What's Actually Happening in Home Care in 2026

What's Actually Happening in Home Care in 2026

Home-based care is at a crossroads, from relentless rate cuts to workforce shortages and a fraud narrative threatening patient trust in the hospice benefit. In this special live episode recorded on the main keynote stage of the New England Home Care & Hospice Conference, host Elyssa Katz sits down with three of the region's most respected operators to cut through the noise and talk about what's actually moving the needle. Ken Albert of Andwell Health Partners, Beth Slepian of Granite VNA, and Mario D'Aquila of Assisted Living Services cover the hard truths facing every service line in the care-at-home continuum, from the erosion of the Medicare home health benefit to the AI tools genuinely changing how clinicians work, to the culture-first retention strategies keeping turnover in the high teens. If you're a care-at-home operator, this conversation is the most honest hour you'll spend this year. What you'll take away: - How to diversify payer sources before rate cuts force your hand The AI tools that actually got 90%+ clinician adoption, and the three-point policy framework you need before you roll any of them out - Why staffing retention beats recruitment every time, and the 1.5:1 caregiver-to-referral ratio that keeps one operator running lean - The community trust-building strategies, thrift stores, death cafes, hospice houses, and helping providers fight back against fraud narratives

What Palliative Care Really Means (And Why It Matters)

Palliative care is one of the most misunderstood services in healthcare—and palliative care is also one of the most important tools for improving quality of life for patients and families. In this episode of Who Cares, co-hosts Elyssa Katz and Dr. Steve Landers break down what palliative care really is, who it’s for, and why it matters at every stage of serious illness. This episode is a long-overdue deep dive into palliative care, led entirely by Elyssa Katz and Dr. Steve Landers. Together, they cut through confusion, address common misconceptions, and explain why palliative care should be a core part of person-centered healthcare in America. With Dr. Landers’ clinical expertise in hospice and palliative medicine and Elyssa’s policy and advocacy perspective, the conversation brings clarity to a topic that is often oversimplified—or avoided altogether. At its most basic level, palliative care is an extra layer of support. Elyssa and Dr. Landers explain how this model of care focuses on comfort, independence, and the whole person—not just a diagnosis. Palliative care addresses pain and symptom management, helps align care with patient goals, and supports both patients and families as they navigate complex medical decisions. A major theme of the episode is how palliative care works alongside other medical treatments. Unlike hospice care, palliative care does not require patients to stop curative or life-prolonging treatment. It can be introduced at diagnosis, during aggressive treatment, or at any point when symptoms or care coordination become challenging. Elyssa and Dr. Landers discuss how palliative care teams help ensure providers are communicating effectively and that care plans reflect what matters most to patients. The hosts also explore where palliative care is delivered. While many people associate it with hospitals, palliative care can be provided in outpatient clinics and increasingly in community-based settings, including the home. Dr. Landers explains why access to palliative care outside the hospital is critical for improving patient experience, reducing unnecessary hospitalizations, and supporting families where they want to be. Eligibility is another key focus. Palliative care is not limited to older adults or those at the end of life. It can support children, working-age adults, and anyone living with a serious or chronic illness. The conversation highlights how palliative clinicians are uniquely trained to manage both disease-related symptoms and the side effects of treatments, while also helping patients navigate uncertainty and changing expectations. Finally, Elyssa and Dr. Landers address one of the most commonly searched questions online: What’s the difference between hospice and palliative care? While hospice is a form of palliative care for people in the final months of life, palliative care itself is appropriate at any stage. Understanding that distinction can help people access support sooner—rather than struggling without help. This episode is an essential listen for care leaders, clinicians, policymakers, and families who want a clear, honest explanation of palliative care—and why it plays such a critical role in the future of care at home.

What Congress Gets Wrong About Home-Based Care

Care at home advocacy and hospice policy are at a pivotal moment. Care at home advocacy and hospice policy are shaping how home health policy and telehealth flexibilities will determine access, quality, and cost of care across America. In this episode of Who Cares, hosts Elyssa Katz and Dr. Steve Landers, CEO of the National Alliance for Care at Home, take listeners inside the Alliance’s first-ever Advocacy Week, where more than 240 advocates held nearly 300 meetings on Capitol Hill to fight for the future of care at home. This conversation breaks down why care at home advocacy is no longer optional—and why showing up matters now more than ever. Elyssa and Dr. Landers reflect on the power of uniting hospice, home health, Medicaid HCBS, and private-duty care under one movement, amplifying the voice of providers, patients, and families in Washington. The episode explores the four key policy priorities advocates brought to Congress: • Protecting access to home health policy and preventing further Medicare reimbursement cuts  • Keeping hospice policy out of Medicare Advantage  • Strengthening Medicaid funding for home and community-based services (HCBS)  • Making pandemic-era telehealth flexibilities permanent Dr. Landers explains why hospice does not belong inside Medicare Advantage plans, detailing how prior demonstrations failed patients, providers, and payers alike. The conversation highlights how hospice already delivers high-value, cost-effective care—and why introducing prior authorizations and utilization management threatens something that is already working. The episode also tackles Medicaid HCBS funding pressures, including workforce shortages, waitlists exceeding 700,000 people, and why underfunding front-line care puts vulnerable populations at risk. Elyssa and Dr. Landers emphasize that investing in Medicaid HCBS isn’t just compassionate—it’s fiscally responsible. A critical portion of the discussion focuses on telehealth flexibilities, especially for hospice and home health certifications. With provider shortages growing and rural access shrinking, the hosts explain why telehealth is essential for maintaining access to care—and how government shutdowns and temporary extensions jeopardize patients today. Throughout the episode, the hosts return to one central truth: numbers don’t inspire movements—stories do. From frontline nurses to caregivers and clinicians, advocacy works best when policymakers hear directly how policy decisions affect real people. The episode closes with a hopeful look ahead to 2026, where demographic shifts, technology, and voter priorities make care at home not just relevant—but inevitable. Elyssa and Dr. Landers make a clear call to action: if you care about patients, families, and sustainable healthcare, advocacy isn’t someone else’s job—it’s yours.

The Truth About Fraud in Home Health

In this episode of Who Cares from the National Alliance for Care at Home, host Elyssa Katz sits down with Dr. Steve Landers to unpack home health fraud and what it means for the Medicare home health benefit. They explore how home health fraud in hotspots like Los Angeles County threatens patients, legitimate providers, and the long-term stability of the  Medicare home health program across the country. Dr. Landers starts with a clear, plain-language refresher on what home health really is: supportive medical care at home for people who are homebound, recovering from illness or surgery, or living with serious chronic conditions. Then he zooms in on patterns that might indicate fraud in home health. While most of the country actually lost home health agencies, Los Angeles County saw an explosion of roughly 900 new agencies. That growth, combined with unusual referral patterns, a lack of low-utilization payment adjustments, and strangely uniform patient diagnoses, points to a potential hotspot of fraudulent activity that could exceed a billion dollars in a single year. But this isn’t just about numbers. Elyssa and Dr. Landers walk through what home health fraud can look like for real people: patients who never received a visit but had their Medicare number billed, families who feel pressured to sign paperwork they don’t understand, or individuals who are referred for services they clearly don’t need. They explain how certain populations—people living in poverty, those with limited English proficiency, or patients with cognitive or neurological challenges—can be especially at risk. From there, the conversation moves to the systems-level damage. Fraudulent claims don’t just siphon money from the Medicare Trust Fund; they also get baked into complex budget neutrality formulas that Medicare uses to set Medicare home health payment rates. That means sham providers in one county can distort national data and trigger real cuts for legitimate agencies everywhere—just as those agencies are already struggling with workforce shortages, rising labor costs, and year-over-year rate reductions. Throughout the episode, Elyssa and Dr. Landers return to a core theme: fix the fraud, not the funding. The Alliance is pushing for targeted action—tighter licensure and certification processes, better vetting of ownership, more on-site surveys, and a laser focus on geographic hotspots like Los Angeles—without unleashing auditors on good providers over minor technicalities. The episode closes with a powerful story from Advocacy Week, where two frontline clinicians crowdfunded their way to Washington, DC so they could advocate for their community on Capitol Hill. It’s a reminder that home health is deeply valued by patients and families—and that protecting this benefit means rooting out fraud while preserving access to high-quality care at home for everyone who needs it.

What Americans REALLY Think About Medicare Home Health

Home health is on the ballot—home health is what Americans want, not Medicare cuts. In this episode of Who Cares, hosts Elyssa Katz and Dr. Steve Landers unpack fresh voter data on Medicare cuts and the Medicare Home Health benefit—plus what stopping Medicare cuts means for patients, clinicians, and taxpayers. Elyssa Katz and Dr. Landers open with a quick primer: what Medicare Home Health actually is (skilled nursing, PT/OT, and rehab brought into the home for people who are homebound or have low mobility) and why the benefit prevents unnecessary hospitalizations and nursing facility stays while preserving independence. It’s beloved by families—and it saves the system money. From there, they break down a new Fabrizio Ward poll commissioned by the Alliance: 1,200 voters, plus an oversample of 600 Trump voters, to ensure the results reflect the full electorate. The findings are striking: 70% oppose cutting home health; over 90% say access is essential for Medicare beneficiaries; 73% say cuts hurt legitimate providers and don’t stop fraud; 71% believe home health is the most affordable Medicare option vs. hospital or nursing home care. Politically, it’s low‑hanging fruit: supporting home health is good policy and good politics. Listeners also hear how the Alliance is moving the issue forward: publishing the poll memo (find it on the Alliance’s site under “Protect Home Health”), meeting with members of Congress and the Administration, activating grassroots advocates, and elevating frontline voices in markets where access is already strained. Then comes the human impact. Landers calls access to home health a life‑and‑death issue, describing later evaluations, missed visits, and agency closures—especially in rural communities where home health is often the only option. He contrasts misguided across‑the‑board cuts with a smarter path: target fraud and abuse while modernizing the program so it can grow. The result? Better outcomes for patients, stability for providers, and savings for the Medicare Trust Fund.