Is home care becoming the new hospital ward?

Hospital in the Home is no longer a niche clinical program operating at the edges of the health system. As hospitals struggle with capacity constraints and older people remain at home for longer, elements of hospital-level care are steadily migrating into the community often landing with home care providers that were never designed for that role.

In an interview with The Weekly SOURCE, Leecare CEO Caroline Lee says the sector is approaching a tipping point where the boundaries between hospital care and home care are becoming increasingly blurred.

“We’re seeing hospital-level expectations applied in the home,” Caroline says. “But without hospital infrastructure.”

Hospital in the Home models were originally designed to substitute short inpatient stays with intensive, time-limited clinical care delivered by health services. What is emerging now is more diffuse, ongoing clinical oversight, monitoring and escalation delivered in people’s homes, often outside formal hospital programs.

This shift is being driven by several forces: persistent hospital bed shortages, ambulance ramping, delays in residential aged care access, and policy settings that prioritise care in the community. The result is that older people with complex needs are being managed at home for longer, sometimes by default rather than design.

The challenge, Caroline argues, is that home environments are not hospitals.

“In a hospital, you have teams, supervision, immediate escalation,” she says. “In the home, staff are often working alone, making judgement calls in real time.”

This places new expectations on home care providers and their workforce. Frontline staff are increasingly required to recognise deterioration, manage risk and respond appropriately, without the clinical density or safeguards of inpatient settings.

Technology plays a critical role in bridging that gap. Real-time access to information, structured escalation pathways and clear visibility of clinical risk are becoming essential as care moves further into the home. Without them, providers are exposed to safety, workforce and governance risks.

Families, meanwhile, are assuming hospital-level vigilance. They expect that changes in condition will be noticed, that someone is monitoring risk, and that deterioration won’t be missed simply because care is delivered at home.

“The expectation has shifted,” she says. “People want hospital thinking, delivered in a home setting.”

As Hospital in the Home expands, formally and informally, it raises uncomfortable but necessary questions for the sector. Who is responsible for clinical oversight? What level of risk is acceptable? And are home care providers being equipped -clinically, digitally and operationally - for the role they are increasingly being asked to play?