Patients with palliative care needs often prefer to be cared for at home, but when their needs are complex or acute this may not be considered feasible or safe. The PallCare@Home pilot was a bed substitution model, delivering intensive, short-term specialist palliative care to patients admitted in their own homes, rather than their usual hospital-based health service.

To deliver specialist palliative care intervention commensurate with patient preferences, whilst reducing emergency department presentations and hospital admissions. 

Led by a nurse practitioner coordinator, a core team of specialist palliative care physicians and clinical nurse consultants collaborated with Hospital-in-the-Home nurses to provide a least two contacts per day, utilising telehealth when appropriate. After hours support was provided by an established state-wide palliative care after hours telephone support service, supplemented by a private generalist nursing home-visiting service for patients in unstable or terminal phase. 

In the first three months of the pilot, twelve patients were admitted to the program, mainly for symptom management, care coordination and to transition from hospital to the community setting. The average length of stay was 11.5 days. An estimated 4 emergency department presentations and 5 hospital admissions were prevented. No patients died during their admission, but of those patients who died during the follow-up period, the home death rate was 66%. Consumer feedback was almost universally positive, with a Net Promoter Score of 90. 

The PallCare@Home model of care was well-received by patients, caregivers and health professionals, achieving high levels of patient satisfaction, and patient-centred care. Collaboration with general nursing teams had limitations when caring for a patient population with complex and changeable palliative care needs. The significant workload of care coordination prior to, during and after an admission was resource intensive but crucial to the success of the program.