Shutdown Puts Home-Care Program at 320 Hospitals at Risk—Jeopardizing Aging in Place for Thousands

Across the country, hospitals are pulling patients out of Acute Hospital Care at Home after Congress failed to pass a budget and prevent a lapse in the Medicare program’s funding.

For patients recovering comfortably at home under UMass Memorial Health’s care, that meant being pulled from their homes and sent back into the hospital, where the number of people waiting for a bed has climbed from 50 to 70, according to reporting from Politico.

For many older adults, hospital-at-home care is part of a broader network of services that makes aging in place both appealing and possible, allowing them to receive hospital-level treatment without leaving the comfort and safety of home. But since a funding bill to end the government shutdown failed to pass in the Senate, vulnerable patients are now headed back to crowded wards just as flu, RSV, and COVID-19 cases begin to rise.

It’s a crisis that shines an unexpected light on a growing problem in the housing market: America’s population is aging faster than its housing stock can keep up. 

Half of baby boomers say they plan to remain in their homes indefinitely, but only about 10% of U.S. homes are equipped for aging in place, per research from AARP. Meanwhile, assisted-living rents now average $6,400 a month, pricing out most seniors on fixed incomes. 

That’s why home-based care models like Medicare’s hospital-at-home waiver have become a crucial stopgap, helping Medicare recipients delay or avoid costly facility care.

“Programs like hospital-at-home are crucial to America’s aging-in-place strategy,” explains Dharam Khalsa, certified senior adviser and co-founder and CEO of Mirador Living, a platform to connect seniors with affordable assisted living. “They allow seniors to get hospital-level care without the disruption and risks of a facility stay.”

But with the federal program frozen amid political gridlock, the gap between how Americans want to age and what the system can support is growing wider by the week.

The human toll: Aging in place in jeopardy

Originally created during the pandemic to relieve overwhelmed hospitals, by April 2024, Acute Hospital Care at Home had grown to more than 320 hospitals across 133 health systems in 37 states, according to the American Hospital Association.

It also led to improved outcomes for patients. Studies show the model lowers mortality, readmissions, and long-term care placement compared with traditional hospital stays—all while freeing up beds in hospitals. That pressure release valve may be one of the most valuable aspects of the program.

Hospitals are facing a similar inventory crunch as the housing market—there just aren’t enough beds for patients, much like there just aren’t enough housing units to meet current demand—except the consequences are much more dire in a hospital setting. 

The national occupancy rate for hospital beds is expected to climb to 85% by 2032 because of an aging population, according to a research letter published in JAMA Network Open. That’s an unsafe level, according to the study’s authors.

“If the U.S. were to sustain a national hospital occupancy of 85% or greater, it is likely that we would see tens to hundreds of thousands of excess American deaths each year,” lead investigator Dr. Richard Leuchter, an internist and assistant professor of medicine at UCLA, said in a news release.

Meanwhile, older Americans own 38% of the country’s homes while accounting for just 21% of the U.S. population. Part of the success of the hospital-at-home model is that it turns that existing housing stock into a decentralized care network, leveraging one of the nation’s largest untapped assets to meet rising health-care demand without building new facilities.

But the shutdown threatens to unwind that progress.

“Patients who have chosen to be treated at home are facing limited space at hospitals and increased risk of falls and other negative events when they are moved to an unfamiliar environment,” Beth Feldpush of America’s Essential Hospitals told Politico. “This needs to be fixed immediately.”

And for caregivers and families, the instability deepens anxiety about whether home will remain a viable place to heal.

How the shutdown stopped it

Since 2020 the hospital-at-home waiver has survived on short-term extensions buried in budget bills. When Congress failed to pass the latest continuing resolution in late September, the waiver authorization expired.

Without it, hospitals can’t bill Medicare for home-based acute care. UMass Memorial suspended its program, sending patients back to the hospital. Delaware-based system ChristianaCare scaled back from 15 to just three patients, while Mass General Brigham has kept some patients at home by using non-Medicare payers.

For aging patients, the sudden lapse underscores how dependent their independence has become on Washington’s ability to function.

“Tying these programs to temporary federal waivers creates enormous fragility in the system,” says Khalsa. “When the waiver is paused, patients are suddenly forced back into hospitals, families lose the support structures they were depending on at home, and health systems have to scramble for additional capacity.”

Aging in place meets policy paralysis

The hospital-at-home model provided better outcomes and dignity for the vast array of patients who have relied on it. But its tenuous funding is laying bare a deeper, structural problem.

“We have not treated housing, caregiving, and health care as one system. The more we build access to care around the home, the more dangerous it becomes to run that access on policy that can vanish overnight,” explains Khalsa.

That’s why advocacy groups like Moving Health Home and the Alliance for Connected Care are urging Congress to decouple the program from short-term funding bills altogether.

“Right now, [Acute Hospital Care at Home] limps along with the government funding bills, which is why we want to detach it,” Kristy Drobac, executive director of Moving Health Home, explained to Politico.

A bipartisan bill from Rep. Vern Buchanan would do exactly that. His legislation would extend the waiver for five years and unmoor it from the budget battle that has put its future in question. 

“Home health services are especially crucial for the nearly 200,000 seniors in my district,” he said in a July press release for the bill. “We must ensure this life-changing model remains available for years to come.”

While the bill passed the House Ways and Means Committee, it has stalled in the Senate, where no companion legislation has been considered.

What’s at stake for aging Americans

If nothing changes, this lapse could be a preview of what’s to come. In the next five years, the U.S. will need more than 560,000 new senior-housing units to meet demand, according to data from NIC MAP, all while hospital occupancy levels are projected to reach dangerous levels.

Programs like hospital-at-home provide essential infrastructure at a time when inventory—whether it be housing units or hospital beds—come at a premium. The longer Washington treats solutions like these as temporary, the more fragile that infrastructure becomes.