South Florida Hospital News
Thursday August 6, 2020

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July 2018 - Volume 15 - Issue 1


From Hospital to Home: Elder Care Investments by 2020

If provider investment plans are any indication, the next big opportunity for care looks to be moving from hospital to home.

Under pressure to curb healthcare spending, providers plan to move away from traditional models like Skilled Nursing and inpatient rehab facilities and toward those that promote care outside the hospital or institutional setting, BDO’s Candid Conversations on Elder Care reveals.
The study (with NEJM Catalyst) asks U.S. executives, clinical leaders and clinicians at nearly 500 healthcare organizations which areas they’ll invest in most by 2020—and how they’ll look to tech—to prepare for the growth of the aging U.S. population. Specific findings include:
- By 2020, healthcare organizations plan to invest most in home health (44 percent), palliative care (44 percent) and geriatric caretakers (39 percent)
- Providers say home-based care (63 percent), care coordination (58 percent) and drug pricing (24 percent) present the greatest opportunity for tech disruptors to improve elder care
- Technology will improve the quality and safety of elder care most in the areas of transportation coordination (97 percent), electronic or telemedicine capabilities (93 percent), and wearables or connected devices (89 percent).
Seniors in the driver’s seat
U.S. providers have historically medicalized old age. Physicians have been hesitant to have uncomfortable conversations with their patients about realistic end-of-life care options that align with their desired quality of life.
That tide is changing, helped in part by recent moves by Medicare to reimburse providers for these candid care conversations. But the bigger driver is senior consumers themselves—which as of 2029 will make up more than 20 percent of the population.
Their expectations are changing. In line with the move to value-based care, seniors are demanding their last years be measured by quality of life rather than number of days. They want to spend their last days outside of the hospital or nursing home and in the comfort of their own homes.
The future of elder care is rooted in empathy.
Tech’s role
Technologies like internet-connected door locks, smoke alarms, thermostats and even at-home cameras enable family members of seniors to remotely care for their loved ones while empowering them to remain autonomous for longer. Telemedicine allows hospitals to provide follow-up care to seniors at more regular intervals in more convenient (and safe) ways.
Technology also has the potential to mitigate the top two social determinants of health that providers say are most crucial to improving elder care: familial support (63 percent) and access to transportation (44 percent). Innovations like connected devices, transportation coordination apps and virtual reality make it possible for seniors to visit with family members across the country—or world—daily. They can get to appointments on time and safely, without driving or relying on a family member.
And soon, self-driving cars will empower them to be even more independent.
Death of the nursing home?
The portion of providers planning to invest in more traditional elder care models is lower than home-based ones: outpatient rehab (12 percent), skilled nursing facilities (12 percent), long-term acute care centers (7 percent), continuing care retirement communities (6 percent) and inpatient rehab (5 percent).
The numbers make it clear.
The ‘traditional’ nursing home—one in which seniors are kept at a home and receive 100 percent of care there—is on the brink of extinction if it doesn’t evolve. Under consumer-centric elder care, providers will need to adopt the mindset that care is everywhere, not just in the hospital or nursing home walls.
One example of a successful ‘care everywhere’ model is Programs of All-Inclusive Care for the Elderly (PACE). Although just 12 percent of providers say they’re planning to invest in the more innovative model by 2020, it provides a good blueprint for the future of elder care.
Primarily through an adult day health center, PACE provides preventive, primary, acute, behavioral and long-term care services for people ages 55 and above through an interdisciplinary provider team. Benefits include home care, hospital care, primary care, meals, physical therapy, prescriptions, social work counseling and transportation.
PACE empowers seniors to remain as involved members of their communities. Its outcomes align with the value-based model: In New York state alone, the quality of health for PACE beneficiaries is about twice as high as that of other managed long-term care participants.
What’s holding providers back from adopting the elder care model of the future? How can traditional providers remain viable as tech blurs with healthcare?
Read BDO’s full study here to find out. 

Steven Shill, Partner and National Leader, The BDO Center for Healthcare Excellence & Innovation, can be reached at (714) 668-7370 or

Patrick Pilch, Managing Director and National Leader, The BDO Center for Healthcare Excellence & Innovation, can be reached at (212) 885-8006 or
Our South Florida healthcare leaders are ready to address your complex and unique needs:
Alfredo Cepero, Managing Partner
(305) 420-8006 /
Angelo Pirozzi, Partner
(646) 520-2870 /
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