Stronger at home Insights from the GO-Home study on developing home-based geriatric rehabilitation

This thesis explores the development, implementation, and evaluation of home-based geriatric rehabilitation (GR) as an innovative and sustainable alternative to traditional institutional care for older adults. In the context of demographic ageing, multimorbidity, and increasing healthcare pressures, the GO-Home study examines how rehabilitation delivered closer to home can support autonomy, participation, and quality of life.
The research consists of two parts. Part 1 defines home-based GR through a systematic review, qualitative research with patients, professionals, and policymakers, and an international Delphi study. Findings indicate that home-based GR is at least as effective as conventional care regarding functional outcomes, quality of life, and readmissions, and may be cost-effective. Key elements include multidisciplinary teamwork, collaboration with primary care, individual goal-setting, blended eHealth, and active involvement of informal caregivers.
Part 2 focuses on practice: the home-based GR pathway was redesigned and tested for feasibility and acceptability in a Dutch skilled nursing facility. The co-created pathway comprises eleven elements, including personalised goal-setting, early home environment assessment, digital blended support, and collaboration with community nursing. Cost analysis showed uneven cost distribution, driven by hospital care, nursing home admissions, and prolonged GR stays, highlighting the potential of early identification and coordinated care.
The study concludes that successful home-based GR requires strong interdisciplinary collaboration and integrated care across the continuum. Blended technology integration enables personalised, efficient, and sustainable rehabilitation. Prevention and lifestyle interventions, alongside active involvement of patients and caregivers, are essential for person-centred rehabilitation.