PICTURE: “Only 0.7 percent of physicians in Medicare provided regular home care,” said Nengliang “Aaron” Yao, PhD, a researcher in the Department of Geriatric Medicine at the University of Virginia Medical School.
view More

Photo credit: Dan Addison | UVA communication

According to a new study, the number of healthcare workers caring for Medicare patients at home is “small and inadequate” recently compared to increasing demand in an aging America.

To keep up, Medicare will likely need to rethink how it reimburses home care providers, the researchers say.

“Only 0.7 percent of physicians in Medicare provided regular home care,” said Nengliang “Aaron” Yao, PhD, a researcher in the Department of Geriatric Medicine at the University of Virginia Medical School. “Targeted measures are required to support home medical care.”

Home Care Trends

The growth in home care was “modest but steady” between 2012 and 2016, with most of the growth being driven by an increasing number of nurses offering home visits, the study found.

The total number of providers offering home care for Medicare patients increased from about 14,100 to about 16,600 between 2012 and 2016, the researchers report. But there was also a heavy churn in the area – about 4,000 vendors offered home visits each year while about 3,000 stopped.

The demand for home care already exceeds supply in large parts of the country. Only about 15% of frail older adults receive medical care at home. America’s aging population, the growing number of patients with dementia, and the growing preference for aging on the spot will continue to fuel demand, the researchers say.

“More and more older adults are at home and struggling to get to their health care providers,” said researcher Justin B. Mutter, MD, director of geriatric medicine at UVA Health, who offers home visits through UVA’s Virginia at Home (VaH) ) Program. “Home visits bring the best personal medical care to where many need it most: in their home environment.”

UVA Health started the VaH program last summer in collaboration with the Department of Memory and Aging Care of the Department of Neurology and the UVA Center for Humanities and Ethics. The VaH interprofessional team consists of mother, nurse Karen Duffy, clinical pharmacist Bethany Delk and care coordinator Tuula Ranta. The team helps patients age on the spot, provides support for caregivers and, in collaboration with the UVA Center for Telehealth, offers home and telemedicine visits. VaH aims to bridge the gap between high demand and low supply of home health care for older adults in central Virginia.

Obstacles to home care

The researchers find that there are many barriers hindering the delivery of home care across the country, including Medicare reimbursement rates, travel time, and the complexities of the needs of many home patients. A GP can see 20 patients a day in an office setting, while many home care providers are unable to see half as many patients at a time, the researchers say.

To address these challenges, Medicare would likely need to re-examine how providers are compensated for home calls. “Home health care … has been described as a low volume, high value service that cannot be rewarded simply by paying service fees,” the researchers write in a new article setting out their findings. For this reason, integrating value-based payment options into traditional Medicare for older adults in the home country is crucial.

The Virginia at Home program benefited from generous support for philanthropic gifts when it was launched, but philanthropy needs to be complemented with sustainable payments reform for all home care providers, say Mother and Yao.

Without such steps, America will continue to struggle to keep up with the growing demand for home health care in the years to come, the researchers say.

“Home health care is care that revolves around patients and caregivers, with goals tailored to their needs in their community,” said Mother. “More than ever, we need healthcare professionals who are trained and ready to deliver this holistic service to our aging population.”


Results published

The researchers have published their results in the journal Health Affairs. The research team consisted of Yao, Mother, James D. Berry, Takashi Yamanaka, Denise T. Mohess, and Thomas Cornwell. Yao announced that he has interests in Heal Inc.; A full list of the authors’ statements is included in the paper.

Mother was supported by Grant K01HP33445 from the Health Resources and Services Administration, a division of the Department of Health and Human Services.

Subscribe to the Making of Medicine blog at to stay up to date with the latest medical research news from UVA http://makingofmedicine.virginia.edu.

Disclaimer: AAAS and EurekAlert! are not responsible for the correctness of the press releases published on EurekAlert! by contributing institutions or for the use of information via the EurekAlert system.