The federal government recently proposed a 2.4% payment increase for Medicare home health agencies, a move that reflects growing recognition that more healthcare is shifting beyond hospitals and into people’s homes. As America’s population ages and more older adults choose to remain at home for as long as possible, the proposal now acknowledges an undeniable reality: home-based care is becoming an increasingly important part of the healthcare system.
But additional funding alone will not solve the challenges facing older adults or the providers who care for them.
The greatest obstacle is no longer simply whether services exist. It is whether enough qualified professionals are available to deliver them.
According to Jim Prussak, CEO of Applause Home Care, a caregiving service located in New Jersey, reimbursement increases are certainly welcome, but they must be viewed within the broader economic pressures facing home health providers.
“A 2.4% increase is relatively modest when many agencies continue to face rising labor costs, transportation expenses, technology investments, and regulatory requirements,” Prussak says. “If cost growth continues to outpace reimbursement, the practical effect on access to care may be limited,” he said.
The proposal does, however, send an important message.
For decades, Medicare has primarily focused on acute and post-acute medical care rather than the long-term support many older adults eventually require. While the latest proposal does not fundamentally change that structure, it reflects a growing awareness that healthcare increasingly happens where patients actually live.
Still, recognizing the importance of home-based care and building the workforce necessary to sustain it are two different challenges.
As demand in this space continues to grow, agencies across the country face persistent shortages of nurses, therapists, home health aides, and other direct care professionals. Without enough caregivers, additional funding cannot automatically translate into greater access for patients.
Prussak also believes future investments should focus directly on strengthening the caregiving workforce.
“If the goal is to strengthen caregiving, I’d focus less on across-the-board payment increases and more on targeted investments that address the biggest bottlenecks: workforce shortages, caregiver burnout, and inconsistent access,” he says.
Those investments could include competitive wages, paid leave, expanded health benefits, retention incentives, career development opportunities, and additional training. Today’s caregivers are supporting older adults who are living longer with multiple chronic illnesses, dementia, and increasingly complex healthcare needs. Preparing workers for those realities requires continuous education and long-term professional support.
Expanding home and community-based services also remains a critical priority.
Many older adults do not require institutional care. Instead, they benefit from a combination of personal assistance, transportation, meal support, medication management, and occasional skilled medical services that allow them to remain safely in their own homes while maintaining independence.
Beyond workforce investment, Prussak sees significant opportunities to improve how care is delivered.
First of all, better coordination between hospitals, primary care physicians, specialists, pharmacists, and home health teams can reduce medication errors, eliminate duplicate services, and help prevent avoidable hospital readmissions. At the same time, technology such as remote patient monitoring, secure communication platforms, and interoperable electronic health records can help clinicians identify problems earlier while reducing administrative burdens.
Importantly, these technologies should enhance human care rather than replace it.
“Technology is most valuable when it enables more responsive, person-centered care rather than substituting for in-person visits,” Prussak says.
For patients and families, higher reimbursement also creates opportunities, but only if providers use those resources strategically.
Additional funding can improve continuity of care by helping agencies retain experienced staff, expand services into underserved communities, strengthen communication among care teams, and invest in systems that improve patient outcomes. Simply increasing reimbursement does not guarantee a better experience unless those dollars are directed toward the people and processes that matter most.
Families also have an important role to play.
Public programs such as Medicare, Medicaid for eligible individuals, veterans’ benefits, and local aging services provide valuable support, but they work best when combined with thoughtful planning and providers that emphasize individualized, relationship-driven care. Understanding what each program covers and coordinating those resources around an older adult’s personal preferences allows families to build care plans that extend well beyond medical treatment alone.
Ultimately, the future of aging at home depends on more than government funding.
Payment increases can help strengthen the system, but only if they are accompanied by policies that recruit, retain, and support the professionals delivering care every day. Without a stable caregiving workforce, expanding access to home-based care becomes increasingly difficult regardless of reimbursement levels.
As more Americans choose to age in place, the success of home healthcare will depend not only on where the care happens, but on ensuring there are enough skilled, compassionate professionals available to provide it.
For those looking to take caregiving to the next level, perhaps the answer lies in the obvious: better awareness and retention in order to cater those we love most.
