senior woman with caregiver
Growing jobs, reducing costs & meeting needs
by Tom Threlkeld

The homecare and home health industry is in an exciting moment, with the possibility of remarkable growth and new technology confronting the reality of increasing regulatory attention.  

“Homecare continues to march forward with strong policy-based and political support as the preferred focus for health care innovations,” said William A. Dombi, president of the National Association for Home Care & Hospice (NAHC). “Other health care sectors have joined the overall transformation in prioritizing community-based care for acute, post-acute and end-of-life services. As a result, new models of homecare continue to emerge along with new types of care providers. Technology advances have accompanied the care policy and delivery reforms, creating expanded tools to extend the opportunities to receive all levels of care at home. The greatest challenge for homecare today continues to be workforce availability, reflecting a combination of factors that include increasing demands for care that follows the aging of America, along with general competition for an adequate workforce among employers at large. All told, the
state of homecare is very positive, but not without challenges.”  


Home health spending in the United States exceeded $102 billion in 2018, a new high, according to the Office of the Actuary of the Centers for Medicare & Medicaid Services (CMS) in figures published in Health Affairs.

Total U.S. health care spending was approximately $3.65 trillion in 2018. That means home health care spending accounted for less than 3% of total health care spending in the United States.

While combined health care spending increased 4.6% in 2018, a slight increase over the growth rate of 2017, home health care spending grew at a healthy 5.2% clip, up noticeably from 4.6% in 2017 and 4.2% in 2016. Home health spending has increased by 30% in just the last five years, and current projections estimate almost $187 billion will be spent on home health care in 2027.

And yet, home health spending is still dwarfed by hospital spending, which reached $1.2 trillion in 2018—about a third of all U.S. health care spending.

In a time of tight budgets, this massive growth in hospital spending is not affordable, making homecare an increasingly attractive alternative. The elderly population of the U.S. continues to grow rapidly, with some of the fastest growth among the 85+ crowd that is most likely to consume more health care. Lowering rehospitalization rates should help provide robust growth for home health for years to come.


Job growth in the health care sector has grown a full percentage point faster than employment in the rest of the economy as a whole, and 10.8% of all jobs in the U.S. are in the health care sector—a record high.

All parts of the health care sector are seeing growth, with residential, ambulatory, nursing care and hospitals above average.

However, home health leads all other settings with 4.4% employment growth from March 2018 to March 2019, adding a total of 64,100 jobs. Outpatient care centers saw 4.3% employment growth, with other ambulatory centers growing 3.8%. Jobs in physician’s offices and hospitals grew by 2.1% over the last year, while nursing and residential care jobs grew by 1.2%.

Home health now accounts for 9% of all health care jobs, behind hospitals (31%), nursing and residential care (21%), physicians’ offices (16%), and other ambulatory care (16%). Outpatient care centers account for just 6% of health care jobs. Based on current trends, experts believe home health jobs growth will continue to match or exceed job growth in all other settings of the health care sector.


Homecare is the fastest growing part of the health care economy, but rising costs will make aging at home increasingly difficult, according to a new report from Genworth.

The 2019 Cost of Care Survey finds that the cost of homemaker services—including assistance with tasks such as cleaning, cooking and running errands—has increased more than 7% in the last year and the cost of a home health aide has increased more than 4.5% in the same time.

The cost of homecare services is rising almost four times as quickly as the cost of nursing homes—7.1% compared to 1.8%—but the $51,480 annual median cost of homecare services is still only about half the annual cost of a nursing home.

“Considering that most people want to stay in their homes as they grow older and 65-year-olds today have a 70% chance of needing some type of long-term care services in their remaining years, it’s evident that planning for how to pay for long-term care is now more urgent than ever,” said  Genworth Senior Brand Marketing Manager Gordon Saunders, who manages the Cost of Care Survey.

The main drivers behind the increase in homecare costs appear to be:

  • The tight labor market;
  • The costs of complying with the new mandates in local, state and federal certifications and regulations, including revised minimum wage and overtime laws in some states; and
  • The shift in post-acute Medicare reimbursement, which incentivizes hospitals to discharge patients sooner and with greater care needs.

There is a need for broad policy solutions to increase access to care at home and make it more affordable, and to encourage savings for it. Every American should be thinking: “My parents might need homecare services, and I might need homecare services.”

Homecare services are not the only sort of health care with rising costs, of course. Adult day health care services now come with an annual median cost of almost $20,000 for care five days a week per year. A private room in a nursing home costs a median of $102,000 per year and in-home skilled nursing is at a national annual median of $87.50 per visit.

Making the Case

At the beginning of 2020, as the home health industry confronts the reality of the new Patient-Driven Groupings Model, we see that American health care needs home health more than ever. With a rapidly aging population and 10,000 people turning 65 each day, the challenge of providing quality and affordable health care to older and disabled Americans has never been more apparent and the need to meet that challenge has never been more vital. 

The challenge for our society is to value the work that home health workers provide to the most vulnerable people in our society while still ensuring access to quality and affordable health care in the home to everyone who needs it. The solution to the health care problem—providing quality care at an affordable price—is to return health care to the home, where it belongs.

Tom Threlkeld is director of communications for NAHC, a nonprofit organization that represents the nation’s 33,000 home care and hospice organizations.