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Policymakers must embrace patient-preferred approaches helping seniors safely heal at home


At a time when the healthcare system is largely focused on advancing equity—a goal that has long eluded us—the federal government is proposing policies that threaten to upend the entire Medicare home health sector and patients’ access to vital services.

Despite more focus in recent years, healthcare disparities across race and ethnicity remain pernicious. We’ve long known that a wide array of socioeconomic factors influence individuals’ propensity to develop certain diseases as well as their ability to access high quality care. This helps explain why communities of color face a disproportionately high burden of chronic diseases such as heart disease, diabetes and obesity.

Research also shows that Black Americans are significantly more likely to develop multiple chronic comorbidities at an earlier age than their White counterparts. Not only do these trends seriously harm a person’s quality of life, they also exacerbate the shameful health inequities communities of color have long faced.

Home healthcare providers play a critical role in the effort to end such disparities. With the help of a professional care team, patients receive highly skilled care in the comfort and convenience of their own homes. This is especially important for those with multiple chronic diseases, as 82% of Medicare home health beneficiaries have three or more chronic conditions (compared to just three-fifths of Medicare beneficiaries as a whole).

Medicare home health not only helps patients improve their health, it is also vital to their overall well-being. Instead of needing to be moved into a nursing home or other institutional setting, home health empowers seniors to stay close to their children, grandchildren, friends and other loved ones. Moreover, home healthcare was vital to helping seniors, particularly those at the highest risk of COVID-19, avoid infection throughout the pandemic.

Little wonder, then, that home health is the most preferred option—hands down. When given the choice, 91% of Medicare beneficiaries say they would prefer to receive short-term recovery or rehabilitation healthcare at home, compared to just 2% who would rather be treated in a nursing home.

Despite the clear benefits home health provides, seniors’ access to care is under threat. The federal government has recently rolled out a proposal to slash Medicare home health by $18 billion over the next decade.

The Centers for Medicare & Medicaid Services proposed implementing a permanent -7.69% cut to home health in 2023—followed by billions of dollars in “clawbacks,” which would force home health providers to return funds for services they provided to seniors at the height of the COVID-19 pandemic when demand for care at home was even more vital to health and safety.

The severity of these cuts is unprecedented—even before you consider America’s economic turmoil. Today, inflation continues rising to levels not seen in decades, making it harder for home health providers to manage. Similarly, labor costs are surging, as is the price of fuel, which particularly impacts the millions of dedicated home health aides who travel to patients’ homes every day.

If Medicare’s disastrous cuts are allowed to be finalized, I fear that many home health providers would be forced to shut down or reduce services in order to remain sustainable. And, if Medicare allows that to happen, patients, especially those in underserved and marginalized communities, would suffer most.

Fortunately, Congress understands what is at stake and is working to protect patient access. Recently, bipartisan leaders in both chambers of Congress introduced the Preserving Access to Home Health Act (H.R. 8581/S.4605), which would block the -7.69% cut from being implemented until 2026 and prevent the multibillion dollar “clawback” from decimating home health providers. With 92% of registered voters (including over 9 in 10 Democrats and Republicans) saying it’s important for the federal government to maintain Medicare coverage for at-home health care to allow seniors to recover and rehabilitate at home, this legislation is key.

Not only does this legislation help seniors who need home health care, but it also helps home health workers, who are disproportionately women of color. These workers are among the least well-paid of all healthcare providers, often working at near-minimum wage. Their jobs must be preserved by this legislation, and it is also important to ensure that these workers, who provide essential services, are fairly paid.

America’s seniors—especially older Americans of color—deserve better. In order to advance equity, policymakers must embrace the patient-preferred approaches that help seniors heal and remain safely at home.

Julianne Malveaux, Ph.D., is an economist, author and dean of the College of Ethnic Studies at California State University, Los Angeles.

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