The Changing Face of Long-Term Care

February 26, 2026 - Long-term care is becoming a care concept rather than a care setting. It’s another node in the care ecosystem where medication intelligence is the connective tissue and a critical success factor for home-based care.

If you mention long-term care (LTC), most people think of nursing homes – brick and mortar facilities where frail seniors go to live out the remainder of their lives when family and friends are no longer able to manage and/or afford their care at home. For a long time, the industry has viewed the LTC segment as a mature market dominated by Medicaid, plagued by staff shortages, with extreme pricing pressure and limited potential for growth.

It’s true that according to CMS certified facility counts from 2015 to 2025 there has been a modest, long run decline in the number of nursing homes from approximately 15M to 14.7M, while licensed beds have remained static for over a decade at 1.6 M. This includes the Covid years that caused a precipitous drop in occupied beds, causing some facilities to close and that has only partially rebounded to about 77% today.

However, this does not reflect a decreasing demand or need for long-term care health services, as many sources estimate that the population of > 65 years old will grow by as much as 30% from 2025 to 2035. After all, today this demographic comprises 17% of the overall population, but CMS and other analysts estimate that it accounts for as much as 40% of overall direct medical costs.

We are not witnessing a decline in long-term care, so much as a transformation of the care settings in which it can be delivered.

“Virtual” Long Term Care

Our aging population is becoming more concentrated with digitally savvy seniors and nearly all of them want to remain in their homes. Home healthcare specifically is growing 7-8% annually. In the U.S., demand for home-based care will expand substantially over the next decade. It is becoming increasingly feasible to deliver facility-equivalent care at home by virtue of distributed, home-centered ecosystems supported by technology, services, remote care teams, and smart infrastructure.

There are powerful forces driving this transformation that not only lower the cost of long-term care but also result in better outcomes for patients as compared with institutional settings. These are among the key drivers:

• Technology is rapidly enabling the "virtual long-term care facility" through telehealth, remote patient monitoring, AI-driven analytics, and sophisticated medication management systems. The “care team” can follow the patient with better monitoring and proactive interventions that can prevent hospitalizations and SNF admissions. This oversight also reduces burden on in-home caregivers.
• Expansion of Home-Based Clinical Care Delivery Capabilities that include mobile labs, imaging, home infusion and IV therapy, advanced wound care, rehab therapies (PT, OT, speech) are now possible, with blended care teams (RN + CNA + virtual MD/NP).
• Payment Reform is further accelerating home-based long term care delivery. States are expanding Medicaid HCBS waivers (Home & Community-Based Services). Medicare Advantage plans are covering more in-home services, meals, transportation, caregiver support. Value-based care organizations like ACOs are pushing care out of institutions through “SNF-at home” and “Hospital at Home” programs.

Medication Intelligence is Central to Safe LTC in the Home

Make no mistake, facility-based LTC is not going to disappear, but its capacity will be reserved for the for the highest-acuity or patients who cannot be cared for safely at home. In institutional settings, medication risks are managed through structured protocols and professional oversight. At home, that infrastructure largely disappears. The result is that preventable adverse drug events drive a substantial portion of at-home complications. These lead to emergency department visits and hospital readmissions. For risk-bearing entities and value-based care programs, medication management and safety become critical to managing total cost of care.

To ensure that the lowest cost of care setting, the home, is also the safest, the following capabilities are essential:

• Medication reconciliation across all transitions. Every time a patient moves from hospital to skilled nursing facility (SNF) to home to outpatient care, or if there is a change in condition, there is an increase in the risk of errors that can result in a re-admission. Medication information must be accurate and complete and available to the care team in real time.
• Continual, predictive risk scoring and early alerts. Systems need to identify polypharmacy patterns, drug-lab interactions, cognitive risk factors, and fall risks before they cause harm. Adverse Drug Event (ADE) prediction must trigger automated care manager workflows.
• Integrated care coordination. With the advent of hybrid (virtual and in-home) care teams, In-home nursing, hospitalists, pharmacy services, and EMS all need visibility into medication changes. Virtual patient education and adherence monitoring become standard requirements.

The Strategic Play

For Medicare Advantage plans, this creates clear opportunities. Partnering with organizations that can follow members through all post-acute care settings is a clear advantage. Implementing medication reconciliation that works across institutional and home environments is vital to success. Deploying technology that identifies rising-risk patients before complications occur will be even more critical moving forward.

Risk-bearing organizations should be asking themselves now:

1. How will we manage medication safety across increasing care transitions?
2. What partnerships do we need to support members in home-based LTC?
3. How will we deliver safe and cost-effective solutions that demonstrate improved outcomes as measured by reduction in preventable hospitalizations and readmissions as care moves home?

Ready to explore how medication management can support your home-based care strategy? Learn more at actualmeds.com or contact our team today.