What Americans REALLY Think About Medicare Home Health

Welcome to Who Cares, the podcast from the National Alliance for Care at Home, where we explore how policy, people, and purpose intersect in Care at Home. Today, we’re talking about what the American people have to say about Medicare home health and why Washington should be listening.

We’re back again with another episode on home healthcare, but that’s because it matters. So, let’s remind our listeners what exactly home health does for patients and families and why it’s so important to keep having these conversations.

Home health is a way for people when they’re low mobility or have a serious medical problem to get care in the privacy and in comfort of their own home. So the Medicare home health benefit provides for nursing services, therapy, like physical therapy, occupational rehabilitation type services where the care is brought to people’s home. This isn’t just done for convenience. This is when somebody is considered homebound or low mobility. Maybe they need the help of other people to leave the home or they can’t leave the home at all because their medical condition. This is an opportunity for people to get care in their home. It saves them from having to be unnecessarily in a hospital. It saves them for having to unnecessarily move into a nursing facility or other setting. So, the great thing about this in our in health policy and in our health care system, one of the great
things about home health is that it’s beloved by people because it helps them stay home and independent and it also saves the system money from unnecessary costly hospital, emergency room, and nursing facility costs.

Exactly. And the exciting part about today is that you don’t just have to take it from us. We’re actually digging into a new poll that the alliance commissioned that shows that Americans voters prefer care at home and they don’t want Medicare to cut any sort of funding.

Yeah. It has been time and time again that I’ve seen, you know, I’ve been in this, believe it or not, almost 20 years working in homebased care. And every time I’ve seen a survey about people’s preference for care after a hospital stay, preference for care for long-term care where, you know, as they age, where do people want care? They want it at home. And home health, actually the Medicare home health benefit is the only program within the
Medicare benefit specifically targeted to homebound people, to people that really struggle to be able to leave their home. and it provides these comprehensive services. It’s actually from a funding standpoint, it’s not a big part of the pie. I mean, it’s less than 2% of Medicare funding for the Medicare home health benefit. Unfortunately, it’s been shrinking in some respects lately because of some misguided policies, which we’ve got to talk about. But, it is so high value. It’s so beloved and we should be doing more of it. It’s something that we should be investing in as a country so that we can get more value and that people can live with dignity and independence.

That’s why I’m so excited to dig into this polling data and understand what patients and what voters and what Americans are looking for because we know that we’re all in alignment on this issue. To help bring forward the proof that Americans do prefer home health, the Alliance commissioned Fabreezio Award, a leading national pollster, to survey a group of 1,200 voters and an additional 600 Trump voters to make sure that we were representing the full American population and to understand how they feel about, number one receiving Medicare funded care at home and number two about cuts to home health care and Medicare funding. So, what did that poll find?

This is an critically important poll that we’ve got to talk about. So we worked with Fabritzio Ward as you said who’s a polling firm that’s used nationally respected by the president. We also we looked at all types of voters. We sampled over sampled some Trump voters which is important. We want the President and the administration to understand that this issue is important to some of his supporters and in addition to all Americans quite frankly. And what we found through this work is that for one, in terms of cutting home health, people across the political spectrum think it’s a terrible idea. 70% of these voters oppose cutting home health. Over 90% say that access to home health is essential for Medicare beneficiaries and that there the over 70%, 73% agree that cuts harm legitimate providers and they fail to stop fraud and you know that’s critically important. I think the common sense thing here is to not cut legitimate care that people desperately depend on and that you know improves lives and saves the system money and focus on fraud, where there are some examples where we think that could be rooted out and get savings that way in the system. 71% believe that home care, home health care is the most affordable option for Medicare compared with nursing home and hospital care. Which it is and that this is true. The facts support the opinions on this and you know a majority support the president acting to stop cuts and to target fraud. I don’t know if there’s any politicians listening to this this podcast I sure hope that they and their advisers are paying attention because you have got an enormous political opportunity sitting in front of you right now if you if you want to kind of keep your job and do good by your constituents and either win your election or beat the person you’re running against. Support home health. Okay, home health is, the voters love it. They recognize the value. They recognize that it’s low cost for the system. They understand that there are ways to support the growth of home health and address some of the costs in the system by addressing fraud and abuse. This is low hanging fruit for politicians. I think in public servants it obviously when we look at our research data and health services and how to best design the system the first thing that will you know come to the top of that is homebased care and home health but also it’s something the voters understand. People get it and we should be talking more about it and you know it should be a core part of the platform of all of our all of our candidates. If they want to, you know, create a high value system and do right by their citizens.

Absolutely. And we’re not just hoping that people are listening to this podcast. Although we are also hoping that but the Alliance put this poll out publicly. So if you’re interested in diving into the full poll memo, it is available on the alliance’s website. It’s allianceforcareathome.org/protectthomehealth. You’ll find it there along with some commentary about what that means. But the alliance is also bringing these conversations forward directly. So, they’re going to policy makers and showing them exactly what their voters and their constituents are looking for. You know, what else is the alliance doing to advance these conversations and make sure that the voter sentiment is brought to fruition on Capitol Hill?

We’re doing everything we can to tell the success story of home health and encouraging our decision makers to protect it, not cut it and harm it. So this includes visits with members of Congress and their teams discussing
these issues, discussing the polls, also discussing other research and technical issues that support home health. We’ve met with administration officials. Certainly we’ve activated our grassroots network and sent thousands of communications to decision makers about these issues. We have worked with the media. Actually, Elyssa, you know, you’ve been a real resource in trying to partner with various media outlets, newspapers around the country and websites to get over a thousand media hits related to home health issues in the public sphere. And, you know, we’re continuing the push. We’re trying to do everything we can to get this message through.

Absolutely. To the media point, it’s important too to note that we’re looking at different markets where providers are feeling the strains the most and where frontline clinicians are having to make really difficult decisions about the care that they’re providing and what they’re able to do for future expansion or not. and you know in areas where there are fewer resources around if home health isn’t an option. And we’re taking those frontline clinicians and we’re highlighting their voices through, you know, local, regional, national outlets so that everyone understands what exactly is at stake because it’s clear that once people understand what’s happening, they agree with the fact that home health should be protected. And you mentioned this at the beginning when you were talking about some of the key findings, but in addition to people preferring care at home, understanding that it’s more affordable, a majority specifically agree that Medicare should not cut funding for home health. I think that’s important to understand because a lot of people don’t wade into the wonky funding issues of the Hill. And in general, people aren’t out here saying, “Let’s fund this and not fund that.” But when a majority of people agree that we shouldn’t cut funding for home health, I think our policy makers should listen.

No question. This is an easy political and policy win. Sometimes for policy makers, they’re stuck because something that’s good policy might not be easy politics and something that’s good politics might not be easy policy. Here you’ve got both. You’ve got a political will, a sentiment of the voters and the people that this is important. And from a policy standpoint, it makes all the sense in the world that to have a high functioning health care system, a high value Medicare system that we would support home health. So, it’s clearly something that that should be focused on. I’m thankful for all the that media work that you’re talking about because, you know, this is a media world we live in, right? And that’s why we’re doing this conversation, right? Is we we’re trying to find every which way to get these messages across. And we’ve also worked, you know what I don’t want to fail to mention, we’ve worked closely with our state home care associations, which are you know, state level home care and hospice groups that we partner with to try to get more local attention on these issues and also to you know, make sure that we’re connecting well with you know, local representation. You know, the old saying that all politics is local. That’s really important in these efforts, but we’ve got to do everything we can. So, I mean, you know, even people if you’re listening this conversation and you’re wondering, you know, how is anybody going to hear this because I care about this, but I don’t know if the my decision. Well, send them this send them this episode. Go and find the Alliance, the full data set from the poll and forward that to your member of Congress and to people that you think are in places of power that might be able to make a decision because that’s the only way we’re going to be heard. The echo chamber. There’s just so many voices and so many people trying to influence and sometimes, you know, older people or people with serious illness and their families and caregivers can be in the shadows and their voice isn’t always heard. So, we’ve got to all amplify and all do what we can, every one of us, to make sure that the message comes through.

Yeah, absolutely. So I want to underscore that by reminding people what is happening right now when we are cutting funding for home health. So this you know environment that we’re currently operating in is already forcing providers to make difficult decisions about the care that’s being provided to patients. Can you just bring us back to what’s happening with delays in care or access to care for patients and families if Medicare continues to cut funding for home health?

Access to home health is a life and death issue. Okay, I don’t want to sugarcoat this. This is not like some convenience thing or nice to have or that you know people are just waiting to have a nice chitchat with a home health person. This is life and death medical care in many instances. Okay, people are often waiting for home health after they’ve been in the hospital. They might have had a complex surgery, maybe multiple surgeries. They may be undergoing incredibly risky and serious treatment for a medical condition with new medications and side effects from the medicines and from their disease. They need to be cared for. They need evaluation. And what’s happening is these evaluations by home health nurses and therapists, they’re happening later because there’s been delays in care. Some cases, they’re not happening at all. People are more and more it’s more frequent now more than ever for somebody to get referred to home health and not actually get it. And we have communities that are losing their agencies. The agencies have closed. They said, “Oh, you know, this town, it’s too rural and remote. We can’t we serve it. This area is you know, there’s too many people on Medicaid. It’s the payments aren’t going to work here. We can’t serve it anymore.” Because of these policies, these misguided policies. We’re seeing worsening access to home health and that is a life and death issue. It’s also it’s also an health economic issue. So we talk about we’re a country, you know, we have to look at our debt and our deficits and we have a lot of advocates in Washington talking about debt and deficit issues and what are we going to be giving our children in terms of the economic legacy of our country and we’re just going to saddle them with a bunch of debt. Well, when we help people get care that they need at home instead of having to go to the hospital, it saves the system money. So, this is a win-win for people that are concerned about the human and I would hope everybody quite frankly is concerned about the human aspects here. But for those also that are concerned about the economics of health policy and Medicare policy, this is the way to help people save lives, support independence, do it in a way that of course by what we see with the polls is beloved and cherished by the public and save the system money.

Thank you for rehashing that. And we see the consequences. I mean, there is real patient harm that happens when Medicare cuts funding for home health. And so now we have the consequences top of mind. We have the evidence to show that this is what people prefer. And it’s incumbent upon our leaders at the national level to take action.

Despite voter sentiment, polling, and clear evidence that shows that home health is preferred by patients and saves the system money, CMS is still moving forward with cuts. And yes, they’ve listened. They’ve been a partner
in some regards and continuing the conversation and working with us to reduce the impact of these cuts, but I don’t want them to get away with this reframe as a positive win for the home health community because there still will be dire consequences. Can you help us understand more about that?

Yeah. So CMS is finalizing, you know, these cuts going forward. And they’re not as severe as what had been initially proposed. But remember, these new cuts are on top of several years worth of cuts that are compounding on one another to harm access, to reduce agency availability. You know, we’ve got places where agencies have closed in communities that have poor access to care, delays in care.

Absolutely. And if you’re listening and you’re a provider on the ground knowing how these cuts will still impact you, let the Alliance know. We have ways that you can submit a video testimonial on our protect home healthcare landing page. We want to help you share the story of what’s actually happening on the ground so that we can do everything we can to stop and reverse these cuts.

You know, the alliance has been doing a lot of advocacy work on this issue since the proposed rule came out. And during that time period, I’ve been speaking with providers across the country that are part of the alliance’s membership and beyond. And we talked about the potential consequences, but this really humanizes it for me hearing directly from the people that are in patients homes providing care. What will happen if these cuts move forward or what will happen if Medicare funding for home health doesn’t match what’s actually required to operationalize care? And in certain rural communities, I’m thinking about conversations that I’ve had with people in Tennessee and Oklahoma, home health is their only option. It’s many miles before they can get to a hospital or a clinic setting. If they don’t have home health care, if home health providers are forced to close because of inadequate reimbursement, these patients will go without care. They will not have another option. That’s absolutely devastating. And we have a clear solution to fix that. That still doesn’t cost Medicare much money. So, it’s unbelievable to me that we aren’t acting on this issue to protect these rural communities. And it’s not just rural communities, but that just helps people understand exactly what we’re talking about when we say home health providers might close. That might literally mean that, you know, Joe or Sally and wherever they are, they’re left without an option. That could lead to serious health consequences, maybe even death.

Yeah. It doesn’t seem fair that when our policy makers make mistakes that rural communities seem to pay the highest price for it quite frankly. You know we’re right now concerned about the impact of Medicaid cuts on rural communities. So you know Medicaid is a big payer for health services. It’s one of the main insurers particularly in rural America. And as these you know one big beautiful bill act or reconciliation bill Medicaid cuts come through that’s going to be a problem in rural communities. And then we’ve got on top of this for home health these home health cuts where like you said home health might be the only option certainly the only desirable option for people in rural communities to deliver home health care in a rural community. It’s hard. It costs more. I was actually talking to one of our leaders who runs home health agencies in some of the frontier west like think western Colorado and Utah and Idaho and you know the drive time might be an hour or more for a nurse to get to a person’s home. Well, that is costly there. There’s fuel costs. There’s wage and labor and hour costs for those workers to be able to get them out there. And so when you cut home health across the board, these are places that hurt the most earliest and where there are the biggest consequences. We have to protect our rural communities and make sure that our home health providers have the resources to continue to deliver care, especially when they’re facing that one-two punch of Medicaid cuts.

If today’s episode got you thinking about what Americans really think about Medicare home health, check out this episode. Dr. Landers and I break down the latest on CMS’s cuts and their growing movement fighting to protect care at home. It’s the update everyone in home health needs to hear.