Tom is a prominent doctor at Salem University Hospital and has five children, Tommy, Addie, Mickey, Bill, and Marie.

In 1993, Alice and Tom set up and found the Horton Center, which runs out of their home and provides shelter and help to run-away teens or families in need.

In 2024, Tom appears in flashbacks as the family reminisces on the good times while salvaging through the charred remains of the Horton house.

[2] In 2020, Charlie Mason from Soaps She Knows placed Tom as #7 on a list of the 35 most memorable characters from Days of Our Lives, commenting that "Only the hourglass itself could possibly be a bigger part of the DNA of Days of Our Lives than the much-missed MacDonald Carey’s family man, a steadying presence in a town that desperately needed it".

[3] Mason also placed Tom 37th on his ranked list of Soaps' 40 Most Iconic Characters of All Time, writing, "For nearly three decades, Macdonald Carey prescribed viewers a steadying presence as the doctor at the head of Salem's Horton family.