It usually requires only three reinforcing trends to fire up my punditry genes, but there are even more when it comes to the likelihood that older Americans will be able to age in place successfully, in large measure because their health care will be delivered to them at home.
In no particular order, they include the Pandemic, health care technology, a shortage of health care workers, the ugly profile of life in a nursing home, soaring hospital costs, the dearth of long-term care, and Baby Boomers, who are growing both in numbers and chronic health problems.
Oh, and don’t forget trillions of dollars in new infrastructure and health spending contained in the two massive bills now making their way through Congress.
Let’s explore them in order.
COVID-19, which seems likely to morph into COVID-21 and so on, is involved in many factors affecting home-based care.
It forced everyone to spend time at home. Once there, we liked what we saw, and have been pouring enormous sums into fixing up and expanding our homes. Home-centric life isn’t going to change anytime soon.
The Pandemic also created enormous pressures on the existing health-care infrastructure. We don’t have enough hospital beds, nurses, doctors, and other health workers. This also triggered the movement of health care to the home.
This virus was especially deadly to nursing home residents. The reasons for this are worthy of book-length treatment. The takeaway for me is that many people will be avoiding nursing homes like, well, the plague that they have been for many occupants.
The disease spurred telemedicine and digitized health technologies. You now can put a device on your wrist that generates real-time health readings and a 24-7 connection with a health care professional. At-home health technology companies say a shortage of Internet broadband service often has been the only serious obstacle to quicker implementation of home-based care programs. Cue the infrastructure bill!
I can’t tell you the fate of proposed increases in health spending being debated in Washington. But it seems likely that Medicare will be expanded and that coverage for at-home health care will be included in the package of enhanced benefits. Providing more funds will accelerate trends already in place that favor more at-home care.
Last year, when many hospitals were overwhelmed with COVID patients, some hospitals began expanding home-based care to free up beds. This real-world experiment has produced some appealing interim findings that home-based care can be as effective as hospital care and is much cheaper.
Brigham and Women’s Hospital in Boston is a leader here. Avera Health, based in South Dakota, at one point was treating nearly 1,150 patients in their homes. Boosted in part by expanded Medicare support for home-based care during the pandemic, nearly 100 hospitals across the country are in the program providing acute care to patients who would formerly have been hospitalized.
If these trends do come together, as I suspect, the impact on the senior care industry and real estate markets could be enormous. People will no longer regard nursing homes as their only source of long-term care.
The appeal of high-end continuing care retirement communities may also dim. Why spend $500,000 for a 1,200 square-foot apartment, and then $5,000 a month for a meal plan and related services? Why not have the care you need delivered for much less money to you in your own (much larger and nicer) home?
It will take many years for these changes to become commonplace. But anyone beginning to plan for their later years should include the development of at-home health care in their thinking.