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October 14, 2019

The State of Home Care and Hospice and NAHC 2.0

The following is a speech by NAHC President William A. Dombi, delivered to attendees during the first General Session of the Home Care and Hospice Conference and Expo on Sunday, October 13, 2019. Mr. Dombi delivered these remarks to a packed audience, as attendance at the 2019 conference is up substantially from 2018. Please read on.

Good Afternoon and welcome to Seattle.

We are gathered here for learning. We are together to further the mission of home care and hospice. We are here to make the lives of the people we serve better during infirmity, illness, or their end of life journey. We are here because we care.

The progress made in home care and hospice has been great over the last several decades. It is progress built through a series of large and small steps. The path to progress has included setbacks and detours. Still, we have advanced to a point we can certainly celebrate. What we do together changes lives for the better every day.

To note just a few of the accomplishments over the modern era of home care and hospice:

  1. In 1965 we took a barely known service, home health care, and turned it into the only Medicare benefit that Is covered under Parts A and B.
  2. In 1972, Congress once again recognized the value of home care and ended the benefits copay requirement.
  3. In 1983, we took the bold step of creating a hospice benefit to provide people with an important care option at the end of life.
  4. Led by the bold initiatives in several states, we took the fledgling Medicaid home care program and started it down a path of expansion that continues even today to create a true and comprehensive alternative to institutional care.
  5. When Medicare challenged home health agencies with near endless and arbitrary claim denials, we fought back and won a landmark victory in federal court in 1989.
  6. In the mid 1990s when home care was challenged within its own ranks with fraud and abuse, we joined forces with enforcement agencies to start the cleanup that gained our community the reputation of compliance that stands above all others.
  7. We survived the impact of the ill conceived 1998 Interim Payment System to emerge stronger then ever and to restore access to care throughout the country. It took time, but we have prevailed.
  8. We took private pay personal care services from a cottage industry with people in need of care and often reliant on classified adds and the generosity of family and friends and turned it into highly accessible, quality driven, dependable care offered by thousands of diverse providers at an affordable price to consumers who prefer to age in place.
  9. We transformed home health services under prospective payment to a more effective, highly efficient, patient centered model of care that utilizes a coordinated, interdisciplinary approach to improving patient outcomes.
  10. Most recently, we conforted an emerging set of challenges in hospice to reaffirm the commitment to the best in class quality of care and to preserve the well deserved reputation of care quality.

The end product of these steps of progress is eminently clear across their country

  • Home care and hospice has travelled from being barely known concepts of care to universally understood as the best options in care and a focus of care to the home as preferred by all
  • There has been a comprehensive cultural shift in end of life care with the widespread acceptance of palliative services to bring death with dignity
  • Public policy is now centered around a “home care first” focus for pre-acute, acute, post acute, long term, and end of life care

We all understand that progress every day as we live within home care and hospice. However, to understand that the  world at large recognizes it we need to look no further than Hollywood,  yes Hollywood, where the setting of home care for drama and comedies, documentaries and sci movies is now ubiquitous.

Here are a few facts that fully evidence the progress in home care and hospice:

  1. Over 5 million Medicare beneficiaries receive home health services annually
  2. Spending on Medicaid long term services and supports in the home surpassed spending on nursing home care n 2015. However, the number of people on Medicaid home care is 4 times greater than those in nursing homes
  3. More than half of all people over 65 who die in a given year have received hospice services in the last year of their life
  4. The fasted growing area of employment is personal care attendant/home care aide as we enter the age of the Silver Tsunami
  5. Health care technologies have expanded the scope of home care opportunities at a pace comparable to transportation when the horse and buggy moved into the barn and was quickly replaced by automobiles—and that pace continues to accelerate.

And for a few words on the status and progress of NAHC 2.0 which was unveiled as a concept at the Annual Meeting just last year. We can proudly report that significant changes have already occurred consistent with our strategic plan.

First and foremost, we are far along in the cultural shift of making NAHC viewed as an association owned by its members. That shows in the amazing fact that we now have over 160 individuals from our members that are fully engaged on committees, councils, advisory bodies and our Board of Directors. That change has made NAHC a much move effective and powerful voice for home care and hospice. As I outlined in 2017, it is the Power of WE!

NAHC membership and conference attendance is at it highest level in years as people see the value of coming together for the greater good, raising all boats!

As a unifying voice in home care and Hospice, NAHC has expanded its alliances and collaborations to bring consistent advocacy. Above all of our collaborations we have the state home care and hospice associations. Partnering with them throughout our advocacy will bring us our greatest successes. We significantly improve our power when our voices aired unified.

While we, the community of home care and hospice have so much to be proud of for the incredible progress that we have made, the work continues. We should never expect to finish the efforts at progress because the world continues to change around us. Instead, we must continue to strive for progress every day.

What are the ingredients to achieve progress. Our experiences to date give us that recipe. Those ingredients include:














Thank you for permitting NAHC to be a partner with you in this journey. Thank you for all you do and will be doing to continue this progress in the revolution of care.