Medicare Home Health Care is the ideal platform for home-based palliative care at the end of life

06/16/25 at 03:00 AM

Medicare Home Health Care is the ideal platform for home-based palliative care at the end of life
Journal of Palliative Medicine; by Tessa Jones and Sean Morrison, with Guest Editor note by Ira Byock, MD; 6/10/25
Recognizing 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.

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