<p>The rise in home-based care for chronic illnesses such as diabetes, cancer, and renal disease has led to a significant increase in hazardous medical waste generated outside clinical facilities. Sharps (e.g., syringes, lancets) and glass medication containers pose serious environmental and health risks when improperly managed, while existing collection systems remain inadequate in decentralized settings. This paper proposes a smart and scalable framework for managing home-generated hazardous medical waste, integrating IoT-enabled smart bins with real-time monitoring and an alert mechanism activated at 80% capacity to optimize collection timing. A dynamic multi-objective optimization model is developed for waste bin allocation and vehicle routing and solved using the hybrid NSGA-II algorithm, representing one of the first applications of a dynamic VRP–NSGA-II approach in this context, enabling adaptive routing based on time-dependent waste readiness. The system is evaluated using simulated data under realistic urban conditions, where the proposed hybrid approach demonstrates improved performance compared to baseline methods in terms of cost, travel time, and environmental impact. In addition, a lightweight reward mechanism is introduced to encourage patient and caregiver participation. The results provide a practical foundation for sustainable home-based medical waste management and support decision-making for municipalities and health authorities.</p>