Everyone Wants to Age at Home. The Race to Deliver Is On.
Ask older adults where they want to live as they age, and the answer is nearly unanimous. When surveyed, almost all say they want to live in their homes and get the services they need in the community rather than move into a nursing facility. That single preference is now shaping an industry. Home-care franchises, safety-modification companies and public benefit programs are all organizing around the goal of keeping people out of institutions. But the same source that records the wish also records the gap: many older adults cannot live the way they say they want to.
The commercial response is loudest in the franchise sector. The home-care franchise provider Touching Hearts at Home recently surpassed 100 franchise locations and is now looking to triple that figure over the next five years. To support that growth, the company says it is offering franchisees new AI-powered tools and coaching tools. It is not the only operator leaning on technology: across recent earnings calls, leadership teams at some of the largest at-home care providers are betting that technology can move the needle where wages alone can't.
Others are expanding differently. A Hug Away Healthcare is taking its home-based care model beyond Houston and opening the door to franchise partners, a move it frames as a new phase of growth, with plans to broaden its offerings to include home health and hospice. Bigger money is moving too: Cityblock announced a deal to acquire Homeward Health, a rural-focused company with virtual and in-home services, and closed a $116 million funding round. Different strategies, the same bet — that demand for care delivered in the home will keep rising as more people try to age in place.
Alongside the care itself sits a quieter market: making the home physically safe enough to stay in. Falls are a central concern, and the bathroom is a focus. Guidance aimed at families points to bathroom safety modifications such as grab bars, toilets and lighting to help prevent catastrophic falls for seniors who want to remain at home. These are not medical interventions; they are the practical retrofits that decide whether staying home is actually feasible day to day.
The public side of the equation runs through Medicaid, whose home and community-based services are one way older adults can receive care where they live instead of in a nursing facility. But that support may be getting harder to count on. A new Justice Department rule upends a 25-year-old interpretation of federal disability law, and advocates fear it could result in cuts to services that help many disabled Americans live at home instead of in institutions.
Put the pieces together and one account emerges. The preference is settled and overwhelming. Private capital is moving to meet it — franchise networks expanding their footprints and layering on new tools, and larger deals reshaping who delivers in-home care. A products market has grown up to make homes livable for people with mobility and fall risks. And Medicaid helps fund home and community-based care. What connects the franchise expansions, the grab bars and the Medicaid benefit is one organizing idea: care should come to the home, not pull the person into a facility.
What the sources leave open is whether that supply reaches the people who most need it. The franchise growth is real and measurable — from more than 100 locations toward a target of 300. But the primer that documents the preference also records that many older adults still cannot live the way they say they want to, and the public financing that could help close that gap now faces the possibility of cuts.