21st WONCA World Rural Health Conference, 10-13 April 2026: Read More – WONCA 2026 | Home
“Geography should not make a difference to the delivery of health care,” says Dr Erik McClain, Clinical Lead of Hospital in the Home (HitH) at Te Toka Tumai Auckland.
Hospital in the Home is an innovative model of care that allows patients to leave hospital earlier and continue receiving hospital-level treatment in their own homes. Patients remain under the close supervision of a Senior Medical Officer (SMO)or Nurse Practitioner (NP) with daily virtual reviews, or home visits.
The service provides both secondary and acute-level care. Treatments delivered at home may include intravenous (IV) therapy, diagnostics, infusions, laboratory monitoring, wound care, and daily clinical assessments. In essence, HitH delivers the same standard of care as a traditional hospital—simply in a different setting.
Technology Supporting Safe Care
The success of HitH relies on rapidly advancing technology. Remote monitoring tools such as blue tooth enabled oximeters, heart rate monitors, and blood pressure devices allow clinicians to track a patient’s condition in real time. These tools enable the medical team to assess progress, adjust treatment plans, and intervene early if required. Dr. McClain says, “ Hospital in the Home is not a Virtual service, but we couldn’t provide it in this country without digital tools”.
A Patient-Centred Approach
Before HitH was introduced, some patients remained in hospital longer than clinically necessary. For example, one patient with heart problems stayed in hospital for several weeks when the only ongoing requirement was a daily 9 a.m. blood pressure check. When he asked whether this could be managed at home, he was told he would “drop out of the system.” HitH addresses this gap by recognising patient needs and providing safe monitoring at home while maintaining full clinical oversight as early as day one.
Eligibility and Assessment
Hospital in the Home is not suitable for every patient. Medical teams carefully assess individuals to determine whether:
· Their condition can be safely managed at home
· They are able to mobilise safely (e.g., preparing a drink, using the toilet), or someone is there to help mobilise safely.
· Adequate support is available at home (helpful but not always essential)
Patient safety remains the primary consideration.
The Multidisciplinary Team
Introduced in New Zealand during the COVID-19 pandemic, HitH was first led by Counties Manukau DHB and subsequently adopted by other districts. The model continues to evolve to meet local needs.
At Te Toka Tumai Auckland, the service is led by an SMO, supported by a Nurse Practitioner and a Nurse Coordinator who often conducts the daily virtual ward round. A Nurse Manager develops care pathways, while Clinical Nurse Specialists provide virtual and in-home assessments and recommend treatment plans.
The wider multidisciplinary team may include:
· Physiotherapists, supporting rehabilitation such as stroke recovery or COPD chest exercises
· Occupational therapists, assisting with daily living activities
· Pharmacists, reviewing medication suitability and compliance
· Speech-language therapists, supporting speech, language, and swallowing
· Registered nurses, attending in person when needed for wound care or clinical procedures and running virtual appointments
· Kaiawhina or carers, providing daily personal care
Many consultations are conducted virtually, made possible by widespread access to smartphones and video technology.
Cultural Support
A culturally specific health professional is also part of the HitH team. This role may be filled by a Māori or Pacific health practitioner to ensure cultural values are respected and communication is appropriate and
meaningful. This support is vital in improving health literacy and delivering culturally safe care.
Community-based staff often live near the patients they support. This proximity reduces travel time and increases efficiency, enabling more patients to receive timely care.
Benefits of the Model
The benefits of Hospital in the Home are both clinical and economic. Keeping a patient in hospital can cost approximately $1,500 per day, whereas providing equivalent care at home costs around $500–$600 per day. This difference frees up hospital beds, improves patient flow, and increases access to care.
Patients also report higher satisfaction. Recovering at home in familiar surroundings reduces stress, lowers travel costs for families, minimises time off work, and eases the financial burden associated with hospital visits. Clinically, patient outcomes such as length of stay, readmission rates, and hospital complications are all improved, as well.
Future Directions: Rural Services
Plans are underway to expand HitH services into rural areas. Tairawhiti offers the first rural-type HitH service. However, rural delivery presents challenges, including travel time for in-person visits, workforce availability, and ensuring timely responses in urgent situations. Financial considerations must also be carefully managed.
Despite these challenges, improved connectivity and greater access to phone and video services are making virtual healthcare increasingly viable in rural communities.
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Hospital in the Home represents a progressive shift in healthcare delivery—placing patients at the centre of care while improving efficiency, accessibility, and overall wellbeing.
