Repeal the Home Care Rule and Restore Community-Based Care

May marks Older Americans Month, a time to honor our nation’s aging population. It’s also a time to consider how public policy can better support seniors’ ability to age with dignity, security, and independence. That means expanding access to in-home care and encouraging community-based solutions. One key step is to repeal the 2013 Home Care Rule.

Most senior citizens want to age in place so they can stay in their communities and maintain critical social connections. However, many need help to continue to live at home. Often, the help needed isn’t medical care, but rather simple help around the house, support with arranging and getting to and from appointments, and assistance with other routine tasks and errands. Some seniors are fortunate enough to have family and friends in the area to provide this support. But others need to be able to hire the help they need. Unfortunately, overly strict regulations make it hard for seniors and their families who need these services.

Under the Home Care Rule, 80% of services provided by a caregiver to an elderly or disabled person must be confined to “fellowship” (conversation, games, reading) or “protection” (accompanying on walks, monitoring). The companionship exemption can no longer be claimed if more than 20% of a caregiver’s time is spent on “care” services (dressing, meal preparation). The rule also introduced onerous recordkeeping requirements for households employing these caregivers, including detailed records of hours worked. Furthermore, caregivers employed through third-party employers are automatically excluded from the caregiving exemption.

These hindrances restrict access to care, drive up costs, and stifle the adaptability required to support seniors who wish to remain in the comfort of their own homes.

This issue doesn’t affect just a subset of households; almost everyone has or will have a loved one who requires assistance. Indeed, the majority of us will eventually need such support.

The current system presents policymakers with an opportunity for simplification and modernization to improve accessibility and affordability for a wider range of seniors with varying levels of need. The 2013 Home Care Rule has had harmful consequences for caregivers and seniors, especially those on fixed incomes, who rely on it. Previously, households had more flexibility in arranging affordable in-home care. Such arrangements are often unattainable, pushing many families to rely on institutions, turn to under-the-table arrangements, or burn out trying to provide care themselves.

The current market is largely confined to home healthcare aides and nurses, and understandably so. It is essential for seniors in need of significant medical support, such as catheterization, injections, and tube feeding, to receive care from medically trained aides or licensed nurses who are compensated appropriately. However, seniors with less intensive needs lack accessible and affordable choices.

The current average annual cost of full-time in-home support for elderly Americans is a whopping $80,000, and it can run upwards of $230,000. Because Medicare does not cover non-medical support, seniors who require assistance not classified as skilled nursing are ineligible for Medicare benefits.

But these costs are more than monetary; they’re deeply personal. The inability of seniors to age in their own homes often results in a loss of vital connections that support their mental and physical well-being. Social isolation in older adulthood is associated with higher rates of depression, cognitive decline, and even early mortality. Therefore, companionship is not merely a convenience; it’s a necessity for protecting individuals’ social connections and overall health and well-being.

As demand for in-home care grows with our aging population, we must get serious about finding a regulatory approach that prioritizes flexible, accessible, and community-based solutions. Removing the rule would give families, caregivers, and seniors the freedom to design arrangements that work for everyone.

Older Americans Month reminds us that aging should not come with a loss of control or autonomy. If we truly want to support seniors, we must look critically at the barriers we’ve built around in-home care and start dismantling the ones that make it harder for seniors to get the care and companionship they need.

This article originally appeared in The Washington Examiner (5/28/25).

Heather Madden is the policy staff director at Independent Women’s Forum.

Reprinted with Permission from The Washington Examiner – By Heather Madden

The opinions expressed by columnists are their own and do not necessarily represent the views of AMAC or AMAC Action.