The U.S. healthcare system was built around hospitals and physician offices. The next decade will be built around the home, and the shift is demographic before it's anything else. The oldest baby boomers turn 80 this year, by 2045 nearly 30% of Americans over 60 will be 80 or older, and someone turning 65 today has a 70% chance of needing long-term services.

Much of that care will be delivered through home health. Instead of keeping patients in a hospital, home health brings clinicians into the home: skilled nursing after surgery, physical and occupational therapy after a stroke, wound care, medication management, and ongoing support for chronic conditions. It's how a growing share of Americans will recover, age, and manage illness.

U.S. spend on home health has nearly quadrupled from $43.8 billion in 2004 to $169.4 billion in 2024, and is projected to reach $317 billion by 2033. Whether home health can absorb that growth depends on the agencies delivering care.