Radical shifts in where care is delivered are taking place. More chronic conditions can now be treated in the home due to significant advances in medical technology, changes in reimbursement structure, and the desires and complex needs of an aging population. These factors are opening up new opportunities for people to thrive at home in a convenient, cost-efficient way, reducing unnecessary hospital admissions and giving patients the opportunity to receive the care they need where they are most comfortable.

The Center for Health Design’s latest online resource—an issue brief titled “Healthcare at Home”—looks at both the research literature and expert knowledge to present design strategies that specifically facilitate healthcare in the home setting. The findings, which include considerations for a variety of topics from room layout and furniture selection to technology (software and devices) and accessible equipment storage, were completed this spring and are as relevant to designers and owners as healthcare institutions and families.

Healthcare-at-home services range from complex dialysis and chemotherapy treatments to diabetes management and rehabilitation from acute conditions. This rapidly growing segment of the healthcare industry serves mainly older adults with acute and chronic conditions who are stable enough to be treated at home but can extend to include those in rehab and patients who reside in rural areas and lack access to services. Though various forms of home-based services, such as visiting nurses and physical rehabilitation services, have existed for years, the trend toward more hospital-level acute and subacute care being delivered at home is relatively new and brings numerous advantages. For many patients, the home is more comfortable and convenient and has the advantage of family and friends being nearby. It can also reduce the risk of complications like healthcare-associated infections.

For the provider, some studies suggest that delivering certain care services at home may be more cost-effective than providing them in a traditional setting. A paper published in Health Affairs in 2012 by Lesley Cryer, Scott B. Shannon, Melanie Van Amsterdam, and Bruce Leff found that healthcare at home costs were 19 percent lower as compared to similar inpatient care. A report, “Hospital-Level Care at Home for Acutely Ill Adults: A Pilot Randomized Controlled Trial,” published in 2018 in the Journal of General Internal Medicine, puts the cost savings at closer to 52 percent. In addition, home care may decrease some of the burden on an oversaturated healthcare system, especially as our population ages.

However, delivering home-based care is not without its challenges. Today, very few healthcare organizations offer formal home-care models. There are also significant challenges related to technology capabilities in the home environment. For example, home-based internet may not support easy access to electronic medical records, and Medicare reimbursements for telehealth are currently limited to specific circumstances. Additionally, current residential designs tend to be oriented toward the young, healthy, and able-bodied, making it difficult to support accessibility needs. Home modifications, such as installing grab bars, railings, and ramps, are needed to support safe accessibility. And while initially these modifications can seem costly, they’re still far less expensive than a trip to the emergency room or a hospital stay.

The Center’s research revealed that two important areas to consider are accessibility and physical safety for activities of daily living. The issue brief explores how to design for both safety and accessibility in building and room layout, patient-handling equipment, furniture, accessibility fixtures, storage, waste disposal, flooring, lighting, technology, and home aesthetics.

Providing more healthcare at home offers advantages over traditional healthcare options but not if the home environment isn’t properly equipped. There’s a great opportunity for the design, healthcare, and manufacturing communities to better understand the value and needs of this growing sector and help move the residential healthcare industry forward.

Debra Levin is president and CEO of The Center for Health Design. She can be reached at dlevin@healthdesign.org. Melissa Piatkowski, MS, EDAC, is research associate at The Center for Health Design. She can be reached at mpiatkowski@healthdesign.org.