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Hospital in the Home (HITH) Service - Community Aged Care

Our Hospital in the Home service provides patients with geriatric focused care in their own home, admitted to a virtual ward under the care of a geriatrician and multidisciplinary team with access to a nurse on call 24/7.

Who should I refer to this service?

  • Patients who would benefit from a multidisciplinary comprehensive geriatric assessment and implementation of a tailored management plan in their own home
  • Patients with an acute condition which can be safely provided and managed outside of a traditional acute hospital bed.


The patient must:

  • 75 years+ or 55 years+ with a Rockwood Clinical Frailty Score (CFS) >4 or 55 years+ if identifying as Aboriginal or Torres Strait Islander
  • Consent to transfer of care and resides within the Darling Downs Health catchment area (approx. 50km radius)
  • The 1st dose of any intravenous medication has been given within the hospital
  • Have access to a telephone with dial out facilities or resides in area with mobile phone coverage
  • Have access to a working refrigerator with suitable storage room (if required to store medications).

An Agreement to Transfer of Care-Hospital in The Home (HITH) form is completed by our team.

Home Visit Risk Screen will be completed in line with Darling Downs Health procedures (by our team).

Referrals are accepted and encouraged from general practitioners.

To refer a patient please contact us directly on:

Patients who cannot be referred to this service:

  • Patients with complex care needs such as physical, cognitive and/or social care needs that exceed the capability of currently available support networks (including carers and health care providers)
  • Post-acute care of chronic conditions, including wounds, where services are available from community and primary care service providers
  • Wound or joint infections and/or abscesses requiring long term treatment should be referred to HITH (infectious diseases)
  • Preadmission care for planned or elective admissions that can be managed by the primary care provider
  • Any patients displaying symptoms of COVID-19 virus – fever of unknown aetiology, shortness of breath, cough, sore throat, fatigue will not be accepted by the HITH-CAC service
  • Any patients with infectious diarrhoea / vomiting.

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Last updated: 19 January 2021