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Impact of Home-Based Care Services on Hospital Readmissions among Older Adults in Nigeria

Abstract

Hospital readmissions among older adults are an important public health and healthcare-system concern in Nigeria. Older adults may have multiple chronic conditions, functional limitations, medication needs, and difficulties accessing healthcare services after discharge, increasing their risk of complications and unplanned return to hospital. Inadequate post-discharge support, limited caregiver capacity, poor medication management, insufficient follow-up, transportation challenges, and delayed recognition of deteriorating health may further increase the likelihood of hospital readmission. Home-based care services provide healthcare and supportive services to patients in their homes and may include nursing care, medication management, health monitoring, rehabilitation, health education, caregiver support, and follow-up visits. By providing continued care in the home environment, these services may facilitate early identification of health problems, improve adherence to treatment, and reduce preventable hospital readmissions among older adults. Against this background, this study investigates the impact of home-based care services on hospital readmissions among older adults in Nigeria. The study will be anchored on the Transitional Care Model, Andersen's Behavioral Model of Health Services Use, and the Donabedian Model of Healthcare Quality. The Transitional Care Model emphasizes coordinated support during the transition from hospital to home and the importance of continued monitoring in preventing adverse outcomes. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors, with home-based care representing an enabling service that may influence subsequent hospital utilization. The Donabedian Model explains how healthcare structures and processes influence patient outcomes, with home-based care services representing an organized care process and hospital readmission serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how home-based care services may influence hospital readmissions among older adults in Nigeria. The study will adopt a quantitative quasi-experimental or prospective cohort research design. The study population will comprise adults aged 60 years and above who have been discharged from selected public and private hospitals in Nigeria and require continued care at home. A multistage sampling technique will be used to select states, local government areas, hospitals, communities, home-based care providers, and eligible older adults. Home-based care services will be assessed using indicators such as frequency of home visits, nursing care, medication management, monitoring of vital signs, rehabilitation services, health education, nutritional support, caregiver education, assistance with activities of daily living, follow-up communication, early identification of complications, and coordination with healthcare facilities. Hospital readmissions will be assessed using indicators such as occurrence of unplanned readmission, number of readmissions, time to first readmission, readmission within 30 days of discharge, readmission within 90 days, reasons for readmission, emergency versus planned readmission, and length of stay during readmission. Data will be collected using structured questionnaires, home-care records, hospital discharge records, patient medical records, readmission registers, follow-up documentation, and caregiver reports. Descriptive statistics will be used to summarize participants' demographic and clinical characteristics, home-based care utilization, and readmission patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, logistic or multiple regression analysis, and survival analysis where appropriate, will be used to determine the impact of home-based care services on hospital readmissions. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that home-based care services have a significant negative impact on preventable hospital readmissions among older adults in Nigeria, indicating that access to appropriate home-based care may reduce the likelihood of unplanned hospital return. Older adults receiving regular and coordinated home-based care are expected to demonstrate fewer hospital readmissions, longer periods before readmission, and improved post-discharge health management compared with older adults without adequate home-based care. Regular monitoring may facilitate early identification of complications, while medication support, rehabilitation, health education, and caregiver assistance may improve adherence to treatment and reduce avoidable deterioration. However, limited availability of trained home-care personnel, financial constraints, inadequate coverage in rural communities, poor referral coordination, transportation difficulties, and limited caregiver support may reduce the effectiveness of home-based care services. The study therefore expects accessible, continuous, and well-coordinated home-based care to contribute significantly to reducing preventable hospital readmissions among older adults in Nigeria. The study is expected to contribute to the literature on home-based care services, hospital readmissions, older adults, transitional care, post-discharge care, community healthcare, chronic disease management, healthcare utilization, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospitals, primary healthcare facilities, home healthcare providers, geriatric care professionals, community health workers, caregivers, development partners, and policymakers regarding strategies for improving post-discharge care for older adults. The study will also provide evidence-based recommendations for expanding home-based care programmes, strengthening community nursing and geriatric services, improving caregiver education, integrating home-based care with hospital and primary healthcare services, strengthening referral and follow-up systems, and developing sustainable models of community-based care to reduce preventable hospital readmissions among older adults across Nigeria.

Keywords: Home-based care services, hospital readmissions, older adults, post-discharge care, transitional care, geriatric care, community healthcare, chronic disease management, healthcare utilization, Nigeria, public health.