Clinical Interventions of Hospital at Home inNursing Home in France: Barriers, Incentives andGuidelines

Background: Hospital at Home (HAH) can intervene in Nursing Home (NH) in France for reinforcing the primary care quality of the very frail residents and reducing hospital admissions. But the development of this innovative care program is still limited and objectives of the study were to identify barriers and incentives of this collaborative intervention. Methods: This is a qualitative study based on semi-structured interviews with clinicians and administrative professionals of the HAH of the Assistance Publique-Hopitaux de Paris and two NH in Paris. Eighteen semi-structured interviews were conducted and data analysis used the Grounded Theory method. Results: The willingness of collaborative practices expressed by the management level met resistances at clinical level; clinicians from NH and HAH had an opposite vision of the nursing home; HAH clinicians felt isolated in their intervention in the NH and a lack of communication tools was compensated by the nurse managers. Conclusions and recommendation: barriers of collaborative interventions were numerous, more frequent at clinical level and mainly for the HAH clinicians whose practices in NH were isolated. Based on the study findings, recommendations are proposed for reinforcing the collaborative interventions: promoting a shared institutions project focused on resident benefits, fostering a common aging culture between clinicians and planning joint interventions with communication tools.