What does “advanced home care” mean?
It means bringing hospital-based care and expertise into the home to assist patients with complex needs. A “complex case” is, for example, a patient with multiple conditions (multimorbidity) and high clinical instability, requiring frequent therapeutic adjustments or possible urgent interventions.
Another example is a patient recently discharged from intensive care or surgery, still with invasive devices such as drains, catheters, or open wounds. Traditionally, such situations would have required hospitalization or a stay in a rehabilitation clinic.
Today, thanks to the evolution of specialized home care and advanced home management, it is often possible to organize care at home safely, with significant benefits.
CAD Ticino defines its mission as taking charge of patients in acute and chronic clinical situations requiring highly complex management, i.e., intensive and specialized care at home as an alternative to long-term hospitalization. This requires highly trained staff, clear protocols, and support technology to deal with emergencies.
Examples of advanced home care interventions
Thanks to dedicated nursing and medical teams, many procedures that were once only possible in a hospital can now be performed in the patient’s home. Here are a few examples:
Complex infusion therapies
Intravenous administration of drugs such as antibiotics, biological therapies, parenteral nutrition, and transfusions. A specialized nurse can safely manage central venous catheters (e.g., PICC lines or Port-a-Caths) and infusions at home with the same accuracy as in a hospital ward. This allows patients with severe infections (e.g., endocarditis) to continue 4-6 weeks of IV (intravenous) antibiotics at home instead of staying in the hospital.
Ventilation and oxygen therapy management
Patients with chronic respiratory failure may require non-invasive ventilators (CPAP/BiPAP masks) or even tracheostomies with mechanical ventilation at home. Specialized nurses are needed who are able to suction the airways, operate the machines, and recognize signs of respiratory distress. In Ticino, there are already patients ventilated at home thanks to 24-hour assistance shared between family members and professionals.
Post-operative care and surgical emergencies
The management of complex surgical wounds with advanced dressings (including VAC negative pressure systems) can be carried out directly at home thanks to specialized healthcare services. If a patient develops a minor complication such as partial wound dehiscence (reopening), the home care team can intervene on site under the guidance of the surgeon, avoiding a return to the ward. Some clinics also offer short post-operative stays in a villa, followed by Spitex care at home, demonstrating that the hospital is trying to reduce hospital stays and allow patients to return home as soon as possible.
Emergencies managed at home
If an emergency arises, advanced home care teams are prepared to provide first aid. CAD, for example, guarantees intervention within 20 minutes in the event of an acute event.
This means that if a patient has a sudden onset of symptoms (e.g., high fever, respiratory distress), a nurse with an emergency kit can be on site within minutes to stabilize them (administer oxygen, reserve medications, defibrillation in case of cardiac arrest, etc.) while the ambulance is called at the same time. This dual response increases the chances of overcoming the crisis without sequelae or complications.
Multidimensional assessments and coordination
Advanced home care involves an in-depth analysis of the person’s health, functional, and social needs. Standardized assessment tools are often used: for example, the RAI-HomeCare system assesses the patient’s functional, cognitive, and nutritional status and support network to tailor the care plan. In Switzerland, home care is prescribed and reimbursed according to specific needs assessments. For highly complex cases, there is usually a case manager or care coordinator who oversees everything, ensuring communication between specialists and the family doctor.
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Alessio Branca, Medical Director at CAD, confirms that in order to best manage a complex patient at home, the fundamental pillars are: high capacity for objective clinical analysis (supported by assessment criteria such as NERAT), extreme availability and ability to communicate with all professionals involved, and rapid decision-making. It is necessary to ensure predictive planning that covers the possibility of intervention at any time of the day or night, anticipating problems and complications.
Technology and operations center: continuous supervision at home
Technology is a valuable ally in advanced home-based care. A complex patient at home can be equipped with multiple sensors: a continuous pulse oximeter, cardiac telemetry, continuous glucose monitor, and bed/chair position sensor. Data sent 24/7 to the operations center means that the clinical situation is under constant control.
Find out more about remote assistance and continuous telemonitoring tools
In the event of an alarm, such as a drop in oxygen below 90%, the center immediately contacts the nurse on duty or the doctor. Alerts are sent in the event of out-of-range values or customized alarms detected by safety and fall detection systems, geolocation, and geofencing, which are in constant communication with nursing and medical staff. It’s like having a virtual “mini ward” distributed throughout patients’ homes. This makes it possible to manage even high-risk patients in a home setting, preventing sudden deterioration.
An example: the CAD nursing coordinator reports the experience of a patient discharged early with ongoing oxygen therapy who had night-time monitoring devices installed. During the night, the oxygen mask became dislodged, causing a drop in saturation to 84%, the threshold parameter set. The system sent an alarm, and an operator intervened at the patient’s home to reposition the oxygen therapy device correctly.
In practice, even if the patient is physically ‘alone’, it is as if they are under continuous, invisible intensive care monitoring. This also allows patients at high risk of deterioration to be managed.
Integration with the public emergency system
The CAD service is fully integrated with the cantonal emergency healthcare system (ambulance, emergency room) and with the attending physician. The aim is to avoid hospital admissions that are not strictly necessary, managing as much as possible through home care.
Examples of integration between home care and the emergency system
If a CAD nurse arrives at a patient’s home and finds a cardiac ischemic event in progress, they will immediately intervene in the clinical situation (oxygen, defibrillation if necessary) and at the same time call an ambulance for transport to the hospital.
The aim of advanced management is not to exclude the hospital, but to filter and, if necessary, postpone hospitalization until it is strictly necessary, or to manage everything that can be managed at home.
A terminal patient with a high fever due to pneumonia, if followed by a home palliative care team, can be treated at home with IV antibiotics and oxygen without going to the hospital, with the guarantee of safe, dignified, and continuous care.
Training and emergency protocols for home nurses
Advanced home nursing requires specialized staff training, which is crucial in the management of complex cases and emergencies. Advanced home nurses are often Advanced Practice Nurses (APNs) with a specialized master’s degree, or nurses with extensive experience in critical care who bring their skills to the community. They follow precise protocols: for example, protocols for managing sepsis at home (recognizing signs of sepsis and immediately starting fluids and antibiotics, organizing hospitalization), protocols for chest pain (immediate ECG and sublingual nitroglycerin, etc.).
Some Swiss projects, such as Home TeleCare, have obtained authorisation to operate with APNs and doctors remotely via telemedicine following current legislation. This has required ad hoc agreements and technical solutions, but it demonstrates that such interventions are feasible.
The recent Swiss federal initiative “Strong Nursing Care” (approved in 2021) strengthens the role of nurses in the autonomous activation of certain treatments without a doctor’s prescription and billing them. This helps advanced home care, because a nurse in an emergency can act more freely.
However, there is a focus on containing costs: in Ticino, a moratorium on new home care companies is being imposed due to the explosive growth of the private sector and the costs borne by the LAMal in recent years. From 2010 to 2020, spending per insured person in Ticino on home care grew by +153% (compared to +85% on average in Switzerland), with private services tripling in number. This shows that more and more patients, including complex ones, are being cared for at home, but also that regulation is needed to ensure quality and sustainability.
An ‘external hospital’ in the patient’s home
The word ‘Spitex’ is a contraction of ‘Spitalextern’ (outside the hospital), indicating that these services act as a hospital spread across the territory. CAD emphasizes that it covers ‘the entire treatment chain, from prevention to emergency’. So not only daily care, but also crisis response.
Flexibility is key: on any given day, the home care team may find themselves administering IVs, dressings, physiotherapy at home, managing seizures, or dealing with difficult IV access.
The dynamic nature of care is essential, and CAD stands out for its rapid response and integration with the most advanced technologies that support and enhance human intervention. It facilitates collaboration between all those involved in patient care by adopting an integrated approach that allows complex situations to be dealt with seamlessly.
If a patient’s condition worsens, they are not ‘lost’: they are either stabilized at home or, if hospital care is really necessary (e.g., for emergency surgery), the home care team works to ensure that the transfer is carried out appropriately, providing hospital doctors with a complete and up-to-date clinical picture. Often, after hospitalization, the same team will facilitate the return home (hospital-to-community transition), creating a virtuous circle.
Conclusion: advanced home care for complex patients
Advanced home care now makes it possible to treat complex patients at home, reducing hospitalization and improving quality of life. This evolution in personal well-being brings benefits for:
- benefits for patients, who avoid long hospital stays,
- for family members, who see their loved ones cared for in the loving environment of their own home
- for the system, because hospital resources are focused on patients who really have an acute need.
However, it requires a high level of professionalism, coordination, and innovation. Ticino is at the forefront in this field thanks to players such as CAD, which combines cutting-edge technology (predictive monitoring, connected devices) with a human approach (empathy, listening) to manage even the most complex situations directly in the patient’s home. A true hospital without walls, delivering precise care at every stage, from emergency to ongoing care, keeping the patient at the center, in the place that matters most to them: their own home.
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Sources and further information:
- Wagner A, Zúñiga F, Rüesch P, Schaffert R, Dratva J. Selecting home-care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland. PLOS ONE. 2020;15(12):e0244577. PLOS
- Hofstetter M et al. Daily practices of advanced practice nurses within multiprofessional primary-care sites in the cantons of Bern e Solothurn. BMC Primary Care. 2023;24:188. BioMed Central
- Zürcher A et al. Advanced practice nurses in primary care in Switzerland: interprofessional collaboration and emerging roles. BMC Nursing. 2019;18:34. BioMed Central
- Johnson S et al. Home treatment for acute mental healthcare: randomised controlled equivalence trial. The Lancet Psychiatry. 2019;6(4):328-337. (Importante per il modello “ospedale a casa”). PubMed
- ICN & ZHAW. Guidelines on Advanced Practice Nursing 2020 – Swiss adaptation and implementation. Report, 2021. ICN – International Council of Nurses
- Addison Care Pilot Consortium. Piloting a culturally-adapted virtual telecare assistant to support self-management at home: feasibility study in Switzerland. Digital Health. 2022;8:1-13. PMC
