The quiet revolution in U.S. healthcare isn’t happening in shiny new towers; it’s happening in living rooms. Since the pandemic, “hospital at home” moved from pilot to policy. As of October 2024, 366 hospitals had CMS approval to deliver inpatient-level care at home—a scale unimaginable in 2019. And by April 2024, CMS reported roughly 23,000 discharges through the program. That’s not a fad; that’s infrastructure. Centers for Medicare & Medicaid Services+1
Follow the money and demographics. National health spending hit $4.9 trillion in 2023. Within that, home health care spending jumped 10.8% to $147.8 billion, accelerating from 2022. Meanwhile, the U.S. 65+ population reached 61.2 million in 2024—up 3.1% year-over-year—while the under-18 population shrank. We’re aging, shifting acuity patterns, and bringing care to where people live. Centers for Medicare & Medicaid Services+2Centers for Medicare & Medicaid Services+2
Workforce economics are leaning in, too. The Bureau of Labor Statistics projects 17% growth for home health and personal care aides from 2024–2034, with ~766,000 openings per year as demand and retirements collide. The hospital workforce shortage is real; home-care roles meet patients where they are and can scale differently. Bureau of Labor Statistics
I watched this up close with a Hallmark Homecare client—post-CHF exacerbation, not a candidate for a long inpatient stay. Daily tele-rounds, twice-daily vitals, quick labs, and—importantly—family coaching. Readmission risk dropped because the house became the unit of care. CareFortis took a similar route, bundling remote monitoring with nutrition and fall-risk interventions. The kicker wasn’t the gadget; it was adherence. Patients do better when the plan fits their life.
Skeptics worry about safety. They should. Home at-scale requires strict inclusion criteria, rapid escalation pathways, and supply chains that can deliver IV meds and diagnostics within hours. But the lesson from CMS’ initiative is clear: with protocols and oversight, home care can match hospital quality for selected conditions while improving patient experience—and often at lower cost. American Medical Association
The bigger story is cultural. Hospitals are vital, but they’re losing their monopoly on “real care.” We’re unbundling the inpatient experience: continuous monitoring, same-day labs, point-of-care imaging, and virtual hospitalists stitched together around the patient. Technology is the enabler; payment is the unlock. Keep the waiver momentum, modernize state regs, and align incentives for home-first pathways, and we’ll shift millions of patient-days from buildings to bedrooms.
If you build healthcare around lives instead of locations, home care isn’t an adjunct—it’s the default. The shift has started. We’re just seeing the first inning.
