Literature Review

Where UnitedHealthcare, Humana rule the Medicare Advantage market Modern Healthcare; by Tim Broderick; 7/22/25 Medicare Advantage competition was meager in 97% of counties last year, where beneficiaries could choose among just a handful of dominant insurers. The health policy research institution KFF analyzed Centers for Medicare and Medicaid Services data on the plans available across the U.S. and Puerto Rico in 2024. The findings indicate that Medicare enrollees have few options in most areas. Market share was “highly concentrated” in 79% of counties and “very highly concentrated” in another 18%, KFF found, using metrics similar to those the Federal Trade Commission and the Justice Department employ to measure competitiveness. ... Ninety-three percent of Medicare-eligible people lived in “highly concentrated” or “very highly concentrated” counties. ... [Click here and scroll down for the national map with] the level of Medicare Advantage market concentration for each county and the market share for each county's top insurer.

Filling the gaps with the loss of Wilshire Health and Community Services NBC KSBY-6, California's Central Coast; by Dylan Foreman; 7/22/25 At the end of June, the longtime medical service provider Wilshire Health and Community Services, which offered everything from hospice and home health care to community services like counseling and transportation, closed its doors, leaving clients looking for help elsewhere. ... [Services] like home health and hospice care are being transferred over to organizations like Dignity Health Home Health and Hospice Care, getting 50% of the patients from Wilshire and sending offers out to 30% of their staff. According to Wilshire, on any given day, they could have at least 250 clients.

Post-acute care faces labor shortage amid immigration scrutiny Modern Healthcare, Post-Acute Care; by Diane Eastabrook; 7/23/25 Nursing homes and home care operators are scrambling to find replacements for foreign-born workers no longer eligible to work in the U.S. due to changes in immigration policy. Providers in Boston, Atlanta and other cities with large populations of immigrants, and Haitians in particular, say the loss of foreign-born workers in an already tight job market is making it increasingly difficult to meet the growing demand for care — and will likely drive up care costs. Last month the Homeland Security Department began notifying more than 500,000 Cubans, Haitians, Nicaraguans and Venezuelans that it terminated a Biden-era program that allowed them to live and work in the U.S. It said those who have not attained legal status to remain in the U.S. outside of the program must leave immediately. Despite court challenges, the federal government also aims to end another program in early September that grants temporary protected status to Haitians and Venezuelans who have lived in the U.S. for more than a decade. [Full access might require subscription.]

Homewatch CareGivers president on moving into clinical care, building partnerships of the future Home Health Care News; by Joyce Famakinwal 7/16/25 ... Denver-based Homewatch CareGivers operates in over 30 states and has 234 locations. The personal care franchise employs over 4,500 caregivers. The company’s goal to continue “filling the white space” has resulted in 20 new franchisees since 2023. Plus, Homewatch CareGivers is expanding into the clinical care space with the launch of a nursing services vertical, and through its partnerships with health systems and hospitals. Home Health Care News recently caught up with Homewatch CareGivers President Todd Houghton. During the conversation, he explained why hospitals benefit from home care partnerships, how Homewatch CareGivers is building out its clinical capabilities and how the company is utilizing AI tools.

Video palliative care improves symptoms but not outcomes in rural hospitals, study reveals McKnights Long-Term Care News; by Donna Shryer; 7/15/25 Researchers from the University of Alabama at Birmingham recently studied whether video consultations could improve palliative care for patients age 55 and older in small hospitals lacking specialized end-of-life services. Participants had an average age of 73. The study, published in JAMA Network Open, found that culturally tailored video consultations — designed with community input to reflect patients’ cultural values and communication preferences — led to a clinically meaningful but not statistically significant reduction in symptom distress. ... [The] video consultations had little effect on hospital readmissions or emergency department visits. The research addressed a critical healthcare gap, as the study notes that only 70% of the Deep South has access to palliative care services, compared to 85-94% in other US regions. This disparity particularly affects rural communities where specialized end-of-life care is often unavailable. 

Humana agrees to purchase bankrupt Florida provider The Villages Health for $50m Healthcare Dive; by Rebecca Pifer; 7/8/25 The insurer’s bid is preliminary and kicks off an auction for the debt-laden provider, which decided to undergo bankruptcy after discovering it owed Medicare hundreds of millions of dollars.

What might the past suggest about rural emergency services amidst critical access hospitals’ decline? AMA Journal of Ethics, American Medical Association; by Siân Lewis-Bevan, MD, MPH, EMT-B and Stephen Powell, MD; July 2025Critical access and other rural hospitals have struggled to remain open, which exacerbates inequity in rural residents’ access to routine and emergency health services and strains already-taxed rural emergency medical services (EMS). This article discusses the recent history of rural hospital closures and their effects on rural emergency care. This article also suggests modifications to EMS policy and practice that could improve rural community members’ access to health services and bolster EMS services in rural areas.

Impending changes in Medicare payments affecting home health servicesInvestors Hangout; by Riley Hayes; 7/1/25 The Centers for Medicare & Medicaid Services (CMS) has introduced a proposed rule that outlines crucial adjustments in how Medicare compensates home health agencies (HHAs). ... [A] routine payment increase of 2.4% has been proposed, amounting to an additional $425 million in funding for home health agencies. However, accompanying this increase are three significant changes that are projected to lead to a reduction in overall payments:

HCS Home Care/Hospice Salary & Benefits studies underway American Health Care Association (AHCA) and National Center for Assisted Living (NCAL); by Lisa Hohenemser; 6/17/25 Hospital & Healthcare Compensation Service (HCS) has announced the 2025 Home Care and Hospice Salary & Benefits studies are now underway. The Reports are recognized as the authoritative source for comprehensive marketplace data for home health + hospice agencies. Last year’s Home Care Report contained data from 1,079 home health agencies. The Hospice Report had data from 797 hospice agencies. Both studies include questions on staffing issues, nursing turnover/vacancy rates, and sign-on bonuses used by agencies to attract new employees. The results cover salaries/bonuses and hourly/per visit rates for 60 positions, with job data reported by auspice type, revenue size, region, state, and CBSA. Also included are 19 fringe benefits, planned salary increases, productivity/caseload, and data on visit and shift differentials.  Directions to Participate in the HCS Home Care or Hospice Salary & Benefits Study: ... There is no cost to participate. 

Medicare Home Health Care is the ideal platform for home-based palliative care at the end of lifeJournal of Palliative Medicine; by Tessa Jones and Sean Morrison, with Guest Editor note by Ira Byock, MD; 6/10/25Recognizing the central role of HH as a de facto means of providing home-based palliative care—and strategizing how to integrate palliative care principles and education into it—holds the potential to expand access to palliative care services and improve the quality of end of life for older Americans. The authors identify four main barriers to successfully integrating HH into the suite of palliative care delivery models. First, the HH workforce lacks training in fundamental palliative care. Second, the current lack of ongoing physician involvement in the HH setting. Third, reimbursement. Palliative care services are often excluded from traditional payment models, particularly in the HH setting. Lastly, financialization of the HH sector. They say that integration of palliative care within for-profit HH agencies may require a strategic emphasis on financial incentives.Guest Editor Note, Ira Byock, MD: This academic oped extends the drumbeat toward alternatives to hospice care. Overcoming barriers to home-based palliative care requires steps that are strikingly similar to those needed to make hospice programs successful. The authors repeatedly refer to HH interdisciplinary teams. In fact, home health is a multidisciplinary model of service delivery that lacks the clinical synergy of high-functioning interdisciplinary hospice teams.

Trends in home health care among traditional Medicare beneficiaries with or without dementiaJAMA Network Open; Rachel M. Werner, MD, PhD; Seiyoun Kim, PhD; R. Tamara Konetzka, PhD; 5/25In the US, nearly 7 million people live with Alzheimer disease and other dementias, a number that is expected to increase as the population ages. Although many people with dementia live in nursing homes or other institutional settings, institutional use is decreasing, and a growing majority of people with dementia are opting to live at home and receive care in the community. Home-based care is typically consistent with most people’s preferences and may be particularly important for those with dementia, as institutional settings and transfers can be stressful and disorienting.

His sick wife asked him to kill her. Now that she's gone, he says the loneliness is worse. USA Today; by Madeline Mitchell; 6/11/25 Ever since his wife died in December, David Cook feels like a stranger in his own home. ... The loneliness “is a problem,” Cook said, and sometimes he slips into dark, depressive episodes he can only shake with sleep. He avoids the living room, with the framed photos of the two of them smiling together, the new plush carpet, the television where they'd watch tennis and golf and the ghost of the recliner she used to sit in. Patricia Cook died there, so for now − maybe forever − it's off limits. ... When she went into hospice in their living room, adamant that she’d die in her own home, the pain was excruciating. “She actually, several times, asked me to kill her," Cook said. "And I didn’t even have to think about it, I just said, ‘I’m sorry.’ I said, 'I just can’t do that.’” “Do you know how hard that is?” Cook said. “When someone asks you to kill them?” ... Editor's note: Spoiler alert. David Cook did not kill his wife. Still, he asks, "What more could I have done?" Read this story to develop your understanding of the profound depths of loss for spouses/partners, especially when they have served as caregiver through challenging needs.

[Wales] 'Breaking point' as people in last 12 months of life occupy 'almost a fifth of Welsh hospital beds' Sky News; 6/3/25 People in the last 12 months of their life occupy "almost a fifth of Welsh hospital beds", according to a end of life care charity. Marie Curie Cymru says end of life care in Wales is "at breaking point" and is calling on the next Welsh government to ensure high-quality care. The charity says that, for many, support could be better provided at home or close to home, as it launched its manifesto for next year's Senedd election at Cardiff Bay's Norwegian Church on Tuesday. Gareth Miles died at home in Llanddarog, Carmarthenshire, in September 2023. Mr. Miles, who had Parkinson's disease, had spent 10 weeks in hospital before his last week.