As technologies empower patients to take more control of their health and health care, hospitals are destined to downsize to the point where (unless they diversify) they will provide only advanced trauma and critical care. It won't happen overnight, but the portents are visible today in declining inpatient business and increasing outpatient business.

It is not just acute care organizations that will be impacted. Intelligent devices increasingly help patients self-diagnose, treat and manage their conditions. Automated systems and ever more intelligent robots provide physical assistance to patients at home, in assisted-living facilities or in nursing homes. Patients will make use of devices, the Internet and social networks to maintain their health and seek help when needed.

People will stay healthy for longer because of advances in postmodern medicines. When they eventually do fall ill or grow frail, globalization will supply an affordable workforce to provide monitoring and other services via telemedicine. Clinician shortages will not be an issue.

Trends and Technologies

Long-term care technologies exist today for entertainment, health maintenance and more. There are systems for assessing and tracking residents' care needs and medical conditions; emergency call systems; and devices to monitor wandering, vital signs, falls and activities of daily living. However, with the exception of wandering alerts and call systems, the technologies are not widely used, for reasons that include cost, value, resident autonomy and privacy, and regulatory impediments.

Trends and technologies that will have a particular impact on long-term care include mobile health—the use of smart phones for diagnosis, monitoring and even some forms of treatment; telemedicine and biomonitoring technologies; sociomedical networks that increase access to (sometimes questionable) care; remote and institutional patient monitoring; robotics/assistive devices; and a virtual/augmented-reality interface that will remove impediments to communication among residents, caregivers and administrators.

Seniors clearly prefer to age in place, and the average length of time in their current residence continues to increase. (See, for example, the 2007 National Investment Center National Housing Survey of Adults Age 60+, Volume III.) Payers, especially Medicare,eventually must recognize the substantial cost advantage of aging in place and start to cover the technologies and services that support it. Thus, no matter where it is provided—in the hospital, skilled-nursing facility, assisted living facility or in the home—there still will be demand for long-term care, but the organizations that provide it will undergo change. Assisted-living facilities, for example, may trend to smaller, modular residence clusters, heavily technologized and closely linked with specialized suppliers and service providers.

Technology will play a key role in the management of long-term care facilities and in helping residents perform daily tasks and activities. Remote monitoring will help staff ensure that residents are safe and well. "Patterning systems" will emerge to provide better monitoring of body temperature, pulse rate, weight and weight fluctuation, and body chemistry patterns.

Tasks that are difficult for individuals to perform will be automated; opening doors or turning lights on and off are trivial examples. Interactive devices, including appliances, monitoring and entertainment systems, will be wired to provide easier or automated access. Medical records will be updated continuously, and prescriptions will be reviewed automatically to alert staff to contraindications and drug interactions.

The virtual-reality interface, which will recognize and understand spoken language and immerse patients in realistic 3-D environments, will improve communication and socialization among residents, caregivers, family and friends.


As the baby boom demographic bulge grows, not everyone will be able to afford a concierge physician and a team of specialists; but then, they won't need to. The market, assisted by technologies, will make satisfactory services available through nurse practitioners and even nontraditional health care providers and caregivers at far less cost.

A dynamic equilibrium for care will develop in the least invasive location. This is another way of saying that there will be a demedicalization or deprofessionalization of health care, or at least that the lines between the health care professions will become blurred. Inexpensive and easy to use, yet reliable and sophisticated, diagnostic and therapeutic technologies will enable caregivers at lower levels to deliver services formerly reserved for caregivers at higher levels.

Rising acuity levels will force assisted-living institutions to become more medicalized as only the most frail patients opt for institutional care. Patients with less-acute frailties can be managed in the home. As hospitals transition to trauma and critical care only, assisted-living companies will assume greater responsibility as direct providers of medical services.

The growing frailty of the baby boomers, the high cost of traditional long-term care and clinician shortages will stimulate demand for such medicalized assisted living. With that demand will come an imperative to educate and train patients in the use of medicalized assistive-living technologies, at least until the technologies are smart and autonomous enough to require no action on the part of patients.

Medicalization also implies a need for more nurses and ancillary health workers in the assisted-living field, which then will have the opportunity to serve as the focal point of the medical home, managing an individual's continuum of care from cradle to grave.

In the long term (10 or more years hence), molecular, genomic, regenerative, bionic and other forms of postmodern medicine will deliver treatments (and cures in some cases) for Alzheimer's, cancer, diabetes, heart failure and other chronic conditions. This will mean delayed and overall reduced demand for assisted-living facilities, as will the growing availability of devices, systems and robots to help people age in place and remain independent. In the interim, demographics (the boomer bulge) and economics (the housing market, recession, structural unemployment, Americans' savings history) may tend to offset the progress that will be made in curing or managing chronic conditions and in automating the provision of care.

Shared Opportunity

Hospitals that recognize the trend have an opportunity to participate and invest money and manpower in a health care system of the future in which they supply trauma and critical care as part of a continuum-of-care/accountable-care/medical-home model, managed by a renascent assisted-living industry that seems destined over the coming decade or two to take center stage in a much more integrated health care industry. Advanced hospitals already are looking to home medical-monitoring technologies to enable surgeons to be more involved in pre- and postoperative home-health monitoring, and thereby help improve care quality while potentially reducing overall costs. It's a start.

David Ellis is a futurist, author and consultant, and publisher of Health Futures Digest, a monthly online review and commentary on technological innovations and their consequences and implications for health policy and practice. He is also a regular contributor to H&HN Daily and a member of Speakers Express. Charles H. Roadman II, M.D., lieutenant general, U.S. Air Force (retired), served as surgeon general of the Air Force from 1996 to 1999. From 1999 to 2004, he was the president and CEO of the American Health Care Association, representing the long-term health care profession to the executive branch and Congress. He also serves on several boards in the health IT and long-term care industries.