Health Care

Improving Medicare at Home for Beneficiaries and Family Caregivers

January 19, 2024  • Health, Medicine & Society Program

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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. This report 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.

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.

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 below.


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