Phil Moeller: Aging in place with health care in the home
Written by Phil Moeller, UnitedHealthcare contributor, Medicare and Retirement expert
When you ask people where they prefer to live when they get older, staying in their homes tops their responses at 80-90%.1 Our homes are not only where many of us prefer to heal but also where we do so more quickly – and with better results, according to a government study.2
An accelerated evolution
Today, “aging in place” has gone from a “concept” to a major focus of care, in part fueled by the health needs of growing numbers of people in their 70s and 80s, along with a shortage of affordable retirement communities3 and a worsening shortage of acceptable care in hospitals and skilled nursing homes.4
During the pandemic, nursing homes were effectively locked down, and hospitals were overwhelmed with COVID-19 patients. They were the last place people wanted to be if you didn’t have COVID.
Hospitals convinced Medicare to waive its coverage rules, allowing hospitals to provide hospital-level care to seniors in their homes. Because home-based care can be much less expensive than comparable care in a hospital, expanding home-care programs became appealing to many hospitals.
At the same time, the pandemic led to a surge in the use of remote telehealth services that people could access from home. Waivers for hospital-at-home and telehealth services have been extended through September 2025, and waivers that run even longer have broad support in Congress.
As I explained in my 2024 book, “Get What’s Yours for Medicare,” these shifts have generated new investments in companies that can work with health providers to deliver increasingly sophisticated care to patients in their homes.
Entrants include companies that will dispatch emergency room teams to your home, bypassing hospitals and urgent care centers. Kidney dialysis machines can be placed in the home, along with health care professionals to operate them. Same for cancer treatments and other infusion therapies. Additional home-based treatments are being added to the list.
Dr. Bruce Leff, a Johns Hopkins University School of Medicine physician who began researching moving health care away from institutional settings in the 1980s, explains the spectrum of home-based care as:
- Personal care by a loved one
- Skilled home care by a professional
- In-home doctor visits
- Sending hospital personnel to the home
“For people who are too frail to come into our outpatient clinic,” Leff told me, “we send doctors out to the home and nurse practitioners out to the home … as a substitute for having people come into an outpatient clinic. That’s home-based primary care.”
What’s more, needs that are common to home health but often outside a hospital’s core skill sets are drawing new companies into health care. Specializing in one or two aspects of care, they can develop deep expertise and, by spreading fixed costs among patients in many programs, provide services at costs that hospital-provided programs can’t match.
It will likely take time for doctors and health plans to adjust to new home-based care models and recognize their value, so staying in close touch with them is essential.
Home has always been where the heart is. Now, it’s also becoming the center of healing and better health.
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Author bio
Philip Moeller is the principal author of the Get What’s Yours series of books about Social Security, Medicare, and health care. Read his Substack newsletter and connect with him on LinkedIn.