Home sweet home? The heat challenge to Hospital at Home services

Heatwaves and extreme heat already exert significant pressure on healthcare systems – a burden expected to intensify with climate change. During hot periods, ambulance callouts, emergency presentations, hospital admissions, and mortality all rise sharply. Hospital at Home (HaH) delivers hospital-level care in patients’ homes, replacing the need for an inpatient admission. HaH is now integral to many healthcare systems, accounting for up to 5% of bed-days in some settings. It alleviates hospital crowding, reduces costs, and provides high-quality care with outcomes comparable to inpatient care, alongside high patient and caregiver satisfaction. HaH serves as a critical pressure release valve for hospital bed demand – particularly during surge periods such as heatwaves – but its continued viability may be threatened by rising extreme heat. In this Essay, we examine key heat-related threats to HaH services, including direct impacts on patients and exacerbation of their underlying conditions, thermal instability of medicines such as intravenous antibiotics, and operational challenges related to staff safety and comfort during community visits. We conclude by outlining potential strategies to mitigate heat-related risks for HaH, including promoting evidence-based cooling for patients, developing novel technologies to keep HaH therapies cool, adjusting prescribing decisions and visit schedules during heatwaves, and embedding heat risk stratification and preparedness into HaH admission processes.