How Home Healthcare Supports Aging in Place

March 12, 2024

The U.S. home healthcare industry was valued at $142.9 billion in 2022 and is predicted to increase at a compound annual growth rate (CAGR) of 7.48% between 2023 and 2030, according to Grand View Research. In addition, according to the U.S. Bureau of Labor Statistics, employment in the home healthcare sector is estimated to grow by 21% between 2021 and 2031, adding 711,700 jobs each year on average over the decade.

The growing senior population and rising frequency of chronic diseases, combined with advantageous reimbursement for home healthcare equipment, are significant drivers of the U.S. market. According to projections from the U.S. Census Bureau, the number of people over 65 will grow from 43 million in 2012 to 84 million by 2050, rising from 14% of the population to 21%. More than two of three older Americans have multiple chronic conditions whose treatment is different from acute care and conducive to home healthcare.

Recent technological advances and the cost-effectiveness of home healthcare services are also expected to drive growth during the forecast period.

The Evolution of Home Healthcare: At the Beginning

In the nineteenth century, hospitals were a last resort for persons who were unwell, giving birth, or dying and without family or compassionate neighbors to assist. According to Penn Nursing at the University of Pennsylvania, which provided a history of home healthcare, those with the financial means would pay for doctors, nurses, or midwives to visit the patient at home.

By the end of the century, philanthropic groups known as “Visiting Nurse Associations” (VNAs) were established across the United States to send trained nurses into the homes of sick, poor people to offer care and prevent the spread of dangerous, contagious diseases. Deciding which chronically ill patients to treat and for how long was a financial problem for these VNAs. The solution: limit care to those who can be immediately returned to their family with appropriate nursing.

Insurance Responds

In 1909, Metropolitan Life Insurance Company (MLI) began offering coverage for home nursing care to its insureds. In providing coverage for such care, the insurer extended an insured’s life, resulting in fewer death claims, lower premiums, and more policyholders. In 1916, 221,566 policyholders received over a million nurse visits. However, since the chronically ill did not improve, determining how to pay for long-term day care became more difficult over time.

By the 1930s and 1940s, a shift had occurred as the demands of the chronically ill strained hospital capacity, and home care was viewed as a preferred lower-cost alternative to hospitalization. The question of how to pay for home healthcare remained open. After decades of research and trial, home care as a benefit was included in insurance programs for serious illnesses with coverage limited to brief acute episodes. Caring for the chronically ill at home remained a personal/family responsibility.

Medicare and Home Healthcare

In the 1960s, Medicare, Medicaid, and the Older Americans Act included home healthcare coverage. At the time, Medicare only covered medically necessary, intermittent skilled care for the acutely ill who were homebound after hospitalization. It was not meant to alleviate the mounting burden of chronic debilitating illness. The federal government gathered funds and redistributed them to individuals to help them pay for home healthcare services in the private sector through intermediaries.

Legislative, legal, and regulatory reforms have resulted in increased home-care benefits throughout time. By the 1990s, Medicare expanded to include long-term care for the chronically ill.

Home Healthcare Today

Today, more than 33,000 primary location home care and hospice providers employ over two million registered nurses, therapists, home care aides, and allied caregivers. Over 12 million patients rely on home care and hospice services, which are currently the “modality of choice” for health and supportive care.

COVID-19 catalyzed care at home. During the pandemic, individuals did not want to enter a medical facility, and those in an assisted living facility or nursing home were on lockdown. Home care emerged as the better option for providing patients with more emotional support and freedom.

Medicare continues to make changes to its home healthcare program, including overhauling the home health payment system and changing its telemedicine regulations for home healthcare in the wake of the pandemic. In addition, legislation in the last few years has been introduced to modernize and strengthen the Medicare program.

Technology advancements, including remote monitoring, vitals capture, medication reminders, and health alerts, have also supported the growth of home healthcare. Remote monitoring allows healthcare providers to transmit their assessments in real time, allowing them to make necessary treatment adjustments and intervene earlier, which results in fewer hospital readmissions.


Home healthcare is often less expensive, more convenient, and more effective than treatment in a hospital or skilled nursing facility. Furthermore, a patient’s alternatives for receiving home healthcare services are virtually unlimited. Depending on the situation, care might range from nursing and specialized medical treatments to assistance with daily tasks like bathing, clothing, feeding, and medical care.

About One80 Intermediaries/Manchester Specialty

Manchester Specialty, a division of One80 Intermediaries, is a national specialty underwriting and insurance program management firm, licensed to do business as a program administrator in all 50 states and D.C. Our agent/broker partners and their Allied Health clients look to us for our expertise, broad product capability, and commitment to the market and the quality and stability of our insurance programs for Home Care, Medical Staffing, Allied Health, and Human Services organizations. For more information, call us toll-free at 1-855-972-9399 or visit Allied Health Firms – One80 Intermediaries.