Home health and hospice care is a lifeline in New York – Washington should not cut it off

Every day in New York, teams of home health and hospice providers step up to care for patients facing some of life’s most vulnerable moments. I see this daily routine from close proximity. From the nurses, caregivers, therapists, aides, and many others who make this work possible, every professional who steps into a patient’s home brings not only the critical skills to make home care possible, but more importantly, a deep passion to provide a lifeline to patients who need it most. Their work is as important as any other form of care.

As a physician, I have dedicated my life to caring for older adults living with serious illnesses. What inspired me about home health and hospice care was the chance to meet patients where they are, in the comfort of their own homes. Being in someone’s home means seeing not just their medical needs but also the family dynamics and personal nuances that shape their lives. That holistic perspective makes this work deeply meaningful.

One of my patients, an older woman with multiple chronic illnesses, had been in and out of hospitals for years. Working alongside a dedicated team, we managed to stabilize her condition and avoid unnecessary hospital trips, giving her a measure of stability in what I can only imagine as an incredibly difficult experience. She was able to remain at home, surrounded by her family, and later transition seamlessly into hospice care. The care she received, and the reassurance it provided her family, gave them back meaningful time together in her final months. This was only possible because of home health and hospice care. Years later, I still hear from her family, a powerful reminder of the deep, lasting connections this kind of care makes possible.

This is the promise of care at home: compassionate, individualized support that prevents unnecessary hospitalizations, saves taxpayer dollars, and most importantly, honors patient choice.

But this promise is under threat.

The Centers for Medicare & Medicaid Services (CMS) has proposed cutting more than one billion dollars from Medicare home health next year. These payment cuts come on top of years of financial pressure. Nationally, providers have already absorbed $25 billion in cuts, stretching agencies, deepening workforce shortages, and putting care at risk for the patients who rely on it most.

We’re already seeing the consequences. Since 2019, more than 1,000 home health agencies have closed their doors across the country, and over half of U.S. counties have lost at least one provider. In many counties, there are now none left.

In New York alone, 14 agencies have shut down since 2019, leaving nearly 91,000 patients without access to critical home care. For those who still have a provider nearby, access is not guaranteed. Forty percent of patients referred to home health following a hospitalization never received it due to agency capacity restraints and workforce shortages.

These aren’t just numbers. These are real people. Real families. And real communities left without the care they need.

Providers are also struggling under immense workforce shortages – one of the greatest challenges in the field today. Recruiting and retaining nurses, aides, and therapists is harder than ever. Additional cuts mean fewer nurses, fewer home visits, and fewer options for vulnerable people who want to recover at home.

Protecting and strengthening access to care in the home must be a priority, not only for the sake of patients and families, but also for the sustainability of our healthcare system. These services prevent unnecessary hospitalizations, reduce costs, and relieve pressure on already overburdened healthcare resources. Most importantly, they allow patients to live fully and, when the time comes, die with dignity in a place they call home.

As policymakers in Washington debate the future of home health, I urge them to listen to the millions of patients, providers, and families who know what’s at stake. Who live in, work for, and care deeply about this system.

Dr. Thomas V. Caprio, M.D. is the Chief Medical Officer for UR Medicine Home Care, among other clinical and leadership roles for the University of Rochester Medical Center in Rochester, New York. UR Medicine Home Care is a member of the National Alliance for Care at Home and Dr. Caprio serves on the board of directors for the Home Care Association of NYS.