Care@home: Core Competencies for Home-Based Treatment

Care@home is a care model where patients with acute illnesses are treated in their home environment. This approach presents healthcare professionals with new challenges and requires special competencies.

Healthcare is facing a paradigm shift: Care@home, the treatment of patients with acute illnesses in their own homes, is gaining increasing importance [1] . In the psychiatric field, various treatment concepts have been tested in Switzerland for several years [2] . The Care@Home service models (Hospital at home, Home treatment, and others) aim to avoid or shorten hospital stays, ensure immediate access to healthcare (timely access), use resources efficiently, and increase the efficiency of the healthcare system.

As part of a research project funded by the BFH thematic field Caring Society, researchers from the Departments of Engineering and Computer Science as well as Health investigated which competencies are required for implementing this model. The goal: to develop continuing education programs that support professionals in successfully implementing Care@home in practice.

Learning from Experience

As part of the project, five professionals were interviewed who were involved in the introduction of Care@home projects in psychiatry and general medicine. The aim of the interviews was to identify key skills and competencies for providing care in the home environment. Three of the respondents led such programs, two were involved in their development – all had direct experience in implementing or conducting Care@home services. The projects examined include:

Intensive psychiatric home treatment for children and adolescents,
Psychiatric Care@home services for adults,
Transitional treatments after hospital stays (up to three months for stabilization),
Acute care in the home environment, comparable to a hospital stay.

The interviewees reported on the content and pitfalls of their projects, their respective roles, as well as technical, organizational, and personnel challenges in practical implementation. They also formulated key competencies required for establishing and operating Care@home structures. The evaluation of the interview notes was conducted using thematic analysis. Additionally, a literature review was carried out on existing education and training programs in the field of Care@home or Hospital at Home [3] .

Changing Requirements for Healthcare Professionals

Care@home models bring profound changes for healthcare professionals. Providing care in the home environment requires a high degree of flexibility, availability, and adaptability. Close collaboration with family members is often necessary, as well as coordinated interprofessional cooperation. Increasingly in demand are abilities to quickly assess complex situations within the family system, make well-founded therapeutic decisions, and communicate these clearly within the team. This requires enhanced clinical and therapeutic competencies to act safely and independently. Digital technologies – such as sensors for monitoring vital parameters, teleconsultations, or mobile laboratory diagnostics – significantly expand the scope of action. At the same time, they place new demands on the technical abilities and skills of professionals, particularly in dealing with digital tools and integrating them into everyday care.

Competencies for Care@home Treatment

Psychiatric care in home environments requires a comprehensive and context-sensitive competency profile. Seven core competency areas proved essential for professionals in psychiatric Care@home services:

Clinical and diagnostic competencies: Deeper knowledge in psychiatry, psychotherapy, and somatic comorbidities as well as abilities for nuanced diagnosis and management of crisis situations.
Home and family-oriented care skills: Abilities to adapt interventions to the respective home environment and family dynamics, and support for families in change processes.
Treatment planning and process management: Skills in planning and managing individualized treatment processes, including the coordination of interdisciplinary teams.
Communication and interprofessional collaboration: Active listening, empathetic communication, and transparent collaboration with multidisciplinary colleagues and external institutions.
Teamwork and leadership: Skills in conflict resolution, promotion of psychological safety, and team coordination as well as strategic thinking and system coordination for leaders.
Professional attitudes and adaptive abilities: High degree of professional autonomy and adaptability to work in decentralized, patient-centered environments.
Data-driven care and evaluation: Ability to collect, analyze, and interpret clinical and operational data to improve quality, safety, and service outcomes.

These competency areas form the foundation for effective and sustainable psychiatric care in the home context.

Conclusion

Care@home is a forward-looking approach in healthcare that opens up new care possibilities for patient-centered treatment in one’s own home. At the same time, the model also brings with it diverse challenges – particularly regarding collaboration, responsibility structures, and technological requirements. Successful implementation requires close cooperation between professionals, patients, and family members, as well as the targeted use of digital technologies. Specialized continuing education programs, such as those being developed by the Bern University of Applied Sciences (BFH) and the Swiss Center for Care at Home, play a central role in preparing healthcare professionals for these new requirements – thus enabling high-quality, hospital-equivalent, safe, and efficient care in the home environment. Starting in autumn, it is therefore planned to offer a CAS in Enabling and Managing Hospital@Home at the Department of Engineering and Computer Science at BFH.

Figure 1: Competencies for Care@home Service Models

References

1 Thilo, F.J.S., Schmid, T. and Seiffert, A. (2023). Hospital@Home – der aktuelle Forschungsstand. Was wir wissen und welche Unklarheiten bestehen. NOVAcura, 54, 5, 13-17.

2 Graf D, Lerch S, Böhnke U, Reichl C, Kindler J, Koenig J, and Kaess M, Treatment outcome of an intensive psychiatric home treatment for children and adolescents: a non-randomized controlled pilot evaluation, Eur. Child Adolesc. Psychiatry. 32 (2023) 685–695. doi:10.1007/s00787-021-01919-y.

3 Denecke K, Reichenpfader D. Preparing for Hospital at Home: A Review of the Current Landscape of Training Practices. Stud Health Technol Inform. 2024 Nov 22;321:48-52. doi: 10.3233/SHTI241060. PMID: 39575778.

Links

Projectsite: https://www.bfh.ch/de/forschung/forschungsprojekte/2023-789-793-005/

Swiss Center for Care At Home: https://www.bfh.ch/de/forschung/forschungsbereiche/swiss-center-for-care-at-home/

Prof. Dr Kerstin Denecke is Professor of Medical Informatics and Co-Head of the Institute of Patient-centred Digital Health at Bern University of Applied Sciences. Her research focusses on issues such as artificial intelligence and the risks and opportunities of digital healthcare solutions.

Manuela Grieser is Head of Continuing Education in Nursing at the Bern University of Applied Sciences, Department of Health. She specializes in innovative care models, psychiatric care and developing the skills of healthcare professionals.

Denis Moser is an assistant at the Institute for Patient-Centered Digital Health and is studying for a Master's degree in Medical Informatics at the FHNW.

Prof. Dr Friederike Thilo is Head of Innovation Field "Digital Health", aF&E Nursing, BFH Health. Her research focuses on the design of human-machine interaction in patient care with a focus on the nursing profession in an interprofessional context, digital transformation processes in healthcare and professional development in Care@home care models.