With the “sandwich generation” top of mind, Vice President and presidential candidate Kamala Harris unveiled plans for a new Medicare home-based care proposal earlier this month.

The proposal would include non-medical home care services under the Medicare umbrella, aiding seniors in need of activities of daily living support. The policy – if enacted – would also ease the burden on American adults who care for both their parents and their children.

Of course, it could also keep seniors out of more costly settings, though there is plenty of skepticism around how cost efficient the benefit would end up being.

The proposal moves to end “estate recovery.” Currently, states are allowed to regain the costs of care from recently deceased Medicaid beneficiaries from the sale of their homes.

Though many home care industry insiders consider Harris’ proposal a step in the right direction, many of these leaders also have reservations about how the proposal would actually be put into practice.

To find out more, Home Health Care News recently reached out to home care leaders to gather their thoughts on the matter.

Responses are listed below, lightly edited for length, style and clarity.

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Vice President Harris is spot on in saying ‘They (older adults) want to stay in their home, they don’t want to go somewhere else.’ She is also correct that current solutions are too expensive for most American families. However, the answer is not for Medicare to assume this massive entitlement program. First, there is no natural governor for utilization, unlike most of health care, which is inherently unpleasant for the patient. Second, if it is taking over Medicaid programs from states, it would take tremendous effort and political will to reconcile 50 different programs. Third, quality and satisfaction will decline if the government becomes the payer instead of families.

The best answer is for the private sector to introduce new and varied business models that make high quality home care more affordable. Innovation comes in many forms, though in our world today too often people define it solely in terms of technology. We need new models in terms of how folks set aside or access funds to pay for care, new operational delivery models that may look different than the 1-1 attention that is the standard today, and new concepts that improve home care jobs so that we can attract, train, retain and treasure amazing teammates who are actually doing the all-important work with clients. It is time for our industry to step up our game.

— Ari Medoff, CEO of Arosa

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The focus on home care in our presidential election is highly encouraging. For quite some time, the demand for in-home care has been rising rapidly, while the workforce needed to sustain it has steadily declined. The COVID-19 pandemic was a key turning point, highlighting the critical importance of home care and magnifying the urgent need for sustainable solutions to protect and strengthen this essential service. The increased attention on our industry couldn’t be more welcomed!

However, to effectively meet the health needs of our communities, strong collaboration between government, industry and consumers is essential. The home care industry is ready and eager to work together to ensure access to high-quality services. A key element of this effort is building a robust and sustainable workforce. By fostering a marketplace that empowers home care providers to innovate, form creative partnerships and establish employee-centric models, we will strengthen the workforce and improve health outcomes for those served.

Home care strengthens communities by empowering individuals to age, recover and thrive at home, allowing loved ones to stay in the workforce, supporting those with special needs to engage in employment, and reducing unnecessary strain on the hospital system. Home care not only enhances quality of life, but also contributes to economic stability of our communities.

— Sara Wilson, president and CEO of Home Assist Health

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Initially, I was thrilled that VP Kamala Harris is planning to address the potential of integrating skilled home health care and home care services under combined federal Medicare benefits. However, my initial excitement quickly led to several critical questions that I hope will be answered should this proposal advance/succeed.

What will happen to existing State-level Medicaid programs for private duty services? Will our states need to redirect Medicaid funding to CMS for a federal home care benefit? When I think about implementation, I wonder if it will be phased or immediate? I’m particularly concerned about how current waitlists will be managed by CMS and HMOs in alignment with state lists. I keep wondering what will happen to the PDGM model for skilled home health care. I need clarity on how licensing and training requirements will evolve for CNAs and LPNs. I’m curious about what certification and survey requirements will apply to home care companies.

I strongly feel the proposal must incorporate clear distinctions between CMS and State Medicaid plan responsibilities. I want to see specific guidelines for managing concurrent services. I believe we need a detailed framework for managing service overlap and agency resource allocation. In my view, clear standards for certification and quality assurance are essential. In-home caregiver responsibilities (benefit) vs. agency provided care and support.

— Cleamon Moorer Jr., president and CEO of American Advantage Home Care

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The Harris-Walz Medicare at Home proposal brings focus to the importance of enabling our nation’s seniors to age in place — at home, where they want to be. Although there is much to be clarified in how this proposal would work, we wholeheartedly concur that seniors living at home need more support. This struggle touches all Americans very personally — each of us and our loved ones. It is far better to meet people where they are, bolstering their independence at home with the right support, than later intervening following an accident or other avoidable health issue. This proposal represents an opportunity to make headway on two essential goals at once, delivering care that helps sustain the health and well-being of our seniors who want to live at home and at the same time avoid unnecessary and more expensive health care.

— Dean Ulizio, chief strategy officer at BrightStar Care

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I was excited to see the announcement and specifically to see that not only Vice President Harris, but others, are beginning to understand the value of CMS covering costs for in-home care services and to start talking about actually making changes to open this up.

We’ve always known the value in the Medicaid sector, so it never made sense to me that people could see value in Medicaid but not Medicare, so this makes a lot more sense to see things moving in this direction.

I’m always concerned when we see statements or press releases so close to election time. While I always want to give people the benefit of the doubt, it’s hard not to let the mindset of ‘I’ll believe it when I see’ it seep in. On the surface, this proposal is amazing and great to see, but underneath it appears a lot of things need to fall into place to even allow something like this to even occur. That is where I’ll remain concerned, whether they can actually do what they are proposing here.

However, everything needs to start somewhere and if this is the beginning of the evolution toward CMS covering these services, then we can mark this year as a great step forward!

— Aaron Sinykin, founder and CEO of Devoted Guardians