A Look at the Past, Present & Future of Homecare

Note: Below is an excerpt of the opening speech National Association of Home Care & Hospice President William Dombi gave at the organization’s annual meeting in Seattle last month. The progress made in homecare and hospice has been great over the last several decades. It is progress built through a series of large and small steps. The path to progress has included setbacks and detours, but we have advanced to a point we can certainly celebrate. What we do together changes lives for the better every day. To note just a few of the accomplishments over the modern era of homecare and hospice:

• In 1965, we took a barely known service, home health care, and turned it into the only Medicare benefit that is covered under both Parts A and B.
• In 1972, Congress once again recognized the value of homecare and ended the benefits copay requirement.
• In 1983, we took the bold step of creating a hospice benefit to provide people with an important care option at the end of life.
• Led by the bold initiatives in several states, we took the fledgling Medicaid homecare program and started it down a path of expansion that continues even today to create a true and comprehensive alternative to institutional care.
• When Medicare challenged home health agencies with nearly endless and arbitrary claim denials, we fought back and won a landmark victory in federal court in 1989.
• In the mid-1990s, when homecare was challenged within its own ranks with fraud and abuse, we joined forces with enforcement agencies to begin a cleanup that gained our community a reputation of compliance that stands above all others.
• We survived the impact of the ill-conceived 1998 Interim Payment System to emerge stronger than ever and to restore access to care throughout the country.
• We took private pay personal care services from a cottage industry serving people in need of care who were often reliant on classified ads and the generosity of family and friends, and turned it into highly accessible, quality-driven, dependable care offered by thousands of diverse providers at an affordable price to consumers who prefer to age in place.
• We transformed home health services under the Prospective Payment System to a more effective, highly efficient, patient-centered model of care that utilizes a coordinated, interdisciplinary approach to improving patient outcomes.
• Most recently, we have confronted an emerging set of challenges in hospice to reaffirm the commitment to the best-in-class quality of care and to preserve the well-deserved reputation of care quality.

Homecare and hospice has gone from being barely known concepts of care to being universally understood as the best option for care and a focus of care to the home as preferred by all. There has been a comprehensive cultural shift in end-of-life care with the widespread acceptance of palliative services to bring death with dignity. And public policy is now centered around a “homecare first” focus. Here are a few facts that fully evidence the progress in home care and hospice:

• Over 5 million Medicare beneficiaries receive home health services annually.
• Spending on Medicaid long-term services and supports in the home surpassed spending on nursing home care in 2015. However, the number of people on Medicaid homecare is four times greater than those in nursing facilities.
• More than half of all people over 65 who die in a given year have received hospice services in their last year of life.
• The fastest-growing area of employment is personal care attendant or homecare aide.

Health care technologies have expanded the scope of homecare opportunities at a pace comparable to transportation when the horse and buggy moved into the barn and was quickly replaced by automobiles—and that pace continues to accelerate. And we are working together for positive change. NAHC membership and conference attendance is at its highest level in years as people see the value of coming together for the greater good. We now have over 160 members who are fully engaged on committees, councils, advisory bodies and our board of directors. That change has made NAHC a much more effective and powerful voice for homecare and hospice. As a unifying voice in homecare and hospice, NAHC has expanded its alliances and collaborations to bring consistent advocacy. Above all of our collaborations, we have the state homecare and hospice associations. Partnering with them throughout our advocacy will bring us our greatest successes. We significantly improve our power when our voices are unified.