Abstract
Background
Hospital-at-Home (HaH) has emerged as an alternative to conventional inpatient care by delivering hospital-level treatment in patients’ homes. While Hospital-at-Home may support recovery in familiar surroundings, uncertainty remains regarding whether patients should engage in activities outside the home while still receiving hospital-level care.
Purpose
This study explored patients’ perspectives on mobility outside the home during home hospitalization, including perceived benefits, limitations, responsibilities, and practical considerations associated with community activities.
Materials and methods
A qualitative study involving in-depth semi-structured interviews was conducted with 25 participants enrolled in a Hospital-at-Home programme in Singapore. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis.
Results
Three themes and six subthemes were identified: (1) navigating mobility during recovery (individual health considerations; family and caregiver support); (2) importance of venturing outside the home (emotional well-being and health benefits; maintaining normal routines); and (3) balancing autonomy and accountability (accountability; arrangements for community leave). Participants viewed venturing outside the home as beneficial for recovery, emotional well-being, and maintaining normal daily activities. Mobility decisions were influenced by health status, available support, and practical considerations regarding communication with healthcare teams.
Conclusion
Patients viewed mobility outside the home as an important component of recovery during home hospitalization. Rather than perceiving autonomy and safety as competing priorities, participants described balancing independence with personal responsibility and ongoing communication with healthcare teams. These findings may inform the development of patient-centred mobility approaches in Hospital-at-Home programmes while highlighting the need for adaptation in populations with frailty or increased care needs.
Keywords: Community, hospital-at-home, mobility, physical activity, qualitative research, safety
KEY MESSAGES
Patients receiving Hospital-at-Home care viewed mobility outside the home as beneficial for emotional well-being, recovery, and maintenance of normal daily routines.
Patients favoured a balanced approach to community mobility based on individualised risk assessment and appropriate oversight rather than blanket restrictions.
Introduction
The Hospital-at-Home (HaH) model has gained traction as an alternative to conventional hospital care providing hospital-level care in the patient’s homes. In Singapore, Hospital-at-Home has been introduced to alleviate pressure on acute hospital beds while enabling clinically stable patients to receive acute-level care in a familiar environment. Reported benefits include cost savings, reduced hospital-acquired infections, improved patient satisfaction, and maintenance of physical activity [1–5]. Treatments such as intravenous fluid, antibiotics therapy, oxygen therapy, and simple radiology investigations can be delivered at home [6,7].
A distinctive feature of Hospital-at-Home is that patients remain within their communities while continuing to receive acute hospital-level care. Unlike conventional inpatients who are physically confined to hospital premises, Hospital-at-Home patients retain access to their usual environments, routines, and social networks. This raises important questions regarding the role of mobility during recovery and the extent to which patients should engage in activities outside the home while remaining under hospital care.
Despite the growing international adoption of Hospital-at-Home, there remains limited published guidance regarding community mobility outside the home during an admission. Existing recommendations largely address programme implementation and patient selection rather than permissible activities beyond the home environment [8].
Venturing outside the home may support recovery by promoting physical activity, emotional well-being, social connectedness, and maintenance of routines [9–11]. At the same time, patients remain formally admitted under hospital care, creating practical questions regarding communication, supervision, and accountability during activities undertaken outside the home. Despite the growing adoption of Hospital-at-Home internationally, there is limited understanding of how patients themselves perceive mobility beyond the home during hospitalization.
Understanding patients’ perspectives is important for informing patient-centred Hospital-at-Home services and future programme development. This study explores how home-hospitalized patients perceive activities outside the home, including the potential benefits, limitations, responsibilities, and practical considerations associated with community mobility during hospitalization. By examining these perspectives, we aim to inform future clinical practice, programme design, and policy development in Hospital-at-Home services. Given the diversity of Hospital-at-Home models and healthcare contexts internationally, understanding patients’ perspectives is important for informing patient-centred approaches to community mobility during home hospitalization.
Materials and methods
Study design and setting
This qualitative descriptive study explored patients’ perspective on mobility outside the home during Hospital-at-Home care. It was conducted virtually in the homes of patients from an acute restructured hospital in Singapore. Participants received hospital-level care at home through a multidisciplinary Hospital-at-Home service, with daily remote clinical reviews supplemented by home visits according to clinical needs [7]. One-to-one in-depth interviews were conducted using a semi-structured guide (available in Supplementary Data) to explore the perspectives of patients on the freedom, safety, reporting, and governance of community leaves (leaving the house for agreed timings during home hospitalization). This study was reported according to the Consolidated criteria for reporting qualitative research (COREQ) (available in Supplementary Data) [12].
Participants
Participants in this study included patients admitted to the Hospital-at-Home delivered by a tertiary hospital during its pilot implementation period (June 2023 to March 2024). Participants were consecutively sampled during the weekday admissions. Patients aged ≥21 years who were receiving Hospital-at-Home care and were able to provide informed consent were eligible for participation. Persons with dementia or cognitive impairment, as specified in the study protocol, were excluded. Participants were eligible to be interviewed in English, Mandarin, or Malay. Participation was voluntary and declining participation did not affect the care they received. Participants were compensated with SGD 40 for their time spent.
Ethical approval
All the patients provided written consent before participation. Centralized Institutional Review Board (SingHealth) approval was obtained. (CIRB 2023–2281). This study adheres to the Declaration of Helsinki regarding research involving human subjects.
Data collection
The individual in-depth interviews were conducted between July 2023 and February 2024 by two authors (AHDT and CYO). The interviews were conducted, audio-recorded via Zoom, and transcribed verbatim. As video consultations formed part of the routine Hospital-at-Home clinical workflow, participants were already familiar with this mode of communication. Interviews were scheduled in the late morning or afternoon to minimise disruption to routine clinical reviews. Additional field notes were made during and after the interviews. Each interview lasted approximately 20 to 45 min. There were no repeat interviews. Transcripts were not returned to the participants and feedback was not sought from the participants. The semi-structured interview guide was developed to explore predefined topic areas relating to mobility, safety, accountability, and community leave while allowing participants to elaborate on issues they considered important. The semi-structured interview guide is available in Supplementary material 1.
Data analysis
Transcripts were read iteratively to achieve familiarization with the data. Although the interview guide was organised around predefined topic areas, codes and themes were developed inductively from participants’ accounts. Codes were assigned to meaningful units of text reflecting participants’ expressed experiences. The first author performed the initial coding, and the second author independently reviewed the transcripts to ensure consistency. Discrepancies were discussed and resolved through consensus. Codes were then clustered into subthemes and themes using NVivo 14 (Lumivero, CO).
Thematic analysis was conducted following Braun and Clarke’s framework. Data collection and analysis proceeded concurrently and recruitment ceased when no new codes or thematic insights emerged from successive interviews, indicating thematic saturation had been reached [13].
Results
A total of 30 eligible patients in the program were approached. 5 declined to participate, resulting in a final sample of 25 participants. Table 1 shows the demographics of the participants. Three key themes emerged from the study: (1) navigating mobility during recovery; (2) importance of venturing outside the home; and 3) balancing autonomy and accountability.
Table 1.
Demographics of participants (n = 25).
| Characteristics | Patients (n = 25) |
|---|---|
| Age (mean, range) | 36.4 (22–63) |
| Age distribution (%,n) | |
| <30 | 6 (24) |
| 30-39 | 11 (44) |
| 40-49 | 5 (20) |
| >50 | 3 (12) |
| Gender n, (%) | |
| Male | 16 (64) |
| Female | 9 (36) |
| Race/ ethnicity (%, n) | |
| Chinese | 17 (68) |
| Malay | 5 (20) |
| Indian | 3 (12) |
| Primary diagnosis (%, n) | |
| Cellulitis | 12 (48) |
| Rhabdomyolysis | 4 (16) |
| Pneumonia | 4 (16) |
| Dengue | 3 (12) |
| Pyelonephritis | 1 (4) |
| Lower respiratory tract infection | 1 (4) |
Theme 1. Navigating mobility during recovery
Participants consistently described mobility decisions during home hospitalization as closely linked to their recovery status.
Individual’s health considerations
Participants’ willingness to engage in activities outside the home depended largely on their physical function, symptoms, treatment requirements, and confidence in managing their conditions. Some cited mobility impairments or infection risks as limiting factors, while others described self-assessment and careful planning as important enablers of mobility.
Participants consistently mentioned that safety was a priority in Hospital-at-Home. While recovering in a familiar environment has advantages, they acknowledged that fall risks may be higher at home due to the absence of hospital safeguards such as alarm bed systems and trained staff. Many participants expressed that their willingness to engage in activities outside the home depended largely on their physical condition and medical advice from healthcare providers. Not all participants favoured leaving the home. Several preferred remaining at home because of concerns regarding infection, pain, or the possibility of falls.
It also depends on your condition. But for me, I am warded for cellulitis, so there is a possibility of me falling if my leg is in pain. -Participant 11
I have a plug inserted (intravenous cannula) with me…I don’t know what other bugs I can get outside, so staying home is better. -Participant 18.
Family and caregiver support
Participants viewed support from family members as an important precaution when undertaking activities outside the home. Caregiver presence provided reassurance and enabled mobility that participants might otherwise avoid [14].
If I am going out for a walk, I will be more careful… I think having family members to follow will be good. - Participant 16.
Theme 2. Importance of venturing outside homes
Participants described venturing outside the home as an important aspect of their recovery experience. Restrictions on mobility were often associated with frustration and isolation, whereas opportunities to leave the home contributed to emotional well-being and a sense of normalcy.
Emotional well-being and health benefits of walking
Going outside, even briefly, was seen as calming and restorative [15].
Go down for just a stroll will improve my circulation…seeing the greenery will help you calm down. - Participant 1.
Go out for fresh air (when it feels a bit stuffy) can help to speed up recovery. -Participant 5.
Mobility was perceived not merely as physical activity, but as contributing to emotional balance and perceived recovery.
Maintaining normal routines
Some participants valued the ability to carry out their routine activities during Hospital-at-Home care, helping to maintain sense of normalcy while adapting activities to their recovery.
I think I can go to the fitness corner near my area for at most 30 minutes, not to do vigorous exercise and not force myself. In the hospital very restricted and hard to do exercise. -Participant 25.
These activities were described as manageable and self-paced, reinforcing independence within perceived safe limits.
Theme 3. Balancing autonomy and accountability
Accountability
Most of the participants accepted personal responsibility for the risk associated with undertaking activities outside the home during home Hospital-at-Home care.
We are not exactly discharged from the hospital. It is our responsibility if we do go out and anything should happen to us. -Participant 8.
Arrangements for community leave
Participants described differing views regarding how community leave should be communicated and documented during Hospital-at-Home care. While most participants valued autonomy, some degree of notification or permission may be necessary to enable the care team to account for their whereabouts.
Participants viewed Hospital-at-Home care as providing greater flexibility than conventional inpatient care, increasing the likelihood of undertaking brief community activities such as buying food or running errands. This was encouraged by the proximity of infrastructure in the urban city-state of Singapore where basic amenities are often located within walking distance from the housing blocks [16].
It is a grey area…I think for this program when patients come to this program; it is already a home leave form. I think should make the form as simple. Blanket approval should be given so as not to inconvenience us. –Participant 21.
Several participants suggested that oversight mechanisms should be proportionate to the duration and purpose of outing, rather than requiring approvals for all activities. Short outings of 15 to 30 min were widely perceived as reasonable without the need to inform the clinical team, whereas longer absences were viewed as requiring notification.
No need to wait for the doctor’s approval for it because you just go out for 15-30minutes. Unless you are talking about the bank for 2-3 hours then it is too long already. - Participant 8.
Participants also recommended digital or app-based reporting systems to streamline communication and reduce administrative burden.
Maybe the tag can also have some app installed in it and can help to notify the hospital about where we are going. I think ok to wear the tag. - Participant 17.
Overall, participants supported structured but appropriate oversight, favouring simplified processes for brief, low-risk activities while recognising the need for greater notification or approval for longer or higher-risk outings.
Discussion
Although such services have existed in many countries for years, Hospital-at-Home is still in early stages of implementation in Singapore. Studies exploring patients’ perspectives on community mobility during acute Hospital-at-Home care remain scarce [17]. This study is among the first to explore patient perspectives on community mobility during Hospital-at-Home care. Participants described mobility during home hospitalization as an important aspect of recovery. While they valued the opportunity to venture outside the home, they generally viewed such activities as contingent on their health status, available support, and individual circumstances. These findings suggest that patients do not perceive autonomy and safety as competing priorities but rather as considerations that must be balanced during recovery.
Based on these findings, we propose a conceptual framework for community mobility during Hospital-at-Home care (Figure 1). Figure 1 represents the authors’ interpretative synthesis of the empirical themes identified in this study and is intended as a conceptual model to synthesise the qualitative findings, guide future empirical research, and inform the development of patient-centred approaches to community mobility during Hospital-at-Home care. It is not intended to serve as a validated clinical decision-support tool. The framework illustrates how individual health considerations, family and caregiver support, autonomy, accountability, and practical arrangements for community leave interact to influence mobility outside the home during recovery.
Figure 1.
Conceptual framework for community mobility during hospital-at-home care.
Participants associated brief outdoor activities with emotional well-being, physical activity, and maintenance of normal daily routines. Many participants described these activities as extensions of their usual routines rather than exceptional outings, highlighting the importance of preserving normalcy while recovering at home. These observations are consistent with previous literature highlighting the benefits of mobility and social engagement during recovery. Importantly, participants did not advocate unrestricted freedom [17–19]. Rather, they favoured a person-centred approach that balanced autonomy with appropriate oversight through shared-decision making. Our findings further suggest that community mobility during Hospital-at-Home should be guided by individual clinical assessment rather than universal restrictions. Participants also demonstrated supported self-management by recognising their own responsibilities, monitoring their health status, and adapting their activities according to their symptoms and treatment needs.
Unlike many published Hospital-at-Home cohorts, which predominantly comprise older adults with frailty, multimorbidity, or post-acute rehabilitation needs, our study population was relatively young and primarily comprised patients admitted with acute infectious conditions, reflecting the patient population enrolled in our Hospital-at-Home programme during the study period. Maintaining community mobility and normal daily activities may therefore have been a particularly prominent concern in our study population. Consequently, perceptions of community mobility may differ, and these findings should be interpreted with consideration of the study population and healthcare context.
Participants frequently described walking to nearby parks, neighbourhood shops, food outlets, and communal spaces. These findings should be interpreted within Singapore’s predominantly high-density public housing environment, where essential amenities are generally located within walking distance and supported by barrier-free infrastructure [20,21]. Consequently, brief community mobility may represent a relatively accessible extension of daily life compared with lower-density settings, where leaving the home often requires longer travel distances or motorised transport. This contextual difference may influence perceptions of acceptable mobility during Hospital-at-Home care and should be considered when interpreting the transferability of our findings.
Our findings complement previous qualitative findings from Singapore showing that patients and caregivers value the comfort, familiarity, and autonomy associated with Hospital-at-Home care [22,23]. The present study extends these observations by examining how patients perceive community mobility outside the home while remaining formally admitted under Hospital-at-Home care, an aspect that has received limited attention in previous qualitative studies. Participants also highlighted uncertainty regarding how community mobility should be communicated and managed while remaining under hospital care. Although many accepted personal responsibilities for activities undertaken outside the home, they also recognised the importance of keeping healthcare teams informed. Preferences generally favoured simple and appropriate approaches, such as streamlined notification systems for brief outings and additional communication for longer absences.
From a clinical perspective, these findings suggest that individualized mobility discussions should consider clinical stability, functional capacity, caregiver support, the purpose and duration of the intended activity, and the patient’s ability to maintain communication with the Hospital-at-Home team. Potential strategies include discussing mobility expectations during enrolment, establishing practical communication pathways for community leave, and tailoring recommendations according to individual circumstances. These considerations are intended to support clinical judgement and shared decision-making rather than serve as a formal risk assessment tool.
Limitations
This qualitative study has a few limitations. First, as a single-center study, the transferability of the findings to other healthcare settings may be limited. In addition, our relatively young study population may not reflect the characteristics of Hospital-at-Home programmes serving predominantly older adults with frailty, multimorbidity, or post-acute rehabilitation needs. Furthermore, patients with cognitive impairment were excluded from this study; therefore, the findings may not reflect the perspectives of individuals who require greater support with decision-making during Hospital-at-Home care.
Second, caregivers were not included in the interviews. As caregivers often support decision-making and daily activities for patients receiving care at home, their perspectives may provide additional insights into community mobility during home hospitalization. Future studies involving frail older adults, patients with cognitive impairment, caregivers, multiple institutions, and diverse healthcare systems may help determine whether similar perspectives emerge across different Hospital-at-Home models and cultural practices [24].
Conclusion
This study explored patient perspectives on mobility outside the home during Hospital-at-Home care. Participants viewed venturing outside the home as an important component of recovery that supported emotional well-being, maintenance of normal routines, and a sense of independence. At the same time, they recognised the need to consider their health status, available support, and ongoing communication with healthcare teams when undertaking activities outside the home. These findings support patient-centred approaches based on individualised risk assessment and appropriate oversight and may inform the future design of Hospital-at-Home programmes and clinical guidance.
Author reflexivity statement
The study team comprised four clinicians (CYO, LMLT, SGL, SHW) and a research assistant (AHDT). Among the study team, only CYO and AHDT were directly involved in the delivery of Hospital-at-Home services at the study site. CYO was closely involved in the implementation of the programme, while AHDT served as both the research assistant and one of three clinical coordinators supporting programme operations. LMLT and SHW are occupational medicine consultants with experience in patient safety, healthcare systems, and clinical governance. AHDT is an experienced research assistant who was trained in qualitative interviewing by CYO.
The researchers brought perspectives from Hospital-at-Home service development, patient safety, and healthcare delivery, which informed the design and interpretation of the study. The research team recognised that CYO’s and AHDT’s involvement in the Hospital-at-Home programme could influence data interpretation. To enhance the credibility of the findings, a semi-structured interview guide was used to ensure consistency across interviews, coding was independently reviewed by a second researcher, and themes were refined through iterative discussions among the research team to ensure that interpretations remained grounded in participants’ accounts.
No prior research relationship existed between the researchers and participants before study commencement.
Supplementary Material
Acknowledgments
We acknowledge the SKH@Home team for delivering Hospital-at-Home care to the patients.
Funding Statement
The Mobile Inpatient Care at Home pilot at Sengkang General Hospital was supported by Ministry of Health Transformation Singapore.
Ethical considerations
This study was approved by the SingHealth’s Centralized Institutional Review Board (CIRB 2023–2281).
Consent to participate
Written informed consent to participate was obtained.
Consent for publication
Informed consent for publication was provided by the participants.
Generative AI use
Generative artificial intelligence (AI) tools were used solely to assist with language refinement and manuscript preparation. All study design, data collection, analysis, interpretation, and final manuscript content were developed, reviewed, and approved by the authors.
Disclosure statement
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available from the corresponding author, upon reasonable request.