Embracing Home Care During This Time of Crisis and Challenge

Over the course of the pandemic, more than 160,000 nursing home and long-term care facility residents and staff have died from COVID-19, representing roughly a third of total deaths in the country. In response, policymakers and federal and state agency officials rushed to put in place emergency guidance and waivers to enhance access to care in the home in an effort to mitigate the spread of the virus. These policy changes catalyzed a long overdue shift toward home- and community-based care.

It’s time for us to continue in this direction and enable individuals to receive care in their setting of choice, particularly older and frail adults and individuals suffering from chronic conditions who can be safely cared for in their homes. Indeed, according to the AARP, most individuals prefer to receive care in their home and that number has only increased as a result of COVID-19.

Public and private payers alike are heeding this shift and testing and implementing new models of care delivery centered around the home.  

Skilled nursing facility-at-home and hospital-at-home models, for example, allow individuals to stay at home while receiving the support and services they would traditionally receive in an institutional setting.  As a result, these models also have the added benefit of breaking down silos of care, increasing care coordination, and driving down overall health care costs.

But despite the uptick and progress of these models, regulatory and statutory barriers to home- and community-based care still remain. From enhancing reimbursement for professional and caregiving services in the home, to removing financial incentives that reward one post-acute setting provider over another, policymakers must address the obstacles that make the home a setting of last resort.

We encourage the Biden administration to follow through with its support for greater access to home- and community-based services, including long-term services and supports and to test and expand home- and community-based alternatives to institutional care. And, where needed, partner with Congress to fund and authorize those efforts.

In the coming weeks, policymakers are moving forward on a bifurcated track for passing the next COVID-19 relief package. Having passed a budget resolution with reconciliation instructions, House and Senate Democrats have set the stage for the expedited passage of COVID-19 relief with a simple majority.  Meanwhile, bipartisan negotiations in the Senate are ongoing – an important step toward returning to the civility and compromise that has been recently missing from the legislative and executive branches.

Still, if we are to have a health care system that can better adapt to our next public health emergency, there is more to be done. Meeting the urgent needs of providers, ramping up our production and deployment of therapies, vaccines, supplies and personal protective equipment, and supporting our small businesses and working families are critical to our near-term response.  Equally important is our innovation in home care so we are better prepared to treat individuals where they are and where they may prefer to be.

If we’ve learned anything from this time of crisis and challenge, it is that we must fully leverage and support the home as a necessary and vital care setting both now and in the future.   


Former Sen. Tom Daschle is a former U.S. Senate majority leader and founder and CEO of The Daschle Group. Former Sen. Bill Frist is a heart transplant surgeon, former U.S. Senate majority leader and special partner at health services firm Cressey & Co., as well as the host of “A Second Opinion Podcast.”

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