- Story
Care@home: “Guests in their patients’ homes”
06.03.2025 Care could change radically in the next few years. Experts Friederike J.S. Thilo, Kerstin Denecke and Manuela Grieser discuss the role that further education can play in this change.
Key points at a glance.
- Care@home promises care and support for patients with acute illnesses in their homes rather than in hospitals.
- The approach engages patients and their relatives more closely in their care.
- Also, it requires new skills from healthcare professionals.
- BFH supports this evolution with its research, the development of basic principles, and relevant training and continuing education.
What will change for nurses or healthcare IT specialists with the Care@home approach?
Thilo: The Care@home approach aims to prevent hospital admissions in cases of acute illness. This requires a ‘new’ flexibility and availability on behalf of nurses and doctors. Furthermore, the integration of digital tools in the laboratory or for diagnostics, teleconsultations and vital sign monitoring is expanding the scope of activities of nursing staff.
Grieser: A key change for nursing staff is the increased level of personal responsibility. Nurses often work independently. They must be able to grasp complex situations quickly, and make therapeutic decisions and communicate them competently within the interprofessional team. This requires advanced clinical and therapeutic skills to ensure safety and self-awareness in practice. They must collaborate with the network caring for the patient. This goes far beyond nursing activities.
Denecke: Sensors will be used to continuously collect data and monitor people’s health. As a result, the handling of data will become a major challenge. How do I identify a health risk amidst all the data? This requires the development of algorithms capable of recognising emergencies or adverse health issues and pointing them out.
People in care will undoubtedly need to rely even more on technology.
What will change for people in care?
Grieser: The Care@home approach means first and foremost that they can remain in their familiar surroundings while receiving care. This can mean greater autonomy and well-being – but it also brings new challenges.
Denecke: For example, people in care will undoubtedly need to rely even more on technology, e.g. to manage their own health. They will need to be trained for this.
Grieser: Dealing with technology – for example with data security and documentation – will indeed play a greater role, but so will the patients’ self-awareness and body awareness. Patients will be required to make independent decisions in uncertain situations – potentially with guidance, but often without immediate professional support. The situation will also change for relatives: they will not simply hand over their loved ones to a hospital, but actively bear responsibility for their care. This additional responsibility will not suit everyone.
Thilo: Exactly, which is why Care@home must remain voluntary and subject to approval by doctors and nurses. However, a rethink is worthwhile for people in care because they suffer fewer complications (e.g. infections or delirium), often have a better appetite, recover faster and maintain more autonomy when they can stay at home. This has been highlighted by international studies.
The interviewees
Prof. Dr. Kerstin Denecke: works as co-head of the Institute for Patient-centred Digital Health on the development and use of new technologies in healthcare.
Prof. Dr. Friederike J.S. Thilo: As co-director of the Swiss Center for Care@home, she is intensively involved in the professional development of healthcare professionals in Care@home models.
Manuela Grieser: Is a registered nurse (RN) and holds a master's degree (MA). As Head of Nursing at BFH, she is responsible for the strategic and content-related development of training and continuing education formats in the nursing field. She focuses on innovative educational programmes that address current professional and practice-relevant developments.
What are the challenges associated with the development of Care@home?
Grieser: Care@home presents a number of difficulties because it implies fostering a new self-image in people: they need to perceive themselves as competent beings again in order to overcome challenges independently, make sound decisions and make only targeted use of support from specialists. The ability to handle one’s own insecurity will be crucial.
The involvement of patients and their relatives will become more intensive.
Which (new) skills are required for Care@home?
Thilo: At this stage, we don’t conclusively know which skills healthcare professionals need for Care@home. However, new roles specialising in interprofessional collaboration, the use of technology and data or the care of specific patient groups are foreseeable. It is clear that the involvement of patients and their relatives will become more intensive, as with the Care@home approach, healthcare professionals are guests in their patients’ homes.
Denecke: We need to find new ways of identifying and managing risks pertaining to patient safety. Crisis management or legal and ethical issues will play a greater role and require appropriate skills for the assessment of care situations.
Grieser: The Care@home approach demands a more extensive knowledge base and greater autonomy from nursing staff, who will need further training in handling patients and technological aids. Skills such as self-awareness, value orientation, process understanding, therapeutic thinking and action, mindfulness-based approach, therapeutic resonance and self-regulation will be essential.
What skills does Care@home require?
For the successful implementation of Care@home, professionals must possess a broad set of skills for their day-to-day work:
- Generalist knowledge: they have a comprehensive understanding of a wide range of illnesses and medical issues as they do not carry out their work in a specialised environment. They must also acquire technical skills and develop a sensitivity for handling data (data literacy).
- Recognition of early warning signs: they are able to identify subtle symptoms and signs of crisis at an early stage, as the home setting offers a less tight monitoring.
- Emergency management in a home setting: they know how to manage acute crisis situations in the patient’s home and initiate suitable interventions.
- Extensive therapeutic skills: they acquire expertise in therapeutic approaches such as systemic therapy, Open Dialogue or crisis intervention in order to provide effective emotional and psychological support to patients.
- Autonomy: since they often work alone, they must be able to make clinical decisions quickly and confidently. Due to the mobile nature of their work, they need good planning and prioritisation skills.
- Analysing situations and prioritising: they are able to assess which measures are necessary immediately and which can be scheduled for later interdisciplinary coordination.
- They can deal with uncertainty in oneself and in those affected and their relatives.
- Joint decision-making: they actively involve patients in their decisions by communicating information clearly and comprehensibly and finding solutions together.
- Communication: they ensure competently the involvement of the family and social environment in order to offer patients the best possible support, without overburdening relatives.
- Patient coaching: they help patients and relatives take responsibility for health and crisis management (e.g. training in early warning signs, medication management, mental health crisis and somatic stress management). Patients can be assisted by apps or wearable sensors. Therefore, professionals must understand these technologies and train their patients on them.
- Network: they can cooperate with various actors (general practitioners, psychiatrists, doctors, social work, nurses and carers, peers, communal organisations).
- Systems thinking: they understand that patients are embedded in complex social, psychological and physical contexts. Interventions must be assessed with a holistic approach.
- Mobile documentation: their care documentation must be efficient and secure.
- Telemedical support: they are able to provide videoconsultations and teleconsultations and can effectively integrate digital communication methods.
- Willingness to learn: they must be aware of their own limitations, engage in regular exchange and use peer counselling techniques.
What specific contribution can our university make in Switzerland?
Denecke: Success models or guidelines can be developed in networks such as the Swiss Center for Care@home, which promotes knowledge and resource exchange. We can also develop innovative technologies and platforms that support healthcare at home.
Grieser: Innovative learning methods are also needed to prepare professionals and volunteer caregivers for the specific challenges of Care@home. This is precisely what we offer in our continuing education courses, which promote the interprofessionalism and participatory action of the target groups and try to involve the relatives and those affected whenever possible.
Thilo: At the Swiss Center for Care@home, we have begun to identify empirically the need for continuing education and the type of courses that are required. For example, we need to better understand which educational formats are preferred. Our aim is to find out what content is suitable for teaching in a university setting and what needs to be taught and perfected with a supervised practice. Based on the results, we will be able to develop new Care@home courses.
