Home Hospitalization Mortality Rate Higher Than US, Experts Say Taiwan Accepts Patients US Rejects

TAIPEI, June 21 (CNA) -- Taiwan's pilot program for acute care at home is nearing its second anniversary, with research indicating that the 30-day mortality rate for patients receiving home hospitalization is higher than in the United States. Experts attribute this to the fact that the US generally only accepts younger patients with fewer comorbidities, while Taiwan is willing to care for patients with disabilities who cannot leave their homes and have the most severe comorbidities.

When elderly individuals with mobility issues develop a fever or severe shortness of breath, they are often taken to the emergency room for hospitalization as a precaution. However, overcrowding in hospital emergency departments leads to long waiting times for beds, causing discomfort for patients and anxiety for their families. Medical staff are also overwhelmed, making it difficult to explain conditions in detail, leaving both patients and healthcare providers feeling helpless. Now, there is a new option: eligible elderly individuals with disabilities can receive hospitalization at home, with medical staff providing treatment on-site.

According to research conducted by a team including Lin Ching-ching, an assistant professor at National Taiwan University's College of Public Health, and Chen Ping-jen, a supervisor at the Taiwan Society of Home Healthcare, the study analyzed 2,158 patients enrolled in the pilot program from July 2023 to March 2024. This included patients receiving care at home, in residential long-term care facilities, and those returning home after emergency room visits. The findings revealed that approximately 44.5% of patients in the acute home care pilot program were 85 years or older.

The study indicated that urinary tract infections were the most common reason for admission, accounting for 51%. Notably, 51.8% of patients were simultaneously using community long-term care services. Approximately 25.2% of patients were cared for by their children, while 64.3% relied on non-family caregivers, such as foreign domestic helpers or friends.

This research found that the 30-day mortality rate for Taiwan's acute home care program was 7% for the overall cohort, and 6% after excluding patients receiving hospice care. This is higher than the 3.2% mortality rate reported for the US's Acute Home Care program.

"We didn't exclude them; we are more capable," Lin Ching-ching told CNA on Thursday. She explained that Taiwan's acute home care program accepts patients in the acute phase, mostly elderly individuals who cannot leave their homes due to illness. The difference in mortality rates between Taiwan and the US is not due to poor quality of care in Taiwan's home hospitalization program, but rather because these patients almost universally have severe multiple comorbidities and disabilities.

The patients accepted into Taiwan's acute home care program are difficult to care for, but they are precisely the ones who need such resources. Approximately 8.9% of patients were receiving hospice care. Lin Ching-ching stated that, in contrast, the US model selects younger patients with fewer comorbidities for home care, and these patients have generally already passed the acute phase. To shorten hospital stays, they transition to home-based care after discharge.

Lin Ching-ching further explained that Taiwan's pilot program for acute home care enrolls patients during their acute phase. These patients do not need to experience hospital stays and can return home directly from the emergency room. Even elderly individuals in residential facilities who are disabled can receive care without coming to the hospital. Medical staff go directly into these facilities and the patients' homes, effectively bringing the hospital to the institution and the elder's residence. This is the most valuable aspect of the Taiwanese model. (Edited by Chen Ching-fang) 06/21/2025

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