Too often, families face an impossible situation: a loved one is ready to leave the hospital, but no home health provider is available. Or they’re told hospice is the best option, but administrative red tape delays access to comfort and support. These failures put patients at risk.
This week, the House Ways and Means Subcommittee on Health will address a critical issue—ensuring access to quality post-acute care, including home health, hospice, and other home-based services. For many, care at home is a lifeline, providing skilled, compassionate support where patients feel safest. It’s also a cost-effective alternative to institutional care, reducing unnecessary hospital stays and saving taxpayer dollars.
Yet today, access to Medicare-covered home health and hospice is at risk due to reimbursement cuts, workforce shortages, and administrative barriers. Congress must act to reverse harmful policies and ensure vulnerable seniors receive care at home. Empath Health serves 5,000 hospice patients daily across Florida, offering crucial support to families facing serious illness. This experience underscores why policymakers must protect and expand access to home-based care—before more patients fall through the cracks.
The numbers tell a clear story. By 2050, the US population aged 65 and older will grow by 47%, soaring from 58 million in 2022 to 82 million by 2050. The population 85 and older will more than double over this same period. With an aging population, increasing demand for dignified senior care, and already strained federal budgets, our country must adopt a new strategy to strengthen post-acute care. According to one analysis, in a recent three year period, hospital stays for patients waiting to be discharged to post-acute care providers increased by 24 percent, deteriorating health outcomes and quality of life. Discharge delays – caused by hospital capacity issues and workforce shortages – not only cause harm to patients; they also add unnecessary strain and costs on our healthcare system.
Investing and innovating in care at home is the strategic focus that’s needed; it’s the approach that offers benefits to Medicare beneficiaries, family caregivers, and the healthcare system as a whole. As policymakers discuss post-acute care, they must recognize that Medicare’s home health and hospice benefits are essential pillars of our healthcare system. The organizations and dedicated professionals working in home-based care are their partners in creating a rational system that serves both patients and taxpayers.
We have 10 recommendations that Congress and the Trump Administration should urgently prioritize to take advantage of the care at home opportunity:
- Stop the destabilizing cuts to Medicare’s home health benefit created by the flawed implementation of the Bipartisan Budget Act of 2018.
- Explore ways to ensure that Medicare Advantage enrollees have access to high quality home health and keep Medicare Advantage out of hospice.
- Extend the imminently expiring telehealth flexibilities for hospice and home health certification visits and explore ways to support the expansion of telehealth options within home health and hospice.
- Strengthen the home health aide and nursing workforce through targeted policies and incentives.
- Protect Medicaid home and community-based services by rescinding the “80/20 rule” and ensuring any Medicaid policy decisions improve access to care at home.
- Support seniors and family caregivers through tax policies that create credits or deductions for home care and caregiving expenses.
- Expand access to high-quality, comprehensive end-of-life care by enabling hospices to provide a concurrent care option that saves Medicare dollars and ensures certain beneficiaries don’t have to abruptly stop treatment to receive patient-centered care.
- Better support overburdened families and patients in hospice care by creating an in-home respite option.
- Work with hospice and home health providers to ensure that efforts to improve quality and reduce fraud actually address the problems without harming the people they were intending to help.
- Expand options for beneficiaries to receive medical care at home such as primary medical care and hospital-like services.
We are at a critical crossroads. As America ages and healthcare costs rise, home-based care isn’t just an option—it’s a necessity. It provides comfort, dignity, and better outcomes while reducing unnecessary hospitalizations and long-term care stays. By modernizing Medicare’s approach, we can ensure a system that truly serves patients, families, and taxpayers. Lawmakers must act now to protect and expand access to care at home, so more Americans can receive the support they need where they feel safest—in the place they call home.
Jonathan D. Fleece, JD, is president and CEO of Empath Health, a national not-for-profit hospice and home care-based health care organization headquartered in Clearwater, Florida.
Dr. Steve Landers is CEO of the National Alliance for Care at Home (the Alliance), a new national organization representing providers of home care, home health, hospice, palliative care, and other healthcare services mainly delivered in the home.
