The Future of Care at Home Demands a New Narrative

Early each morning, a nurse pulls into a driveway before the rest of the neighborhood is even awake. She isn’t heading into a hospital or a clinic. She’s walking into someone’s kitchen or living room to change a dressing, adjust a medication or simply sit with a patient managing a serious illness. That scene repeats itself millions of times a day across this country. It rarely makes headlines, but it is the hidden scaffolding that lets older adults, people with disabilities and families facing serious illness stay where they most want to be: home.

I’ve spent my career in this field, and I know that home is where care happens. Recovery happens faster surrounded by family photos instead of fluorescent lights, and dignity is easier to preserve in your own bedroom than a shared hospital unit. Care at home is a unique setting where care, dignity and daily life can coexist.

That is why I’m concerned about the conversation in Washington and the media about these services.

No one disputes that fraud, waste and abuse have no place in Medicare or Medicaid. Our community has been clear and consistent on that point. But there’s a difference between rooting out bad actors and treating an entire sector as suspect until proven otherwise. Right now, we are drifting toward the latter.

Consider the nationwide moratorium on new home health and hospice provider enrollments that the Centers for Medicare & Medicaid Services put in place earlier this year. A blanket freeze doesn’t distinguish between a fraudulent operator and a provider trying to bring hospice care to a rural county that currently has none.

The same misguided program integrity attempts appear in the proposed Service and Spending Variation Index’s 2027 Hospice Final Rule and provisions of the home health payment rule (pending at press time). These are being framed as fraud-fighting measures, and while some elements may help identify outliers worth examining, these broad, formula-driven screens risk flagging providers for the crime of serving medically complex or high-cost patients.

There is a better way. Our community has been asking for targeted, data-driven enforcement that goes after bad actors paired with policies that make it easier—not harder—for legitimate, high-quality providers to serve patients. Program integrity and access to care are not opposing goals. The future of care at home depends on targeted enforcement.

In a moment like this, silence is a risk our community cannot afford. When the loudest narrative in Washington is fraud, the absence of a counter-narrative makes the fraud story the whole story. Shifting that narrative falls to those of us who do this work honestly. Providers, clinicians and caregivers must speak up about what quality care at home looks like—not just when a policy threatens our business but because patients and families deserve to understand what’s at stake for them. We must also share the stories statistics can’t tell, like of the mother who was able to die at home surrounded by loved ones instead of in a hospital bed, the veteran who avoided a nursing home because a home health aide helped him stay independent, or the family caregiver who kept her job because a hospice nurse was there when she couldn’t be.

We cannot let the conversation about fraud be louder than the conversation about care. When I think about the future of care at home, I know that in order to meet rising demand, we must maintain the trust essential to our care.

Home is where care happens. Protecting access requires more than defending the sector against an unfair narrative. It requires policymakers willing to distinguish between fraud and the vast majority of caregivers, nurses, aides and clinicians doing this work with integrity every single day.

As Washington finalizes these policies in the months ahead, I hope it chooses precision over blunt force, because access to these essential services is at risk.