The sun’s not up yet, and my chest feels tight. Sitting up in bed, the room slides briefly out of focus. I attempt a deep breath… Sharp needles pierce deep into my chest. The cough I downplayed yesterday tears up my throat as I shiver with a chill.
Pneumonia. After turning 70, I’ve had it more than once. I reach for my digital assistant, Juliette. Her screen lights up and displays, Tuesday, February 10, 2050, 5:40 am.
Juliette instructs me to stick the little patch on my chest that takes my temperature (a little high), oxygen saturation (a little low), heart rate, blood pressure, as well as interstitial fluid glucose and white count (also elevated). She listens to my cough.
“You may have an infection,” Juliette says. “I’ll connect you with telehealth.”
After a quick visit to the nontrauma ER to get my lungs scanned and blood analyzed, I’m back in bed when a nurse arrives with my fluids and antibiotics. She starts the IV and wheels in an oxygen tank — just in case. My husband hands me a steaming cup of tea.
It’s 2050. Yes, I’m sick. Yes, I’m in the hospital. But I’m home.
The Future of Hospital Care — at Home
This is a glimpse of medical care in 25 years. By 2050, the concept of acute-level care being delivered to patients in their homes in lieu of traditional hospitalization could be commonplace. Even in 2025, the Hospital at Home (HaH) care model has existed for decades in countries such as Australia, Italy, Israel, and Canada.
Today, hospitals across the United States are treating patients at home for conditions such as congestive heart failure, chronic obstructive pulmonary disease, pneumonia, sepsis, and cancer. The range of available treatments continues to expand for patients sick enough to need acute-level care, but stable enough to remain outside a brick-and-mortar hospital.
Michael Maniaci, MD, enterprise medical director of virtual care at the Mayo Clinic Center of Digital Health and medical director of Mayo Clinic Hospital in Florida, has personal experience with this approach.
The period after Maniaci’s second daughter’s birth was painful. His newborn had hyperbilirubinemia and went straight to the NICU. For a week and a half, Maniaci and his wife traveled 45 minutes to and from their home while their baby received treatment. The stress was terrible.
When Maniaci’s son came along 3 years later, he had high bilirubin as well. But this time, the hospital set up phototherapy in his home. Every night, a nurse visited to take his son’s blood to be analyzed.
“It worked wonderfully,” Maniaci says. “All he was getting was sitting under lights and a little bit of fluid and blood. There was no reason to be in the hospital.”
In 2050, the patients using HaH the most will likely be a little older. Healthcare systems are bracing for what has been called the “Peak 65 Zone” or the “silver tsunami,” as the largest group of Americans in history begin turning 65. In 2025, this has already begun. A higher life expectancy, increased rates of chronic conditions … everyone’s afraid of the Baby Boomers (and forgetting about Gen X).
And what about the next pandemic? It was in response to COVID-19 that the Center for Medicare and Medicaid Services (CMS) launched its Acute Hospital Care at Home program in 2020. The waiver allows hospitals to receive the same reimbursement as hospital care for HaH patients and covers more than 60 conditions.
Will there be enough hospital beds in 2050? Yes, if a good number of them are in patients’ bedrooms, and a growing body of evidence supports putting them there.
“Research has shown patients heal better in their homes if safe to do so,” says Jared Conley, MD, an emergency physician at Massachusetts General Hospital and Harvard Medical School, Associate Director of the MGH Healthcare Transformation Lab, and co-chair of the Hospital at Home Tech Council. The council is run by the Hospital at Home Users Group, a US-based collective dedicated to expanding HaH care.
Conley predicts that within the next 10-15 years, up to 30% of inpatient care could be delivered at home, but this requires a mindset shift. “Instead of designing care around facilities, we are designing care around the patient,” he says.
The Tipping Point for HaH
In 2025, only a small percentage of US hospitals have HaH programs. What will make Conley’s prediction a reality? The answer lies with two key issues: technology and money.
Albert Siu, MD, MSPH, professor at the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai, and former director of Mount Sinai at Home, has seen HaH tech evolve over the past decade.
The original program at Johns Hopkins, Siu points out, “was fairly simple in hardware. They had no electronic medical record. Their communication system was a telephone and pager. Now, we have much greater advances we can bring to bear in the way of remote monitoring, doing testing faster, doing video visits with greater fidelity and clarity.”
By 2050, new wearables and AI assistants might make those advances seem quaint.
But what Conley calls the “holy grail” of technology that will benefit HaH programs isn’t a sleek new sensor or a medical Alexa. In fact, it’s something the patient will never see — supply chain logistics.
Maniaci describes delivering healthcare at home as a complex orchestration of events. “I compare it to ordering an Uber,” he says, “but the car, the engine, the tires, the fuel, and the driver all show up separately. If you only get four out of five, you can’t get a ride.” Likewise, when a physician orders a liter of fluid, “I need the pharmacy to make the fluid, a DME company to deliver the tubes, a nurse to give it, medical waste to take it away.” If one link in the chain fails, it all falls apart.
Tracking each element of patients’ treatment plans on a large scale, requires industrial-level software, which Maniaci says, must be “more advanced than anything that runs Amazon, Walmart, or FedEx. We need something that doesn’t even exist in today’s world of technology,” he says, “and that’s what we’re building for with partners.”
Solving the Money Problem
Reimbursement is the other stumbling block.
The CMS waiver was created as a temporary measure set to expire at the end of 2024. Congress has since extended the program through March 2025 but has not resolved whether it will continue for a period of years or become permanent. Hospital systems are hesitant to invest in a program when the revenue source is not secure.
Studies on HaH care often celebrate its comparable outcomes to inpatient care at significantly lower costs. But physicians and patient advocates have questioned whether that advantage only benefits investors.
“A cynic might contend that hospitals are excited by these programs since they shift hospital overhead costs onto patients by sending them home for their care,” wrote orthopedic surgeon James Rickert, MD, in a 2021 column for Clinical Orthopaedics and Related Research.
A 2023 report by the Center for Economic and Policy Research sharply criticized the CMS model, stating that “the lack of adequate CMS standards, data, and oversight systems for H@H programs provides incentives for financial interests to take advantage of taxpayer subsidies for private gain.”
Are Medical Roles Changing?
There is concern about how the HaH care model, along with other “disruptions” in medical practice, will shift many of the established roles of healthcare workers. Nurses are particularly skeptical.
“We call it ‘home all alone,’” says Michelle Mahon, RN, director of Nursing Practice at National Nurses United (NNU), the largest union of registered nurses in the United States with almost 225,000 members.
NNU has been vocally opposed to the HaH model, alarmed by a concept of care divorced from around-the-clock, in-person contact between patients and trained clinicians. Union members fear that HaH prioritizes profit over patient safety and devalues the vital skills and experience that nurses provide at the bedside 24/7.
The HaH model, Mahon says, “relies heavily on the idea that data capture is equivalent to nursing assessment.” But there is no substitute for being with a patient in person. Painting at-home acute care as equally safe for patients, Mahon believes, is capitalizing on the fact that, “nobody wants to be in the hospital” and taking dangerous risks with patients’ lives.
Others disagree that HaH discounts the role that nursing plays in patient care. Daniel Kraft, MD, faculty chair for medicine at Singularity University and founder of NextMed Health, believes it gives nurses the opportunity to expand their scope. “We still need skilled nurses for sure,” Kraft says. “It doesn’t mean you drop [patients] off at home and don’t touch them with anybody clinical. With these new tools, we can upskill nurses to do more things. They could have a pocket ultrasound with them and rule out a cardiac effusion or a kidney stone.”
Just as the field of hospitalists was created in the 1990s, Kraft imagines a new one in 2050: “homespitalists,” clinicians who specialize in providing acute care at home with a range of digital diagnostics.
Maniaci feels that as AI bots become able to access the entire repository of medical knowledge, they can guide patients to take on more and more of their own low-acuity care. “I think there’s a future where the patients become the providers and their homes become the clinics and hospitals,” he says.
Conley believes that as patients experience HaH care and discover the benefits, they will begin to demand it. And that will be a “watershed moment” for the care model.
“One of the clarion calls we hear from patients in the hospital is ‘Doc, when can I go home?’” Conley says. “Once more and more patients understand that they can be hospitalized at home when it’s safe and appropriate, I, as an emergency physician, would find it very difficult to persuade them to get care within the hospital walls.”
