There was a time when most illnesses were treated at home, and the family physician made house calls. Caregivers were always family members, and no one, unless they lapsed into a coma, ever went to a hospital for care. Of course, that was also a time when most people didn’t have any medical insurance, and a house call was paid with a single bill slipped into the physician’s hand as he left. Female physicians were as common as hen’s teeth. A very good book on the rise of the American hospital system is available.

Since then, times have changed dramatically with regard to illness and how it is treated. Trips to the ER or hospital stays have become more common, and physicians no longer make house calls unless you have a concierge care contract. Membership fees and monthly costs can range from $1,200 to $10,000 a year.

But, as with everything, a review of the economics, the need, the shortages of staffing, and the income drain on space is bringing about a new look at homecare, and it’s being seen in a more favorable light. Of course, home care provided by families around the world is more standard than unusual.

Finance and the involvement of corporations seeking new profit streams now see a potential market here, not by families but by corporate employees. “The global home healthcare market size was valued at USD 362.1 billion in 2022 and is expected to grow at a CAGR of 7.96% from 2023 to 2030.” Money, not family values, is driving the market back home instead of to a sterile institution.

A small study on the home-as-hospital approach for acute-care patients was revealing. It indicated that “home patients had better experiences with their care team, had more experiences promoting healing such as better sleep and physical activity, and had better experiences with systems factors such as the admission processes.” One aspect of this type of care is that it can reduce the re-admission rate, which may or may not benefit hospitals.

In my experience, I have seen nursing home patients admitted to hospitals for a short course of treatment, then returned to the nursing home and re-admitted a day or two later. The discharges may be related to the DRGs (Diagnosis Related Group), which mandate the number of in-hospital stays for each illness. This re-admission can negatively affect hospital profits, but I’m not an expert on this. If a patient were able to be maintained at home, everyone might benefit.

Patients appear to be more than satisfied with hospital-at-home care and would choose it whenever possible. The programs, including the placement of advanced medical equipment in the home, have also been associated with additional benefits such as reductions in mortality, readmission rates, and cost, as well as increases in patient and caregiver satisfaction.

Will we be seeing more patients being treated in their homes instead of hospitals? The wind would seem to be blowing in that direction.