When Grampians Health nurse William Ho talks about patient care, he rarely starts with hospitals – instead, he talks about homes.

As manager of Grampians Health’s Hospital Without Walls program, Mr Ho and his team provide hospital-level care in patients’ living rooms and at kitchen tables – surroundings that feel less clinical.

Hospital Without Walls is a new department at Grampians Health, bringing together services including GH at Home, Ballarat and Horsham; post-acute care; and Grampians Watch.

GH at Home Ballarat currently has five clinical streams, including acute medical and surgical care, complex conditions, home-based cancer care and an older-person stream that focuses on supporting elderly patients to regain independence, with additional clinical and allied health involvement.

Mr Ho said GH at Home functioned as a hospital ward without a physical location.

Medical teams, nurses, allied-health teams and pharmacists in the department collaborate to deliver co-ordinated care at patients’ homes instead of hospital wards.

Instead of long hospital stays, eligible patients are discharged earlier and supported at home with the same level of clinical oversight they would receive on a ward.

Under the program, nurses travel instead, covering distances of up to 35 kilometres from Ballarat and Horsham to reach patients who would otherwise need to make regular trips into hospital. Mr Ho said the model was working, with GH at Home Ballarat increasing its capacity by 20 per cent to care for 50 patients at a time, sometimes reaching as many as 55 patients.

He said by patient numbers, GH at Home was one of Grampians Health’s largest wards.

Mr Ho said a complex workload – with nurses often providing care alone in patients’ homes, making real-time decisions without the support of a team – meant the program typically recruited nurses with at least five years of clinical experience in acute, subacute and critical settings.

“They need strong clinical judgement,” he said.

“They’re on the road, they’re assessing patients, they’re responding to urgent changes or deterioration of patients. There’s a high level of autonomy.”

Mr Ho said patients receiving treatment at home could require intravenous antibiotics, complex wound management, post-surgical monitoring or ongoing infusions.

Allied-health teams, physiotherapists, dietitians and occupational therapists visit patients alongside nurses to ensure holistic recovery.

“Our Home-Based Cancer Care stream has saved patients more than 150,000 kilometres of travel over the past five years,” Mr Ho said.

“We’re saving the patient from having to travel and reducing the burden on the family and trying to maintain their life at home as much as we can.”

Originally trained in hotel management and human resources, Mr Ho said he made a late pivot into nursing, completing an intensive master’s program at Monash University in 2017.

He first encountered hospital-in-the-home care during the early days of the COVID-19 pandemic and said the model stuck with him.

“It’s challenging. But it’s also very rewarding because you can see the difference it makes,” he said.

Grampians Health is planning to expand the Hospitals Without Walls program’s capacity in the next two years to meet rising demand, and is currently rolling out a pilot virtual-discharge clinic allowing patients to return home while waiting for test results, with follow-up consultations conducted via video.

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