Healthcare at Home: Six Forecasts for 2020

Nurse and elderly man spending time together --- Image by © Jose Luis Pelaez, Inc./Blend Images/Corbis

The number of individuals receiving medical care at home will grow over the next decade, driven by demographics, economics, consumer preferences, and technology enablers. IBM notes that residential care and home care together constitute a $45 billion industry that is projected to grow, and that “the cost and quality of care improve” as care moves across the continuum from hospital and clinic to residential to home settings.

The growth of care at home will have implications for all of the stakeholders involved— patients, informal caregivers, medical professionals, and medical organizations. As home care becomes more common, the nature of home care itself will also change.

3 KEY FINDINGS

  • Medical care at home can play a key role in reducing the cost of medical care while simultaneously improving quality and patient satisfaction, as the home may become the new center of medical care.
  • Supported by information technology (IT), medical care at home may grow to encompass both acute care and prevention/ wellness, and become a new lifestage for seniors.
  • The growth of medical care at home will change the roles of medical institutions and medical professionals, and provide major opportunities not only in the health and medicine sector but also for many other sectors of business and industry.

FORECAST 1. THE HOME MAY BE AT THE CENTER OF THE FUTURE HEALTHCARE SYSTEM: Many experts forecast the growth of home healthcare in the coming decade; one possible future is that the home may become the center of healthcare. This change could be well on the way by 2020. In fact, a 2009 forecast by Naomi Fried, vice president of the innovation and advanced technology group at Kaiser Permanente, stated that “By 2015, the home will be the hub of care.” While much can change in three years, this seems somewhat optimistic for 2015. Still, over the next eight to 10 years there should be a substantial shift away from institutional care toward the home.

FORECAST 2. ACUTE CARE WILL INCREASINGLY TAKE PLACE AT HOME: The home—which today is usually reserved for the treatment of minor injuries or short-term care of common illnesses (e.g., colds, flu)—will be increasingly important as a site of acute care. This will include “hospitalization in the home” for conditions ranging from pneumonia and heart conditions to post-op recovery.

FORECAST 3. HOMES WILL BE THE CENTER OF WELLNESS AND PREVENTION: In addition to encompassing chronic and more acute care, the focus of care at home will also broaden to emphasize the maintenance of health and the prevention of chronic and acute illness. The home will become the center of lifestyles focused on wellness and prevention for individuals and families alike. The two primary forces that will drive this shift and make home wellness a central theme of healthcare in the next decade include a focus on prevention and cost, and a focus on real-time health monitoring.

FORECAST 4. INFORMATION TECHNOLOGY WILL BE CRITICAL TO GROWTH: The proliferation of IT in the form of sensors, personal monitoring and communication devices, and healthcare apps will be critical to the emergence and growth of medical care at home and its expansion to both acute and preventive care. IT and remote monitoring are widely expected to transform healthcare in the coming decades. Futurist and graphic designer Patrick James foresees a number of healthcare technologies that will improve at home care by 2020 including: app-driven diagnostics, virtual triage, at-home medical sensors (which may include, e.g., epidermal sensors, ingestible sensors, and non- invasive glucose sensors), and data-driven patient communities.

FORECAST 5. HOME CARE WILL BECOME A NEW SENIOR LIFESTAGE FOR MANY: Home care will emerge as a new lifestage for more and more seniors. It will be a lifestage that exists between living at home unassisted and moving to one of a variety of senior living or institutional care settings. Current trends in senior living are consistent with this hypothesis:

  • Seniors are waiting longer to leave their homes and enter senior living facilities;
  • In the US, the number of nursing homes declined during the first decade of the new century, while the growth of assisted living and continuing care retirement communities was stalled by the recession, as seniors were less able to sell their homes in preparation for a move.
  • Prospective senior-housing residents are presenting with “higher levels of acuity (a.k.a. sickness).” As a result, Senior Housing News forecasts a shift in the function of senior facilities, with independent living functioning more like today’s assisted living, assisted living operating more like today’s skilled nursing, skilled nursing receiving the sickest patients as an alternative to hospitalization, and growth in dedicated facilities for Alzheimer’s patients. Senior living providers will partner with home care, clinic, and rehab providers to provide a network of care that begins in the home but also offers residential facilities when needed.

FORECAST 6. CHANGING ROLES FOR INSTITUTIONS AND PROFESSIONALS: The preeminence of home care will be one of many forces that will substantially change the roles of the various healthcare institutions and healthcare professionals in the coming decade. In part because of the looming physician shortage, but also as the result of a shift toward care in the home, patients of all kinds will see doctors less often and nurse practitioners and physician’s assistants more often.31 Data from the Bureau of Labor Statistics underscores the rising importance of non-physicians in the future healthcare system. Some 712,000 new registered nursing jobs and 706,000 new home health aide positions are expected to be created between 2010 and 2020, making them some of the fastest growing occupations in the US. And, as care models like the medical home take hold, doctors will team with nurse practitioners, physician’s assistants, pharmacists, dietitians, and possibly social workers to provide coordinated care, with the doctor functioning as “a kind of quarterback.”

3 BUSINESS IMPLICATIONS

The growth in medical care at home will create new business opportunities across many business sectors.

1. Design and construction: Existing housing often contains features that “limit independent functioning, impede caregiving, and contribute to accidents such as falls.” There will be ongoing need to retrofit existing housing to facilitate medical care at home. There will also be opportunities to add purpose-built home medical suites to existing dwellings. These may be integrated into the existing design, or provided as modular, separate buildings. As aging in place and care at home become more common, the need to design and construct living space more flexibly and according to universal design principles will increase. Finally, there will be opportunities for both new and retrofit solutions that help homes become active elements in health monitoring and care provision. This will primarily require the development and deployment of sensing, monitoring, and health IT. Note that, outside the home care arena, there will also be opportunities to create more home-like senior living facilities.

2. Fast-moving consumer goods (FMCG): A wide variety of products will be needed to meet the special needs of those being cared for at home; for example, cleaning and disinfecting products or personal care products currently used in clinical settings may need to be marketed more directly to consumers or home caregivers. There will also be an opportunity to redesign packaging across the consumer goods sector to make it more accommodating to individuals with physical limitations.

3. Financial services: The financial services sector has an opportunity to help catalyze the growth of medical care at home, for example by offering financing to support the development of hospital-at-home services or financial products such as long- term care insurance that provides for care in the home. Insurance carriers can offer coverage for new home health technology as part of medical insurance plans. Banks could tailor telephone and Internet home banking services to meet the needs of home patients and their caregivers.