Well,
HA has come a long way and it demands more resources as you get more devices, automations and etc which put more strain on your tiny SD card no matter how you spin it.
Official support for HA using SSD on rpi with boot support and all the other bells and whistles would be a much appreciated feaure.
There are ways to actually achieve that but it is a time consuming process. Furthermore, you can crash unexpectedly losing all your precious data.
Hope HA team pays attention to this.
I think the Home Assistant team is paying attention to this. The problem could be a hardware or software issue. I’m not sure that a conclusion has been reached. There are some very good forums with directions on how to boot the Pi4 using an SSD. Some Pi4 work with SSD and certain controllers and some don’t. For right now, the recommended solution is to boot off of the SD and move everything else to he SSD. Again, there are directions on how to do this. I am booting off the SSD using OS 5.4 and everything else at the latest version and my pi4 boots and runs with no issue. If I update to 5.10 or 5.11 my pi freezes in less than a day (see github issue 1119 for further info).
Ha, good old #1119. Still no progress I assume? 
I think that there is some progress. Looks like (I’m still guessing) that it is kernel / EEPROM related. Raspberry Pi has just implemented the Linux 5.10 kernel in their new software releases and hopefully a build for Home Assistant will be done with this same Kernel for Home Assistant to test. We shall see. The boot from USB has been a lot more difficult than people thought. I’m hoping that they keep working on it and the fix is not “go back to the SD” as we do not support USB boot from PI. I have been following the Pi4 since it was released and the hope for all was to get away from the SD due to reliability issues. Little did I know that the SSD would be worst.
I get that but if you are only booting from the SD card and all the data is on a usb ssd then I don’t see the issue except of course for the OCD among us (like me)
I agree that it should not be an issue. It is just hard to get over all the “don’t use an sd card as it is not if it will fail, but when”.
That is only if the database is on the SD card. An SD card only booting the system will last forever
I have had too rated sd cards fail with no database. Much earlier than the mtbf rating. More than one failed on my android tablet, had a couple in a camera. I agree it should last forever, but it they did not (at least for me).