Staying Put: How Aging in Place Is Reshaping LTPAC and Family Caregiving

The U.S. population is slowly but surely shifting toward older age groups.

As a consequence, there’s a quiet revolution happening in almost every American community. As millions of baby boomers age, an overwhelming majority are choosing to remain in their own homes and communities rather than relocate to assisted living or nursing facilities.

What was previously a niche trend known as “aging in place” is now a golden standard that represents the needs of an entire growing demographic. This wave will also ripple into the future, forever changing how we think of at-home care.

Meanwhile, millions of family caregivers are bearing the insurmountable load of becoming the front line of support. And all of this without adequate training, tools, or support from professionals.

Long-term post-acute care (LTPAC) clinicians should urgently rethink what care delivery truly becomes when fewer older adults want to live in institutional settings. Hybrid models are just the start. Policies, technology, workforce, and infrastructure all play a role.

It’s crucial, however, not to think of this paradigm shift as a financial or structural black hole. It’s an opportunity to stay ahead of the curve while also providing professionals and family caregivers the tools they desperately need.

Below, we’ll break down why aging in place is becoming so prevalent and what’s behind the movement. We’ll also unpack what this new relationship between the aging population and healthcare means for clinicians, caregivers, and health leaders, and how you can take on the challenge.

The Demographic Tidal Wave

The U.S. population is growing old — and it’s growing old fast.

The so-called “silver tsunami,” which refers to the demographic expansion of people over the age of 65, perfectly captures the scale of what’s coming. The oldest baby boomers are already in their late 70s, with the youngest approaching 65, creating unprecedented strain on healthcare infrastructures. According to the U.S. Census Bureau, the growth of the 65-and-over population rose by 9.4% from 2020 to 2023. This demographic represents over 1 in 6 people in the U.S., with the entire generation expected to reach their peak care needs during the 2030s.¹

At that point, growth in the older population is projected to start slowing.² This trend, however, foreshadows a greater demand for home- and community-based care services. The system has to scale up its support to avoid a constant struggle for senior independence and management.

The popularity of aging in place reflects older adults' rejection of institutional care in favor of community-based independence.

The Johns Hopkins Bloomberg School of Public Health remarks that aging populations are putting more and more importance on staying at home. But it also notes that there’s a lack of infrastructure to meet this demand.³ The first issue arises from a serious shortage of paid caregivers available to help. Currently, three-quarters of the U.S.’s older population relies on unpaid family members in cases of functional and/or cognitive impairment.³ These caregivers are having to make unprecedented financial and emotional sacrifices. And that’s not to mention the lack of training — a fundamental need that homecare policies still fail to meet in full.

The problem, however, shows its true colors when it comes to financing. Medicare coverage doesn’t fully extend to long-term maintenance services, leaving families to drift on their own through financial hardship.³ The system must consider a significant increase in support for aging in place. Housing, transportation, and all other necessities should be thoroughly met to finally provide the correct care for the aging population. But it’s not just about public policies. Care centers and hospitals must also partake in a deep change in both mindset and infrastructure. Most health systems still rely on in-person visits and care at centralized locations. As care starts to shift into each patient’s home, mobility and flexibility become a key part of the puzzle.

In other words, the aging boom isn’t a distant concern anymore. LTPAC clinicians will have to take swift steps to adapt care models and technologies to reach adults at home, where they want to be.

Family Caregiving: The Hidden Workforce

While medical professionals get the spotlight in elder care, the reality behind the scenes is actually about a much quieter and larger workforce: family caregivers.

There are over 53 million adults currently providing care for a relative in the U.S.⁴ This includes spouses, elderly relatives, and special-needs children. Almost a quarter of these people have to split their time between full-time work and caregiving, posing a significant toll on their physical and mental health. And these people aren’t just lending an occasional helping hand, either. On average, family caregivers spend 26 hours per week providing care.⁴ Most of these people then effectively act as an unpaid healthcare workforce without the training and support that professional caregivers receive. However, their work is essential to the care ecosystem. From bathing and dressing to managing medications and preparing meals, caregivers become the primary (and oftentimes only) connection of an older adult to the healthcare system.

But the healthcare system rarely returns the favor; family caregivers are often overlooked and unsupported.

Struggling with unclear guidance, lacking proper training, and being left out of care planning are common challenges for family caregivers, creating a strong disconnect that results in fragmented care.

And that, of course, doesn’t come for free.

Unsupported family caregivers can be subject to mental health concerns ranging from depression and anxiety to isolation and negativity.⁵ The financial, emotional, and logistical demands can devastate entire families. According to the American Psychological Association (APA), unpaid caregivers of older adults are three times as likely to abuse substances or have suicidal thoughts.⁶ Almost 33% of unpaid caregivers report mental health challenges, compared to 6.3% in non-caregiving respondents. While caregiving can be deeply rewarding, families need proper support to make it sustainable. And that includes efforts from state and federal authorities as well as from care centers, hospitals, and professionals.

Some states and health ecosystems are beginning to recognize the critical role of caregivers through new initiatives and programs. Forward-thinking care centers and clinicians are beginning to recognize family caregivers as core members of the care team. When LTPAC clinicians embrace caregivers as care partners, seamless care will become a possibility for the thousands now entering the 65+ demographic. This means equipping caregivers with easy-to-use tech and providing them with the emotional and logistical support they very much need. Clinical guidance should be present at all times, and coordination should become a priority during all stages of care.

The Shift in Care Models

As the baby boomer population ages, the traditional care delivery models will no longer fit the realities of older Americans. It’s not about avoiding institutional care altogether, as these systems can and do meet the needs of many older adults. Instead, it’s about supporting home-based care for those who want it or who can't otherwise access institution-based care models.

As always, flexibility remains the number one priority in these cases. Hybrid care models allow clinicians to meet people where they are and fulfill patients’ deep desire to remain in their homes and communities. Hybrid healthcare consists of bringing together remote and in-person treatment. Using technologies such as video conferencing, professionals can deliver better and more cost-effective healthcare.

Take, for example, an older adult who has concerns regarding their medications. Instead of making them move to get proper care, telehealth support lets them speak directly with clinicians to explain and re-evaluate any possible doubts faster than ever. If that same person were to need surgery or any other kind of complex treatment, the doctor can ask them to come to the health center. In essence, hybrid models allow patients to stay at home for as long as possible.

This shift isn’t an option or an advantage anymore — it’s a necessity.

Home-based approaches are quickly becoming the norm, as shown by initiatives such as the Home Health Value-Based Purchasing Model.⁷ There’s a clear effort to build a healthcare system that results in the independence and happiness of the elderly. The COVID-19 pandemic served as a stepping stone for the creation of a “hospital-at-home” mindset. Over 360 hospitals nationwide are currently participating in at-home care initiatives, helping over 31,000 patients stay at home during care.⁸ These models deliver hospital-level care directly in the patient’s home. Treatments such as IV or oxygen therapies no longer require the patient to move to a hospital. Professionals can meet them exactly where they are. Telehealth has also become something of a golden standard, allowing patients to receive care from specialists via video or phone. Some systems even allow for at-distance chronic disease checks and therapy. Remote patient monitoring tools allow clinicians and professionals to track symptom changes and medication adherence in real time. Paired with telehealth, they enable a proactive mindset that’s more holistic than reactive care.

LTPAC clinicians and organizations are also playing a key part in this paradigm shift.

Embracing these hybrid models means rethinking and reshaping everything from workforce deployment to documentation practices and standards. Home-based care requires a flexible approach to staffing, where professionals can feel comfortable with at-home programs. Tech systems should also be updated to support mobile teams and patients who constantly move between home and clinical settings. Again, flexibility is the key. As the care continuum expands into the patients’ homes, clinicians who can quickly adapt will be able to provide better services. Today's models don't confine care to a hospital or a care center.

The future is, instead, dynamic, tech-enabled, and heavily centered around the home.

Care no longer has a fixed place — it’s a service that travels according to the patients’ needs. For clinicians ready to innovate, this shift will better fit the new value-based care models that are quickly encompassing the full spectrum of care. Transforming requires thoughtful planning, though, and being aware of possible challenges ahead of time can help convert them into opportunities.

LTPAC clinicians shifting to home-based models will benefit from operational agility as well as an investment in workflow redesign and technology infrastructure. Training and documentation practices should also be aligned with a proactive mindset for delivering decentralized care. But the benefits are hard to ignore. Older adults receiving at-home care will see noticeable improvements in comfort and quality of life. Their support systems will be at hand’s reach — always ready, always available.

For clinicians, aging-in-place models offer a chance to build a more meaningful relationship with patients. Constraints of institutional rounds will transform into useful tools to focus on what really matters: delivering high-quality, compassionate care.

EHR & Technology's Role in Supporting Aging in Place

The explosion of aging-in-place models places a spotlight on both health information and documentation technology. Older adults require care to be well-coordinated and responsive to fit all their needs and preferences. And if there’s one thing that can bridge traditional models with aging-in-place approaches, it’s data-driven digital tools.

Unfortunately, most traditional electronic health record (EHR) systems aren’t built to support multi-setting, home-based care. They were originally designed to keep care in hospitals and clinics, posing several challenges for this transition.

A clear example of this is interoperability — the ability of electronic health information systems to exchange and share data securely across platforms.

A late 2023 report published by the U.S. Department of Health and Human Services found that interoperability was neither routinely nor widely implemented in LTPAC settings. EHR adoption is estimated to be above 78%, but information exchange remains slow.⁹ Although this is due to structural and regulatory barriers, interoperability remains a key priority in home-based models. Otherwise, patient information is bound to get lost during transitions. Even if it doesn’t, staff and professionals could waste precious hours in search of the right paperwork or calling other clinicians to get all the data they need.

But there are also more surface-level problems that need to be addressed.

For example, most EHRs aren’t ready to fully track and support non-clinical caregiving tasks and activities. Meal preps, home safety assessments, daily check-ins, and medication reminders are just some of the things that are essential to an older adult’s well-being. Not having a way to easily track these across patients, clinicians, and settings results in fragmented care that can’t properly keep up with aging-in-place models. When clinicians can’t see what’s happening behind the scenes, they lose the context needed to make informed decisions.

New, more flexible tech platforms are required — ones that go beyond checkboxes and billing codes.

Real-time communication across facilities and clinicians is the one thing LTPAC providers should look to support aging in place. Without EHRs that reflect the full clinical and non-clinical picture, professionals are essentially flying blind. But it goes way beyond clinicians and nurses. A sound digital infrastructure also provides more touch-points with family caregivers. The National Alliance for Caregiving (NAC) reported that fewer than three in 10 caregivers had felt fully supported by their doctor, nurse, or social worker.¹⁰ Solutions that enable shared care plans between caregivers and clinicians will give families the confidence and clarity they so much need.

However, there’s still one piece of the puzzle that often goes under the radar: documentation.

LTPAC clinicians are no strangers to operating on slim margins. Reimbursement models don’t always account for the time needed to document care when it happens outside of a clinical visit. Systems, fortunately, are starting to catch up. Novel documentation solutions can capture caregiver input and services delivered anywhere, both inside and outside of a clinical setting. This information, at times, is also needed to keep family members informed of the patient’s status. A 360-degree view is paramount to keep care seamless during all stages and across everyone involved.

For LTPAC leaders, this presents an opportunity to recognize that strong infrastructure is essential to future-proof their services. Investing in modern aging-in-place-ready tech means tending to a clinical (and yet deeply human) need to stay connected.

What Comes Next

Aging-in-place models aren’t a fleeting trend. They stem from a generational shift that will shape how we think of LTPAC for the foreseeable future. The ripple effect of the needs of millions of older adults raises a question not of whether systems will adapt, but how well they do it.

LTPAC clinicians and leaders should meet the moment with an innovative, proactive mindset that actively supports aging in place.

If there’s one clear direction for this, it’s expanding the scope and flexibility of home-based care services. Building a wraparound offering that includes both digital and in-person support means adapting and staying ahead of a future that’s coming on much quicker than we expected. In other words, hybrid models can be a holistic solution for the silver tsunami.

For the financial aspect, national associations recommend LTPAC clinicians to participate in accountable care organizations (ACOs).¹¹ This presents a unique opportunity to improve outcomes and reduce Medicare costs at the same time. Pairing this with tele-health and home-based long-term care means safely delivering services at home. Clinicians who can quickly adapt to the new paradigm will find growing demand — and a deep infrastructure of ACOs willing to help out.

Experienced clinicians may wonder, at this point, how federal and state policies fit into these new models.

Medicare and Medicaid are (and will keep on) adapting to cover more home- and community-based services (HCBS). Recent regulations promote further HCBS waivers and benefits. A clear example of these is the new codes for caregiver training.¹² State-wise, authorities are expanding caregiver benefits and leaning further and further into the Caregiver Advise, Record, Enable (CARE) Act.¹³ Over 40 states have enacted it, giving critical information and education to family caregivers. Although thorough adoption rates are still slow, the trend is clear.³

Both private and governmental sectors should pay attention to one key aspect: ensuring the long-term sustainability of at-home care systems. The general advancement of the 65+ demographic won’t slow down until the end of the 2030s, so infrastructure, technology, and staffing should remain scalable and affordable to support an ever-increasing population.

Long-term discussions are still ongoing, though. Policymakers must address workforce-related issues and encourage the full implementation of at-home models.

Technology is, naturally, a hot topic in these discussions. Well-implemented platforms can connect families to care providers in ways we’ve never imagined before. From secure messaging apps to monitoring dashboards, digital tools are becoming the baseline for effective care delivery. Take, for example, patient status. Families need to know how their loved one is doing during a visit to the hospital — and a doctor needs to know how their patient is doing at home. An app that allows these kinds of updates lets caregivers and professionals bridge a gap that’s inevitable when dealing with multiple locations.

For LTPAC clinicians, technology is the backbone of coordinated, patient-centered care. The differentiator, however, is how well it's implemented.

Leaders who invest in these systems will undeniably be better positioned to scale as demand and services grow. And, of course, as competition arises and policies become stricter over the following years. Rethinking care delivery systems means recognizing that, for older adults, even a simple trip to the clinic can be a burden. Smarter infrastructure allows health leaders to let the elderly be where they want to be: at home.

The future is both about scaling according to the demographic shift and about honoring our older adults' preferences. LTPAC providers have a unique chance to build a care model that's deeply human — and that also meets clinical standards. Aging in place has long been the preference of older adults, an unaddressed desire to stay within their communities during the later stages of life. While that used to be the norm during much of American history, home-based aging has grown harder and harder to sustain over the last few decades.

With the tens of millions of baby boomers reaching the 65+ demographic, however, this deep desire to stay at home should be addressed head-on. The overwhelming majority of older adults aren't asking for anything radical; they're simply in need of support systems that make staying at home possible and safe.

Aging in place isn’t a hypothetical trend for the future. It’s a natural consequence of the silver tsunami.

As the demand for home-based care rises, so does the pressure on caregivers and clinical infrastructure. Staying at home safely and sustainably requires more than good intentions — it calls for a reimagined care ecosystem. Clinicians and systems that adapt to these new needs will lead a paradigm shift that won’t slow down until well past the 2030s. Services that include and recognize caregivers (the invisible workforce) will undoubtedly have the edge in the market.

And, as always, technology is here to bridge the gap between day-to-day operations and human touch.

Aspiration and sustainable care can meet as long as interoperability and documentation are soundly taken care of. Digital tools aren’t a financial setback. They are the foundational piece of aging in place. ChartPath by LivTech is closely monitoring this paradigm shift and taking steps to support clinicians looking to move into care at home. Through innovative workflows and a family-first mindset, we strive to help professionals take tangible steps toward a future where aging in place is the standard. We firmly believe that at-home care is a call to action. It’s about dignity and choice — and about embracing a transformation that will lead the following years.

 

SOURCES:

1. United States Census Bureau: "Older Population Grew in Nearly All U.S. Metro Areas."
2. United States Census Bureau: "2020 Census: 1 in 6 People in the United States Were 65 and Over."
3. Johns Hopkins Bloomberg School of Public Health: "New Study Explores the Need for Expanded Long-Term Care Services to Support Aging-in-Place."
4. Guardian: "Standing Up and Stepping In."
5. American Psychological Association: "Common Caregiving Problems."
6. American Psychological Association: "Stress and Caregiving."
7. Centers for Medicare & Medicaid Services: "Home Health Value-Based Purchasing Model."
8. Centers for Medicare & Medicaid Services: "Lessons from CMS’ Acute Hospital Care at Home Initiative."
9. Provider Magazine: "Federal Report on Interoperability of Health IT in Long Term Care."
10. National Alliance for Caregiving: "Caregiving in the U.S. 2020."
11. Provider Magazine: "Long Term and Post-Acute Care Providers in V