My grandmother lived at the top of a hill overlooking the magical mountains and valleys of the Ozarks until the day we literally had to drag her off of it. Our family was spread out across Texas and California working full time, so no one was able to check in on her regularly. When she had home health workers, they helped with her medications and recovery after shoulder surgery. Overly friendly neighbors also helped by changing her will and emptying her bank accounts — a story for another day.
Older Americans want to be cared for in their homes for as long as they can. But that’s not always possible, especially when families are spread out. Home health care workers make such care a reality for many families, including mine. I’m part of the sandwich generation: raising 9-year-old twin boys and helping take care of my 87-year-old mother-in-law, who lives with us. Before my father-in-law died, he had his wounds dressed right in my living room. My stepmom was diagnosed with Alzheimer’s and needed support to stay in her home before finally settling into an assisted living facility five miles from my home.
Home health care offers several advantages for older Americans. It allows them to get care in the comfort and familiarity of their own homes, close to established friends and social networks. It provides personalized care and greater independence. And it is often more cost effective than a nursing home. Home care also allows older Americans and people with disabilities to recover faster from serious injuries or illnesses with less exposure to hospital-based infections and readmissions.
Despite the popularity and advantages of home health care, access to it is being threatened by deep cuts proposed by Medicare.
In its latest proposed rule, Medicare is considering implementing a permanent nearly 8% cut in payments to home health services. This would mean $1.33 billion in 2023 alone, another $2 billion beginning in 2024 through a clawback for services that were provided to seniors and disabled people during the first two years of the Covid-19 pandemic, and an estimated $1.2 billion clawback for services provided in 2022. These cuts, which could reach an estimated $18 billion over the next 10 years, would be a devastating blow to the more than 3.5 million people whose home health care is covered by Medicare.
After ensuring the health and safety of older Americans during the worst public health crisis in 100 years, why is Medicare trying to reduce access to home care and also take back payments for it that it made fair and square?
One analysis suggests that the cuts and clawbacks could put 44% of America’s home health agencies at risk of closing, seriously risking beneficiaries’ access to care, especially in rural and underserved communities. This policy just doesn’t make sense.
The population of Medicare home health beneficiaries has grown older and sicker. More than 25% of home health users across the country are over the age of 85, and 43% have five or more chronic health conditions, compared to just 22% of all Medicare patients. That means these cuts will target some of the sickest, most at-risk older Americans.
These cuts would further limit access to home health care, which is already being stretched by booming demand as many Americans want to stay out of the hospital to avoid contracting the coronavirus and other infectious illnesses and made worse by a shortage of home health workers, sparked in part by low pay.
Advocates for seniors must step up to protect access to home health services. Lawmakers in Congress have introduced the Preserving Access to Home Health Act of 2022 (H.R. 8581 and S. 4605). This bipartisan legislation, currently before the House and Senate, would prevent Medicare from imposing these cuts until 2026, ensuring that people have continued access to care and giving providers the stability they need while Medicare takes more time to hone its payment system.
A recent poll conducted by Morning Consult found that 97% of Medicare beneficiaries want the federal government to maintain Medicare coverage for home health care and 88% believe it is important for Congress to pass legislation that would stop the proposed payment cuts to Medicare home health services. Nearly all of those affected by this harmful policy want something done.
Those in need of health care who are covered by Medicare deserve access to care in the setting of their choice. More than 90% of seniors say they prefer to receive ongoing care or short-term recovery or rehabilitation care in the safety of their homes. By supporting the Preserving Access to Home Health Act and ushering it through to timely passage, Congress can protect home health patients and ensure stability within the home health community as demand grows.
Terry Wilcox is the co-founder and CEO of Patients Rising, a nonprofit patient education and advocacy organization that helps people get access to the diagnostics and the treatments they need. Patients Rising is one of 13 organizations that have asked Congress to pass the Preserving Access to Home Health Act of 2022.
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