthcare sector.

Where does the project stand today?

Over the past year-and-a-half, the project team has done a great deal of conceptual work and laid a broad foundation for the idea of Care@home, such as hosting workshops to bring the partner organisations into contact with each other. Thanks to startup funding from the canton, we have also been able to support initial ideas for research projects and get the studies off the ground.

What is still needed for the competence centre to begin its work is the green light from both the Executive Council and the Grand Council. These decisions will be made at the end of the year.

What role does BFH play in Care@home?

Besides the remit to set up the competence centre and support research projects for Care@home models, BFH is playing a key role in connecting up the various partner organisations.

In the longer term, the aim is to develop Care@home into a standard healthcare service and to transform the competence centre into a definitive organisational form. This final step is planned for the years 2028 to 2030. It remains to be seen whether the competence centre will then remain within BFH or become an independent entity.

What would Care@home be like for me as a patient?

Care@home works on three levels. The models seek first to avoid hospitalisation as far as possible or, second, to help shorten it. Third, the goal of Care@home is to guarantee timely access to healthcare services for the population in peripheral regions of the canton.

Let’s say, for example, you suffer from chronic obstructive pulmonary disease. You ask your family doctor or hospital to ascertain whether Care@home treatment would be an option for you. If it is, the specialists will come to your home, where you will receive exactly the same treatment as you would in hospital.

For this to work reliably, technological solutions are needed that make it possible to log your health data such as blood pressure, oxygen saturation, etc. and transmit them electronically to the hospital. This ensures that you as a patient are monitored at all times and that immediate medical interventions can be initiated if necessary.

For Care@home models to work, certain social and technical conditions must be met. Can you give us any examples?

Studies have shown that relatives and friends play a key role in the success of Care@home. Care@home models are difficult to implement for patients who live alone and have no supportive social network.

Relatives play an important role in the care or monitoring of the person receiving treatment. This involves administering medication, supplying meals, keeping an eye on symptoms such as the patient’s temperature, or helping the patient to the toilet, to name just a few examples.

Of course, there is also the need for technical equipment that can record key health data and enable specialists to remotely monitor the condition of the patient around the clock.

Who benefits from Care@home?

We know from countries that have introduced Care@home that the model is extremely effective and delivers good results for patients. It is safe to say that Care@home offers the greatest benefits to patients.

Another well-known fact is that people recover better in their familiar home environment than in a hospital. For relatives and friends, Care@home makes everyday life easier thanks to the support of medical professionals.

Are there also losers?

Care@home certainly raises social and ethical issues. With Care@home, there is the risk of a redistribution of professional treatment work to unpaid, informal care by relatives and friends.

That is something that needs to be talked about. Otherwise the work could end up largely falling to women. After all, they still usually end up doing most of the domestic chores and care work.

What are the biggest challenges for Care@home?

The financing is a major challenge. Care@home does not fit into any of today’s healthcare financing models, in that it involves a mix of outpatient and inpatient treatment.

It would be unacceptable if a service provider such as a hospital gets the money and the relatives at home do even part of the work free of charge. In order for the system to be as cost-efficient as intended, it needs its own innovative models for the payment of services.

Studies from abroad have identified other challenges with regard to medication management. Even if relatives are provided with clear instructions, they can still make mistakes when giving medication, for example in the dosage or the time of administration.

Other problems include relatives not realising that a patient is showing signs of poor or inadequate nutrition, or responding too slowly to a deterioration in the patient’s health.

You see Care@home as a model for integrated healthcare – could this be the miracle cure for the problems in the healthcare system?

I’m not a fan of miracle cures, because they promise a lot but aren’t always able to deliver. Care@home is a promising model that can make a significant contribution to solving the most pressing problems in the healthcare sector.

This approach, in that it involves a participatory collaboration between patient, relatives and professionals, creates a new kind of relationship based on mutual respect, which in turn has a positive impact on both the work of the professionals and the recovery of the patients.

When could the first implementations of Care@home go live in the canton of Bern?

I anticipate that we will have completed the first pilot tests within the next four years and that the financing of the models will have been sorted.

Let’s look ahead: what’s your vision of Care@home for the year 2034?

Ten years from now, Care@home will be a cornerstone of our healthcare system. One that can guarantee a high quality of in-home healthcare through personalised treatment solutions and the use of modern technology.

Technological advances hold enormous potential for new applications such as telemedicine, the monitoring of health data using wearable devices, or ‘wearables’, autonomous transport of medicines and much more. Care@home entails a high degree of innovation and will change healthcare.