Portrait of nurse in front of suburban home

Though providers weathered hardships from Medicare rate cuts to worker shortages in 2023, developments on the horizon give encouragement for home care’s future, according to William Dombi, president of the National Association for Home Care & Hospice.

“There is no shortage of innovations and reforms ongoing now,” Dombi said in a Thursday webinar hosted by healthcare technology firm Relias. He reassured providers: “You are all in the right place. The challenges will be there, but so will opportunities.”

Many of these innovations came in the form of successful payment or care delivery models that hit their strides during 2023. One of these, the Home Health Value-Based Purchasing Model, expanded on a national scale in January. It represented “one of the very few value-based programs that has been shown to work,” according to Dombi. Other positive developments include the ever-growing hospital-at-home program, advancements in telehealth services and strong Medicaid support for home- and community-based services.

Medicaid HCBS concern

Still home care initiatives such as Medicaid HCBS, one of the largest home care programs in the nation, Dombi noted, are facing challenges. The Medicaid Access Rule, proposed in May, would require 80% of Medicaid payments for homemaker, personal care and respite care services be used on worker compensation.

“If you’re a Medicaid provider, this is something to pay attention to,” Dombi said.

Though the rule was designed with noble intentions, including alleviating home care workforce challenges, such stringent payment mandates could give providers cause for concern, he added. 

And while shortages may signal increased demand for home care services, staffing remains a top priority across the home care, hospice and healthcare industry at large.

“Demand and interest remains exceptionally high — higher than we have the supply,” Dombi noted. “Currently, the data is showing that more than half of all referrals to home health agencies are being rejected due to workforce shortages.” 

Recruitment and retention therefore should remain at the forefront for providers, as losing employees sacrifices time, money and even quality of care. But to reach these workforce goals, “better compensation starts with better payment rates,” Dombi asserted.

Strong congressional support

NAHC and other advocates made strong headway with congressional leaders in 2023, particularly through the introduction of the Preserving Access to Home Health Act of 2023 and the recent House passage of the Elizabeth Dole Home Care Act. In September, home care allies spoke out against erosion of the Medicare home health benefit before the Senate Finance Committee’s Subcommittee on Health Care, winning support from both sides of the aisle. 

“We are seeing strong bipartisan support for home health services,” Dombi said. And while political bickering and sticker shock surrounding pricey legislation are eternal barriers to strong, consistent federal support for home care, the reality that older loved ones are in need of care “tends to bring the parties together,” he noted.

Engage in advocacy

Looking ahead, Dombi encouraged providers to embrace innovation, engage in advocacy and look for new ways to deliver high-quality care.

New opportunities continue to surface throughout the marketplace to those that want to embrace change,” Dombi said. “What we need to do, we need you all engaged in advocacy … When you have a chance, please do so. Those voices are counted, they matter, we need to be really really loud.”