Senior health trust sources have told News NI they can no longer wait for change to come from the Department of Health and instead are going it alone.
They say it is not about more money but how current funding is spent.
There are several initiatives which can keep older people at home and out of hospital but they are not part of a specific, overarching strategy with ministerial direction.
They are often pilot schemes and the funding eventually runs out.
Betty McKenzie, 88, is receiving hospital care at her home in Comber, provided by the South Eastern Health Trust.
She has a pacemaker to regulate her heart rate and is recovering from a broken femur after falling in the Ulster Hospital.
A multi-disciplinary team delivers her care package, which includes two nurses attending daily, a consultant geriatrician and a physiotherapist.
Betty also has a carers package which means four visits a day and all of this is paid for by the health service.
“The hospital has come to me,” she said.
“It’s a brilliant service and keeps me out of hospital which is good as they are short staffed, and you can’t sleep with the bright lights, and it is so noisy.”
