(How) Does “Home Hospitalization” Transform The Relationship Between Patients and Healthcare Professionals?

“Home hospitalization” was officially instituted in France by an act of parliament in 1970. It has been largely developed over the last ten years.

Two major arguments are advanced in its favor of this mode of healthcare. The first, is that this form of hospitalization is chosen by patients who prefer to undergo long-term treatment (often with a fatal outcome, as many of those concerned are undergoing palliative care) surrounded by their families. The second is that of its cost-effectiveness. This factor is important in a traditionally public-dominated health service which is presently under pressure to comply with managerial objectives more often found in private enterprise.

Our ongoing empirical study, carried out between 2012 and 2014, in a service of home hospitalization situated in a French province, has revealed the complexity of the situation which, among other things, transforms the domestic environment, exerts pressure on the carers (usually other members of the family) and transfers running costs to the home. As far as professionals are concerned, it is sometimes difficult to conciliate professional practice and the domestic environment. Various pressures on practitioners seem to reinforce prescription of this mode of care.

If home hospitalization does transform the relationship between healthcare staff and patients, this does not necessarily “empower” the latter or otherwise reverse hierarchical relations. As is usual in human relationships, inequality is not a two dimensional phenomenon. On some counts home hospitalization may reinforce structures of inequality, whilst modifying them on others. With reference to interviews with professionals and patients and observations carried out in the home and the work base, I will show the complexity of the adjustments made by all participants whose actions respond to diverse and conflicting pressures; economic, moral and relational, among others.