Should Home Care be a Right?

Kitchen_Aging_in_Place_Design_1Blog post by Colin Hung

Over the past several months we have had a string of amazing guests on #hcldr. The discussions and topics have all been extremely interesting and relevant to healthcare leaders. I spent the week reviewing the transcripts (something I would highly recommend) and I felt that the prior chats were leading me to a topic that brings several of the topics together – healthcare at home.

On February 23rd we had Dr. Joyce Lee MD, MPH on #hcldr talk about the need for #designthinking in healthcare. On March 24th Rev Amy Ziettlow guest hosted a discussion on the challenges of caring for seniors – a topic that was again discussed two weeks ago with Leslie Kernisan MD. We also had a number of chats around the concept of patient-centered care with Dr. Michael Fisch, Michele Longabaugh RN and Morgan Gleason. Finally there was the great discussion with Lisa Fields on the science of healing places.

All of these posts and chats got me thinking about healthcare at home. To me there is no greater example of patient-centered care than allowing someone to receive care in what is arguably the place where they are most comfortable – their own home.

As little as 15 years ago home care was only an option for those wealthy few who could afford to hire a nurse and pay for all the monitoring equipment. With the falling cost of medical devices, the rise of remote monitoring technology and the growth in home care services, being at home is now becoming an option for more and more people.

A big driver for the growth of home healthcare is older adults who want to stay in their own homes as they age – rather than go to an assisted living facility. According to research by the American association of Retired Persons (AARP) (and reported by Psychology Today) 9 out of every 10 older adults want to stay in their own homes – often referred to as “Aging in Place”.

The Aging in Place trend is having a significant economic impact. The National Association of Homebuilders (NAHB) estimates that more than 70% of homeowners are remodeling or are planning to remodel for their own future needs or the needs of their parents. The NAHB goes on to predict that this will represent $20-$25 billion of the US $214 billion remodeling market (about 10%). This trend is so important that the NAHB has created special training and accreditation for people who design/redesign homes to accommodate for special needs.

Aging in Place is also impacting the technology market. IT research firm, IHS Technology, predicts that the worldwide revenue for home health devices and services will rise to $12.6 Billion in 2018, up from $5.7 Billion in 2013.

Wen DombrowskiIn an interview with MedCity News, Dr. Wen Dombrowski, CMIO and Vice President at VNA Health Group (aka the amazing @HealthcareWen) talked about the potential of healthcare technology to help older adults and drive down healthcare costs:



If you look at (the costliest) Medicare patients, they’re elderly, disabled patients often requiring home care or long-term care. We recognize that there’s a lot of opportunity to innovate care for these patients. I think a combination of technology on the healthcare side and on the consumer side could help manage these high-risk populations.

– Dr. Wen Dombrowski

However in that same interview Dombrowski also talks about how technology vendors are falling short of designing products that are truly useful and usable by older adults.

The problem…is that some sensors and apps try to address the senior population as one homogeneous market, when really it comprises endless sub-populations of people with varying literacy levels, functional statuses and cognitive abilities.

– Dr. Wen Dombrowski

Susan DeVore, President and CEO of the Premier healthcare alliance, reminds us in her post “The Changing Health Care World: Trends to Watch in 2014” that healthcare at home is not just for older adults. There are many people who want to receive care at home.

…driving the growth is the need to make care more convenient, particularly for those with chronic conditions, so patients can be monitored and coached to health anytime, anywhere. And there’s a cost component to the trend as well…

– Susan DeVore

That cost component can be enormous – especially for families taking care of special needs children at home. A 2010 NPR article highlighted the challenges faced by the family of Olivia Welter, who was being cared for at home by her parents at a cost of $220,000 per year. That annual cost is less than half of what it would cost to have Olivia stay at a hospital, but the Welter family has had to fight hard for home care funding. Many other families in both the US and Canada face similar challenges.

Despite a mountain of evidence of the cost benefits and improved outcomes of home-based care, the healthcare system lacks the infrastructure, funding and qualified personnel to effectively support it. Progress has been painfully slow. A report from the American Academy of Pediatrics “Home Care of Children and Youth With Complex Health Care Needs and Technology Dependencies” succinctly describes the situation:

The provision of uninterrupted home care is threatened by national nursing shortages, limitations in the availability of skilled pediatric nurses in rural areas, and lack of funding…equipment is not universally available.

So why is home care not thriving? The answer, according to the good folks at McKinsey & Company, is a combination of poor technology, lack of financial alignment and no political will to change the current system. They published their findings in a report which you can find here.

This week on #hcldr I’d like to explore the challenges and potential of home healthcare. Please join us Tuesday May 20, 2014 at 8:30pm Eastern (for your local time click here)

  • T1: Would you choose home care for you or your loved one? What would factor into your decision?
  • T2: Should home care be a patient right? If so, should govt’s & insurance cos be on the hook for costs?
  • T3: What tech needs to be created & home design challenges need to be overcome to better facilitate home care/Aging in Place?
  • CT: What’s one thing you learned tonight that you can take back and use to help a patient or your organization tomorrow?


“The Changing Health Care World: Trends to Watch in 2014”, Susan DeVore, Health Affairs, February 10 2014,, accessed May 15 2014

“Aging in Place”, Mario D Garrett, Psychology Today, April 27 2013,, accessed May 15 2014

“CAPS Remoderlers: Helping Clients Stay in the Home They Love”, Age in Place,, accessed May 15 2014

“In Your Home – Remodelors for Aging in Place – Facts & Statistics”, In Your Home USA,, accessed May 15 2014

“Home Health Market Soars as Medical Providers Seek to Cut Costs”, IHS Technology, May 8 2014,, accessed May 15 2014

“Where digital health and seniors meet: An interview with Dr. Wen Dombrowski”, Deanna Pogorelc, MedCity News, December 27 2013,, accessed May 15 2014

“Families Flight To Care For Disabled Kids at Home”, Joseph Shapiro, NPR, November 8 2010,, accessed May 15 2014

“Spurring the market for high-tech home health care”, Kayyali et al, McKinsey & Company, September 2011,, accessed May 15 2014

“Home Care of Children and Youth With Complex Health Care Needs and Technology Dependencies”, Elias et al, American Academy of Pediatrics, April 30 2012,, accessed May 15 2014

“Aging in Place choices”, Alesha Churba,, accessed May 15 2014

“The Patient Will See You Now: The Future of Technology in Healthcare”, Dr. Nic Gay, Wired, January 16 2014,, accessed May 15 2014

“Big Baby Boomer Trend: Home Design for ‘Aging in Place’, Caroline Wilkes, Examiner, March 3 2010,, accessed May 15 2014

“Golden Opportunities: ‘Aging in Place’ Trend Builds Business Potential”, Durability + Design, February 13 2012,, accessed May 15 2014

“Boomer Fuel the ‘Aging in Place’ Trend”, Lisa Howell, Thrive Senior Living, January 15 2014,, accessed May 15 2014

“Tech for Aging In Place at #mHealth13”, Wen Dombrowski MD, Storify, December 2013,, accessed May 15 2014

“We need more innovations in caring, not curing”, Leslie Kernisan MD, MPH,, October 13 2013,, accessed May 15 2014

Image Credit


  1. All interesting comments, but until such services become #reimbursible, you are just shooting the breeze.
    The case for reimbursability can be made on political grounds or on the grounds of inducing future cost savings; but you’ve need some sort of study / clinical trial to support that.

    1. Kelly Russo Stone · · Reply

      Studies are definitely being done within the occupational therapy and inter- disciplinary healthcare professionals. Unfortunately these things take time, but I (we) do agree with you! Trying so hard for it to NOT be downplayed as just “shooting the breeze”. Thanks Kelly Stone OTR/L CAPS

  2. I won’t miss this one! Due to my specific health concerns, if I had receive medium-term care (for several months, for example,) I would have to weigh the consequences of staying in a facility vs. having strangers in my home. For long-term care I would definitely need home care.

  3. Robert Jacko · · Reply

    I absolutely agree with this. Home is the most comfortable place for living. People love to stay in their own home only. But, with the increasing age of seniors, they need assistance and care for their daily activities such as grooming, bathing, transportation to appointments, companionship etc. The seniors get depressed at the thought of losing their independence. A unique approach of home care helps to grant the services to the seniors by helping them to maintain their independence. You can find many home care services in Miami, where the agencies provide a comprehensive non-medical care to seniors, chronic illnesses sufferes and those recovering from an injury or surgery at home, hospital or hotel room.

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