Home Health Care Faces Staffing and Reimbursement Challenges Amid Rising Demand

Home health care services in New Hampshire, exemplified by providers like Ascentria Care Alliance and Cornerstone Visiting Nurse Association (VNA), are facing significant operational challenges despite their critical role in patient care and aging-in-place strategies. Staffing shortages, increasingly complex patient needs, and looming federal reimbursement cuts are converging to strain the home health sector. A dramatic increase in family-provided care, rising from 40% pre-COVID to 85% post-pandemic through Medicaid programs, highlights systemic issues in professional home care availability and affordability. While New Hampshire saw Medicaid rate increases in 2023, including a 42% rise and further 3% increments, proposed 2026 Medicare reimbursement cuts of 6.4% threaten to undercut these gains, risking service reductions or closures of agencies. Nationally, home health agencies have declined from 12,613 in 2013 to 11,506 in 2023, intensifying concerns over access, especially as patient acuity rises with medical advances enabling more complex care at home. Providers like Elliot VNA and Cornerstone VNA address medical and social determinants of health with interdisciplinary teams and integrate technology like telehealth and AI to maximize efficiency amid workforce shortages. Medicaid programs such as New Hampshire's Choices for Independence facilitate paid family caregiving roles, reflecting adaptive care models to resource constraints. Financial sustainability is pressing, with reimbursements often covering less than half of actual care costs, further exacerbated by competition for workers from higher-paying sectors and neighboring states. Medicare Advantage plans add complexity by often underfunding required services. The industry's advocacy includes support for the bipartisan Home Health Stabilization Act of 2025, proposing to delay Medicare cuts and reevaluate payment structures. The history of community nursing, with roots in early-20th century organizations like Cornerstone VNA, underscores the sector's mission-driven nature but foreshadows potential critical service gaps without policy interventions. The underlying theme is balancing cost-effective, high-quality home care with the financial and labor market realities influencing provider operations and patient access nationwide.