Home Health Sector Sees the Largest Job Loss in More than a Decade


The December Bureau of Labor Statistics (BLS) jobs report projects that 3,700 home health jobs were lost in December, demonstrating the biggest loss in home health jobs in more than a decade. Leaders in the home health community have warned these cuts are directly related to the unprecedented 14 percent cut to the Medicare home health benefit, which went into effect on January 1.

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This new report confirms what senior advocates have been concerned about – this deep 14 percent cut will negatively impact millions of American seniors, their families and needed healthcare jobs.

As the unprecedented cut to Medicare home health starts to take effect, 40 percent of all home health agencies are projected to end up operating at a loss.  These agencies may be forced to reduce staff, limit patient services, file bankruptcy or close their doors completely. Avalere Health projects that a total of 500,000 home healthcare jobs could be lost.

As a result, nearly 1.5 million seniors could lose access to the high-quality, cost-effective home health services they need, and taxpayer costs will therefore rise as medical services are instead delivered in more costly institutional settings.

Medicare home health services are delivered to approximately 3.5 million Medicare beneficiaries, who are documented as being poorer, older, sicker, and more likely from a minority population than other Medicare beneficiaries.

These cuts should be stopped to protect access to care for our most vulnerable seniors.




What the Home Health Rule Means For Providers & Patients

Despite the concerns expressed by more than 200 bipartisan Members of Congress, leading senior advocacy organizations, patients, and providers, the Centers for Medicare and Medicaid Services (CMS) chose to cut Medicare home health payments to the fullest extent allowed by the Affordable Care Act. These cuts, at 3.5% per year, total an unprecedented cut to Medicare home health funding of 14% between 2014-2017.

Cuts of this magnitude have never been seen before. CMS itself admits that approximately 40 percent of all home health agencies will experience negative Medicare margins by the time these cuts fully take effect in 2017.

These cuts directly impact homebound seniors in rural and underserved communities who are among the Medicare program’s oldest, sickest, and poorest beneficiaries. Because home healthcare providers care for Medicare’s most vulnerable patients, adequate Medicare funding is especially critical.  In home health – unlike other healthcare sectors – private pay and Medicaid can’t be used to offset Medicare losses. Therefore, net losses in nearly half the nation’s home health agencies will inevitably lead to closures across the country, compromising the care nearly 3.5 million vulnerable seniors depend on to remain in their homes.

While the Final Rule could have devastating consequences for the home health sector, Health and Human Services Secretary Kathleen Sebelius has the authority to revise the rebasing cut to protect seniors’ access to home health.  The Secretary should update the rule because:

  • The cut directly targets 3.5 million homebound seniors, who are older, sicker, poorer, and more likely to be a minority than the typical Medicare beneficiary.
  • Approximately 40 percent of all home health agencies will experiences negative Medicare margins by the time these cuts fully take effect in 2017.
  • Negative Medicare home health margins will lead to closure of provider facilities, therefore limiting beneficiary access to patient-preferred home health.

Without action from the Secretary, access to clinically advanced, cost-effective and patient preferred care is in real danger.

November is National Home Care & Hospice Month

Thanksgiving is just around the corner, and many Americans will be making their way home to spend quality time with family and friends. And while there is much to be thankful for, perhaps “home” might be the most important of all.

November is National Home Care and Hospice Month, a time dedicated to preserving andrecognizing the need for home health and hospice, while giving thanks to the many dedicated skilled nurses, therapists, and aides across the United States who care for our homebound seniors.


Home healthcare is not only the preferred choice of most seniors; it also provides the most value. Seniors who rely on Medicare for vital home care services costs an average of $44 per day, compared to hundreds – or even thousands – of dollars per day for care in costlier settings. With baby boomers becoming eligible for Medicare last year, home health services are poised to play a key role in the coming years.

Despite its bright future, home health services are facing deep Medicare cuts by the Centers for Medicare and Medicaid Services (CMS). This past summer, CMS proposed cuts of 14 percent totaling about $21.5 billion, which do not include over $72 billion in prior funding cuts to the home health community since 2009.

Drastically reduced reimbursements for home care would be devastating for the more than 3.5 million seniors and disabled Americans who rely on Medicare’s home health benefit. So while thinking of home and in the spirit of Thanksgiving, please take just a few moments to join the thousands who have already written letters to lawmakers in Washington D.C., urging the President to protect seniors from the impact of home health cuts.  Click here to write the Obama Administration to ask it to protect funding for home healthcare for America’s seniors.

Lawmakers and Advocates Speak Out Against Proposed Home Health Cuts

stand_up_buttonIn June, the Centers for Medicare and Medicaid Services (CMS) issued a draft regulation that proposes to deeply cut Medicare funding for home healthcare services. Cuts of this severity could threaten the delivery of quality skilled home health services for Medicare’s most vulnerable beneficiaries.

As home healthcare providers and patients wait to see whether the rule will be finalized in its current form, lawmakers and fellow advocates are standing up for home healthcare.

Bipartisan Representatives Doris Matsui (D-CA) and David McKinley (R-WV) recently spoke out against these cuts together in a joint op-ed published in Roll Call.  The lawmakers wrote:

“Home health care is a vital solution to improving patient health while also decreasing costs. Home health allows patients to receive low-cost care in the safety of their homes, which reduces Medicare expenditures in more expensive institutional care settings. That’s why we believe Medicare should support and encourage the delivery of home health care.

“We are concerned that a proposed rule issued by the Medicare agency will do just the opposite.”

More than 200 bipartisan members of Congress share their concerns and have called for reconsideration of this rule. AARP, the American Hospital Association, the Small Business Administration, and dozens of other stakeholder groups have also written to CMS asking for a more full analysis of the proposal to ensure patient access to care is not compromised.

Supporters of home healthcare understand that proposed cuts of this magnitude will threaten patient access to skilled home healthcare services. As one of the Medicare program’s most disadvantaged patient populations — many of whom live in underserved and rural communities — home health beneficiaries are uniquely vulnerable to patient access challenges as well as chronic disease and medical conditions that can benefit immensely from the delivery of home health.


Preparing Home Health Patients for Natural Disasters

With the start of Hurricane season, we are reminded yet again of the importance of emergency preparedness for the home health sector. While hospitals and shelters help to protect many individuals in the event of a natural disaster, homebound patients often continue to rely on their home health providers to deliver the care they need before, during and after a disaster.

To help ensure patient safety and continuity of care throughout an emergency situation, home health agencies develop a preparation and response system for its staff to implement in the event that tragedy occurs.

Emergency planning starts the day a patient joins a home healthcare network. Most home healthcare providers have systems and practices in place that work to protection patients and their caregivers alike.

Once a patient enters the home health continuum, he or she is assigned a disaster classification code based on his or her condition and needs. These codes are updated regularly and allow the home health agency to prioritize care during emergencies.

For a natural disaster with warning, like a hurricane, home health agencies will start preparing patients in the days leading up to the storm. Each home health aide and manager will contact his or her patients to ensure that they will be safe during the storm, or relocated to their nearest family member or emergency contact’s home if needed.

If a patient must stay at home, their home health providers will make sure he or she has medication, medical equipment, food, and water to keep them comfortable and safe. In some cases, home health providers will even stay with patients throughout the storm or disaster. Providers will also notify the authorities about their patients and contact power companies in the event that a patient relies on electricity for a piece of medical equipment, such as a ventilator.   The goal is always to ensure that the patient’s healthcare is never at risk.

Once a disaster has hit, home health providers immediately start their recovery efforts. Within 24 hours, on-call nurses will attempt to visit all patients in the affected area, starting with the highest acuity patients. Home health providers will often work with the authorities to locate and care for their patients as quickly as possible.

Natural disasters are unpredictable and potentially devastating, particularly for home health patients with physical restrictions and health concerns. Home health professionals go above and beyond the call of duty to ensure that their patients remain healthy and safe, but real security is derived from the extensive emergency preparedness and planning that takes place before events even occur.

INFOGRAPHIC: Home Health Patients versus All Medicare Beneficiaries

While all Medicare beneficiaries are in need of healthcare services, home healthcare beneficiaries are typically more vulnerable than the average Medicare patient. They are older, more likely to live alone, have fewer financial resources, and suffer from more chronic health conditions.

In recent years, the home health benefit has been repeatedly hit with spending cuts, which have the potential to directly impact the services offered to some of the most vulnerable of Medicare recipients.

The Partnership is committed to developing innovative reforms to improve and protect home healthcare for all our nation’s seniors.

The infographic below explains the differences between Medicare home health beneficiaries and the average Medicare beneficiary.


Caring For Our Fellow Americans

Tomorrow is the 4th of July, a day to celebrate democracy, community, and to recognize the efforts of those that serve at home and abroad.

But Independence Day also allows for reflection on the meaning of patriotism. A patriot understands the importance of both country and community, and cares deeply for the welfare of others. Being patriotic is not just believing in American values and pledging allegiance to the Stars and Stripes; it requires action towards making our towns and cities better places to live for all citizens, young and old.

We believe nurses, therapists and home care aides in a home health setting epitomize patriotism by caring for fellow citizens and providing quality health services rain or shine, most likely without glory or recognition. These men and women give back by providing the seniors in their community access to patient-preferred healthcare promptly and comfortably.

Protecting our most vulnerable citizens is at the heart of what we do at the Partnership. We believe in the value and dignity of home healthcare, and we support and commend all of the clinicians who are committed to their communities and families.

From all of us here at the Partnership, we hope you enjoy a happy, healthy, and safe Independence Day!


Congress Repealed the Medicare Home Health Copayment Because It Increased Costs. So Why Are They Considering It Again?

In 1972, Congress passed an amendment repealing a 20-percent copayment to beneficiaries who received home healthcare under Part B citing copayments as “a financial burden to many elderly persons living on marginal incomes.”  The coinsurance requirement lead to increased hospital costs and was found to discriminate against patients.

Similarly, our nation’s 3.5 million Medicare home healthcare beneficiaries are today facing the prospect of a copayment on home health services, most recently proposed in the Obama Administration’s FY2014 budget plan. Despite evidence that copays actually increase Medicare costs by forcing patients to seek care in costlier institutional settings, some lawmakers are looking at instituting increased fees on seniors in need of home health as a means for generating federal cost savings.

A recent Forbes column details some of the myriad reasons a home health copay is bad policy and why lawmakers should instead look for Medicare savings by targeting federal dollars lost to fraud and abuse.

The Partnership strongly opposes the reimposition of a beneficiary copayment in the Medicare home health benefit.  Instead, it is encouraging Congress to advance targeted reforms that do not harm innocent seniors.

Letter to President Obama: Support Program Integrity Reform Instead of Across-the-Board Cuts and Higher Costs for Seniors

The Partnership for Quality Home Healthcare supports program integrity reforms in the Medicare program specifically targeting fraud and abuse to prevent these behaviors before they can occur.

As a member of the Fight Fraud First! coalition, the Partnership is working with others to ask policy makers to make every effort to eliminate waste, fraud and abuse from the Medicare program before cutting Medicare payments or asking beneficiaries who rely on these important services to shoulder more out-of-pocket costs.

In a letter sent to President Obama this week, Fight Fraud First! urged the Obama Administration to support program integrity reform instead of across-the-board cuts and increased costs for our nation’s vulnerable seniors. Read the letter below:


April 10, 2013

President Barack Obama

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dear President Obama,

As a coalition of groups representing millions of older Americans, persons with disabilities, minorities, veterans and healthcare providers – founded on the premise that eliminating waste, fraud and abuse in the Medicare and Medicaid programs should be a priority for lawmakers to reduce health care spending – we urge your Administration to support program integrity reform instead of across-the-board cuts and increased costs for our nation’s vulnerable seniors.

We respect that leaders in Washington have to make tough decisions when it comes to securing America’s financial future. While progress must be made, we ask that lawmakers strongly consider advancing policy solutions that generate savings through targeted efforts to prevent fraudulent activity and wasteful spending in the Medicare program, and increase successful programs designed to recoup government funds lost to fraud and abuse.

As you prepare to release your FY 2014 budget, we respectfully ask you to propose targeted solutions to prevent improper and fraudulent payments before they occur. Strengthening the current pay-and-chase system through program integrity reforms is a solution that makes sense for older adults, taxpayers and our nation’s health care delivery system.

Data suggest up to an estimated ten percent of Medicare funding is lost to waste, fraud, and abuse each year.1 Successful programs created by your Administration have addressed system weaknesses and yielded billions of dollars in Medicare savings. We believe even more can be done. Therefore, we ask that you support targeted approaches to combating fraud and abuse to protect our nation’s nearly 50 million Medicare beneficiaries.

Our organizations came together in the collective belief that correcting inefficiencies in the Medicare program is the most prudent approach to reducing federal spending within the Medicare program. Rather than turning to Medicare cuts or higher premiums or copayments that unfairly burden seniors, we urge the federal government to achieve savings by implementing policy solutions that stop waste, fraud, and abuse before it starts.

We encourage you to reject increased out-of-pocket costs or cuts to Medicare that would restrict beneficiary access or reduce benefits, and instead call for program integrity reforms that protect beneficiaries and save valuable taxpayer dollars.



American Autoimmune Related Diseases Association

Caregiver Action Network


National Association for Uniformed Services

National Grange

National Hispanic Council on Aging

Partnership for Quality Home Healthcare


Veterans Health Council

Vietnam Veterans of America

 1 U.S. Government Accountability Office. Medicare: Program Remains at High Risk Because of Continuing Management Challenges. GAO-11-430T. March 2, 2011.



CMMI Director Touts Value of Home Health

In a hearing before the Senate Finance Committee last week, CMS’ Center for Medicare and Medicaid Innovation (CMMI) Director, Dr. Richard Gilfillan, was the sole witness at a recent Senate Finance Committee hearing on ways to reform Medicare and Medicaid.  In his written testimony and during the hearing, Dr. Gilfillan sited the value of home healthcare in new delivery models for Medicare and Medicaid.

He further described how demonstration programs involving home health are working to improve outcomes and reduce Medicare costs.

In his written testimony, he states:

“Innovation Center initiatives include the Independence at Home Demonstration, created by the Affordable Care Act, which uses home-based primary care teams designed to improve health outcomes and reduce expenditures for Medicare beneficiaries with multiple chronic conditions. Under the Independence at Home Demonstration, selected primary care practices will provide home-based primary care to targeted chronically ill beneficiaries for a three-year period. Participating practices will make in-home visits tailored to an individual patient’s needs and preferences with the goal of keeping them from being hospitalized.”

Click here to see the video recording of the hearing.