America is about to experience the most expensive decade in the history of healthcare. Within five years, one in five Americans will be 65 or older. By 2034, older adults will outnumber children for the first time. The Centers for Medicare & Medicaid Services (CMS) is already moving in anticipation: its proposed 2026 Physician Fee Schedule, released in July, directs reimbursement toward remote monitoring and value-based care in the home. CMS has also expanded remote patient monitoring rules this year, signaling a clear priority—reduce preventable hospitalizations, especially among older adults.
Falls are the most urgent—and solvable—driver of these preventable costs.
Nearly 90% of older Americans want to remain in their homes as they age, yet fewer than 10% of homes are equipped to keep them safe. In 2020, non-fatal falls cost the U.S. healthcare system over $80 billion, up from $50 billion in 2015. Medicare covers more than $31 billion of that total. Families pay nearly 30% out of pocket, often wiping out savings after a single incident. And the trend is accelerating: falls caused over 41,000 deaths in 2023, a 75% increase since 2003.
I have seen the effects firsthand. A hospital administrator told me about a patient who suffered a serious fall at home just two weeks after being discharged. The resulting complications were not only traumatizing and life-threatening, they cost more than $100,000 in acute care and rehabilitation. They also triggered a readmission penalty for the hospital. The executive told me, “If we had a sensor in that house, this never would have happened.” He was right.
Insurers are facing the same liability. One of our Medicare Advantage partners shared a case in which a single preventable fall erased months of capitation revenue. The member’s care episode—emergency room, surgery, rehabilitation—exceeded $30,000 in costs. For plans operating on thin margins under value-based models, one fall can make the difference between profitability and loss.
CMS is recognizing this exposure. In fiscal year 2026, 240 hospitals will face Medicare readmission penalties of 1% or more, up from 208 the year before (Becker’s Hospital Review). CMS has also signaled that Medicare Advantage plans will soon be subject to similar penalties. CVS Health and Aetna recently expanded monitoring programs for high-risk members in direct response. The market is not waiting for Washington to mandate intervention—insurers and health systems are acting now because the economics demand it.
What makes this moment different is that we finally have the technology to solve this problem at scale. AI-enabled ambient sensing hardware, deployed in the home, can passively monitor movement and detect subtle changes that precede a fall, without privacy-invading cameras, often-unworn wearables, or subjective human input. These systems connect to caregivers, clinicians, or care platforms in real time. When a fall occurs, they trigger an immediate response. When a fall is likely to occur, they generate alerts that allow intervention before an incident happens.
This model is not hypothetical. It is in use today.
In my work with health systems and Medicare Advantage organizations, we’ve seen up to 20–30% reductions in readmissions among members enrolled in in-home monitoring programs (JAMA). RAND research shows that remote monitoring can reduce ER visits by up to 35%. According to the National Council on Aging, every $1 invested in fall prevention yields $3 to $5 in healthcare savings. In-home safety is not a quality-of-life luxury—it is a life-saving, cost-containment necessity.
It is time to kick the doors wide open on the adoption of these advancements. Many still think of fall prevention as a matter of grab bars and handrails. That is outdated thinking. The next cost crisis—and the next cost solution—is digital, predictive, and already reimbursable under emerging CMS rules.
Here’s what needs to happen:
- CMS should finalize reimbursement pathways for AI-supported fall prevention and ambient monitoring technologies, not just traditional remote patient monitoring.
- Hospitals should integrate in-home monitoring into discharge planning for high-risk patients, to improve outcomes while protecting against penalties and avoidable costs.
- Medicare Advantage plans should deploy these tools immediately as a financial defense strategy. The plans that adopt first will have a material cost advantage over those that wait.
The future of improved health outcomes and healthcare cost reduction will be found in the living room, where ambient sensing, AI-powered systems can prevent the next $100,000 fall.
Aging at home should not mean aging at risk. The technology exists. The incentives are aligning. The economics are clear. The only question is whether we act on what we already know.
About Evan Schwartz
Evan Schwartz is CEO of Aloe Care Health, a company building ambient sensing and AI-powered solutions to keep older adults safe and independent in their own homes. With deep experience at the intersection of health technology and elder care, he writes and speaks on how smarter homes can transform aging, reduce hospitalizations, and restore dignity. Aloe Care Health serves numerous home healthcare organizations and insurance partners throughout the U.S.
