To address escalating care demands in a rapidly super-aged society and persistent post-pandemic hospital capacity constraints, XXX launched a government-led Hospital-at-Home (HaH) pilot program in July 2024.The program enabled functionally dependent patients with urinary tract infection, pneumonia, or soft-tissue infection to receive intravenous antibiotics at home rather than in hospital. Our community-based public hospital enrolled 206 patients during the first 15 months of implementation, through which we identified practical issues involving eligibility criteria, antibiotic decision-making, and patient autonomy.Among the 206 patients (mean age 80.19 years; 85 male, 121 female), 109 had urinary tract infection, 64 had pneumonia, and 33 had soft-tissue infection. A total of 37.37% were long-term care facility residents, and 36.4% were referred from the emergency department. The recovery rate was high (90.77%), while 7.77% were readmitted and 1.46% died. The mean duration of intravenous treatment was 6.87 days (SD = 2.31). Clinicians showed a preference for once-daily antibiotic regimens. In the subgroup of UTI cases, frequently prescribed agents included Amikacin (33.3%), Ertapenem (21.21%), and Ceftriaxone (21.21%).UTIs dominated admissions, a pattern inconsistent with national epidemiology. This may reflect restrictive pneumonia eligibility criteria within the pilot program; expanding these criteria could improve equitable access and overall program efficiency. Antibiotic choices were shaped not only by dosing convenience—critical in the context of limited nursing manpower—but also by pathogen profiles, resistance trends, and patient-specific risk factors. These insights underscore the need to align clinical pathways with the operational realities of home-based acute care.In practice, HaH functioned as more than a substitute for hospitalization. It reduced avoidable transfers for homebound patients, aligned with patient and family preferences for treatment in familiar settings, and lowered the risk of hospital-acquired infections. Delivering acute care at home also offered clinicians a clearer understanding of patients’ daily environments and mobility constraints, thereby supporting more individualized care.Our reflections suggest that HaH represents not only an alternative clinical pathway but a model that restores autonomy, preserves familiarity, and supports aging-in-place in meaningful and dignified ways which respects the rhythms of patients’ daily lives.