The Home Is Becoming Healthcare’s Next Infrastructure Layer

TL;DR: Healthcare cannot scale without the home becoming a real site of care. Making that shift work requires new infrastructure for trust, coordination, payments, and financial planning. That is where SixThirty is investing.

For most of modern healthcare, the home was where patients recovered. Treatment happened at the hospital. Decisions happened at the clinic. That model is changing, not because hospitals are going away, but because the system is hitting structural constraints that cannot be solved with more beds, more buildings, or more people.

Why is healthcare moving into the home?

Because the numbers leave no alternative. As the Financial Times recently noted, healthcare accounted for 43% of new jobs in the most recent BLS report, represented roughly 18% of U.S. GDP in 2024, and is projected to exceed 20% by 2033. The number of Americans 65 and older will grow from 58 million to 82 million by 2050, and they overwhelmingly want to remain at home. Chronic conditions are rising. Care labor is harder to find and more expensive to afford. Care is moving into the home because the system needs it to. The question is who builds the infrastructure to make that shift work.

Moving care home moves the complexity home, too

A hospital is purpose-built for care: trained staff, clinical workflows, records, billing, escalation protocols, compliance. A home has none of that by default. Who coordinates the caregiver, nurse, physician, pharmacy, payer, and family? Who catches the early signs that something is going wrong? Who explains what insurance covers and what must be paid out of pocket? These are the core issues, and they map directly to where we have been investing.

SixThirty portfolio company Senniors, with roots in Spain, home to one of the oldest populations in the world, is building a coordinated care layer around the home, connecting patients, caregivers, and providers in partnership with hospitals and insurers. The future is not just more care delivered at home. It is more coordination, navigation, and accountability organized around the household.

Trust is also a labor question. Someone still has to show up at the door, and in much of rural America that workforce does not exist. That is why we recently invested in Paralign Health, which mobilizes paramedics and EMS workers, among the most trusted professionals in any community, to deliver preventative care to rural health plan members at home. With $50 billion in federal Rural Health Transformation funding allocated over the next five years, the timing could not be better.

The caregiver layer matters just as much. According to AARP and the National Alliance for Caregiving, 63 million Americans are now family caregivers, nearly one in four adults. Portfolio company TCare measures and reduces caregiver burnout; if caregivers break, the home-based care model breaks with them. Employers see it too. Unum, one of SixThirty's LPs, built Care Hub to support employees navigating caregiving, leave, and disability.

Aging is becoming a financial planning event

Care decisions arrive in moments of stress. A parent falls, a diagnosis lands, a discharge planner calls, and suddenly a family is navigating Medicare, Medicaid, long-term care insurance, private-pay care, and lost wages. That is a financial journey wrapped inside a healthcare crisis, and most financial plans are not built for it. Portfolio company Reframe is reimagining insurance to help families prepare for the financial issues of aging before the crisis arrives. Aflac's new long-term care rider shows incumbents moving in the same direction. Longevity is no longer just a retirement assumption. It is one of the largest and least predictable expense categories in a household's financial life.

Payment is part of the care experience, too. Multiple providers, invoices, reimbursements, and surprise out-of-pocket costs land on families mid-crisis. Portfolio company PayGround lets families pay all of their providers through a single application. That sounds like payments infrastructure. In this context, it is care infrastructure.

The opportunity is at the seams

No single incumbent owns this problem. Hospitals need to extend care beyond the facility. Payers need to manage risk before high-acuity events. Employers need answers for caregiving employees. Wealth managers need to plan for longevity. The opportunity sits at the seams: between healthcare delivery and financial planning, between provider workflows and family workflows, between institutional systems and the reality of life inside the home.

Senniors points to technology-enabled care in the home. Paralign points to the trusted labor networks required to deliver it. TCare points to the caregiver as critical infrastructure. Reframe points to the financial preparation aging demands. PayGround points to simpler, more humane healthcare payments. Different entry points, same structural signal: healthcare, aging, caregiving, and household finance are becoming inseparable.

The home is becoming healthcare's next infrastructure layer because the current system cannot scale without it. We are backing founders who see that structural change early and build the new rails: trust, coordination, payments, planning, and risk.