Working Group Identifies Urgent Need to Improve Home-Based Care Resources for Medicare Beneficiaries and Unpaid Family Caregivers

January 22, 2024

Expert working group finds that a financially sustainable approach to strengthening home-based services and supports would better meet the needs of Medicare beneficiaries, their unpaid family caregivers, and society as a whole.

Contact: Jon Purves
Media Relations Director
The Aspen Institute

Washington, DC, January 22, 2024 — A new report released by an expert Working Group offers a package of recommendations designed to strengthen the home-based healthcare and social service resources available to Medicare beneficiaries and their unpaid family caregivers. The report, “Improving Medicare at Home for Beneficiaries and Family Caregivers,” draws on commissioned research and the expertise of senior leaders in the public and private sectors who convened at the Aspen Institute to explore strategies for change.

The report is available online. The Health, Medicine & Society program of the Aspen Institute and Cascada Consulting guided the convening and published the report, with support from the Commonwealth Fund. A list of Working Group participants is included below.

“Healthcare has shifted out of the hospitals and into the home, but Medicare has failed to keep up with the pace of the change,” said Working Group co-chair Sheila P. Burke, MPA, RN, FAAN, Chair of the Government Relations and Public Policy Group at Baker Donelson and Adjunct Lecturer with Harvard University’s Kennedy School of Government. “Most people prefer to stay at home as long as possible, but the cost and care burden unpaid caregivers are shouldering is overwhelming.”

An aging population, the availability of new technology, and recent legislative and policy changes at the federal level create a timely opportunity for overhauling the system. “We need to document the cost effectiveness of investing money in home-based care so that we avoid the consequences of failing to act,” said Working Group co-chair Risa Lavizzo-Mourey, MD, MBA, President Emerita, Robert Wood Johnson Foundation. “There are practical solutions at hand that we can put in place quickly, setting the stage for additional, long-term structural changes.”

Five key findings, drawn from research and the expertise of Working Group participants, support the recommendations in the report:

  • Home-based care plays an increasingly important role for Medicare beneficiaries.
  • Home care offers advantages to Medicare beneficiaries, their families, and the Medicare program itself.
  • As care shifts from institutional to home-based settings, family caregivers face intense pressures that put them at risk of burnout.
  • Caregivers say more support would help them maintain their caregiving roles and lessen the likelihood that their family members would require institutional care.
  • While limited, Medicare does have some mechanisms in place to support home-based services.

Building on those findings, and a commitment to equity, consumer participation, and a family-directed approach, Working Group members advanced a package of recommendations that would both require changes to the Medicare benefits package and foster broader engagement with other public agencies, health systems, and community-based organizations.

To strengthen the role of the federal Centers for Medicare and Medicaid Services:

  • Identify the locus of responsibility within Medicare where efforts to better meet the needs of beneficiaries at home could be lodged.
  • Reconsider eligibility criteria to broaden the home care benefits available to Medicare beneficiaries.
  • Develop a community-based coordinating system, funded by Medicare, to help beneficiaries and their caregivers access medical and nonmedical home care, including health-related social services.

To support caregivers:

  • Offer caregivers of Medicare beneficiaries a package of services that enhances their skills, knowledge, and emotional health and eases the financial strain associated with caregiving.
  • Develop mechanisms to embed more knowledge and sensitivity to the needs of family caregivers within the health system.

To grow knowledge:

  • Build the evidence base essential to effective policymaking.
  • Design demonstration projects to learn more about what is most valuable to Medicare beneficiaries, their families, and the health system.
  • Define, collect, and analyze performance measurements tied to clinical and patient-reported outcomes to assess the impact of home-based Medicare services.

In its call to move forward, the report underscores the urgent need to respond to the needs of Medicare beneficiaries and their unpaid family caregivers, and the opportunity to build political will. “Strong bipartisan support for family caregiving seems plausible,” states the report. “The shared value that American families need help as they care for their loved ones may be enough to move policymakers on both sides of the political aisle toward consensus.”


  • Sheila P. Burke, Chair, Government Relations and Public Policy Group, Baker Donelson;
    Adjunct Lecturer, Kennedy School of Government, Harvard University
  • Risa Lavizzo-Mourey, President Emerita, Robert Wood Johnson Foundation


  • Donna Benton, Director, Family Caregiver Support Center, USC Leonard Davis Center of Gerontology
  • Mercedes E. Bern-Klug, Professor, University of Iowa
  • Henry Claypool, Policy Director, Community Living Policy Center
  • Richard Frank, Senior Fellow, Economic Studies, Director, USC-Brookings Schaeffer Initiative on Health Policy
  • Terry Fulmer, President, The John A. Hartford Foundation
  • Sister Carol Keehan, Former President and CEO, Catholic Health Association
  • Emily Largent, Assistant Professor, University of Pennsylvania, Perelman School of Medicine
  • Loren Saulsberry, Assistant Professor, Public Health Sciences, University of Chicago
  • Eileen Sullivan-Marx, Dean, New York University Rory Meyers College of Nursing,
    Erline Perkins McGriff Professor of Nursing
  • Yulya Truskinovsky, Assistant Professor of Economics, Wayne State University
  • Reed Tuckson, Managing Director, Tuckson Health Connections

The Health, Medicine & Society Program of the Aspen Institute brings together influential groups of thought leaders, decisionmakers, and the informed public to consider 21st-century health challenges in the U.S. and around the world and to identify practical solutions for addressing them. The rigorously nonpartisan work spans a range of timely topics. At the heart of most of its activities is a package of research, convenings, and publications that supports policymakers, scholars, advocates, and other stakeholders in their commitment to better health for all.

The Aspen Institute is a global nonprofit organization whose purpose is to ignite human potential to build understanding and create new possibilities for a better world. Founded in 1949, the Institute drives change through dialogue, leadership, and action to help solve society’s greatest challenges. It is headquartered in Washington, DC and has a campus in Aspen, Colorado, as well as an international network of partners. For more information, visit


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