By Russell R. Barksdale, Jr.
For the fourth year in a row, Medicare and commercial insurers are slashing reimbursement rates for home health services. That is not a typo. Four consecutive years of cuts to the very system that enables older Americans to live safely, independently, and with dignity in their own homes.
The timing could not be more perilous. America’s senior population is swelling, and their preference is unambiguous: they want to age in place. Surveys confirm that more than 90% of older adults would rather receive care at home than in an institutional setting if given the choice. This is not merely a preference, it is a right earned after decades of contributing to the very system now narrowing their options.
Home health care was once heralded as the most cost-effective alternative to hospitals and long-term care facilities. But relentless reimbursement reductions are transforming that advantage into an illusion. Consider the nurse who now spends time commuting between dispersed patients, reducing their caseload to four or five visits a day. The inefficiency is staggering, the costs are mounting, and the model is fast becoming unsustainable.
To their credit, many mission-driven providers remain committed to offering a full continuum of care and placing patients at the most appropriate level. Yet when financial pressures limit options, too often sales imperatives begin to drive placement decisions—resulting in costly and, at times, suboptimal settings.
Governing policies are both shortsighted and inverted. Instead of reinforcing a cost-effective model of care, policies are steadily undermining its viability. Each cut forces home health agencies into impossible triage: reduce staff, curtail services, or deny patients altogether.
The statistics are sobering. A recent industry report revealed that agencies are now declining nearly one-third of their referrals—most often patients with complex medical needs or those covered by low-paying insurers. Longer commutes combined with extended care times for patients with multiple comorbidities have eroded productivity. The result: fewer patients served, families left scrambling, and a workforce stretched past its limits. In simple terms, agencies are paid less to care for patients whose needs are more demanding and whose care is more expensive.
Policymakers often cloak these cuts in the sterile language of “budget neutrality” or “utilization adjustments.” But stripped of jargon, the reality is this: both government and commercial policymakers are demanding that home health agencies deliver more care with fewer resources, a persistent workforce shortage, and mounting regulatory burdens.
To be sure, the industry has not been without its bad actors—providers who have manipulated and upcoded diagnoses or billed for phantom visits, siphoning hundreds of millions of dollars from taxpayers. These abuses warrant strict enforcement. But sweeping, across-the-board reimbursement cuts punish the many for the sins of the few, leaving honest providers gasping for air.
The consequences are not theoretical. They are borne out in families’ lives every day. Without adequate reimbursement, loved ones are left in unsafe conditions, placed prematurely in assisted or long-term care institutions, or forced to rely on exhausted family caregivers who often jeopardize their own health and financial security.
What we are witnessing is not a modest policy adjustment. It is the systematic dismantling of a model that can be both compassionate and cost-effective. The preference of seniors is clear. The data confirms it. Yet another year of cuts threatens to transform aging at home from a cherished American ideal into an unaffordable luxury.
If we continue down this path, the results will be predictable: hospital stays will be longer than necessary and more costly, long-term care facilities will continue to be overcrowded and overstretched, and fewer older Americans will be able to spend their final years where they most want to be—at home.
Russell R. Barksdale, Jr., PHD, MPA/MHA, FACHE is President and CEO Waveny LifeCare Network.
