By Al Cardillo | May 9, 2020


Well before the present crisis shut down business operations and activities deemed incidental, New York law created a process for governments to confer home health care nurses, aides and therapists with “essential-personnel” status in public emergencies.

The law, signed in 2017, was designed expressly for a crisis like our present one; and it arose fresh from the memory of home care’s needs, struggles and heroism during Hurricane Sandy.

Those needs – and countless others – have come roaring back in the COVID-19 pandemic, with New York at the epicenter.

Again, home care rightly holds essential-business responsibilities in this public health fight, caring for our nation’s most vulnerable. But these providers and their frontline staff also still need essential-business supports. Many of these supports require action from Congress.

Home care personnel deliver vital services to patients in their own homes, from rural farmhouses to high-rise city apartment complexes. They are treating more and more COVID-19-positive patients. Many of these patients are referred from overburdened hospitals who rely on home care agencies to help with decompression amid surging hospitalization rates. Home care needs personal protective equipment (PPE) but these providers are often left out of guidelines or government prioritization protocols.

To cope, providers and staff are making valiant efforts to implement protective measures in a setting where contact is all but impossible – whether it’s a nurse treating complex wounds or IVs prone to infection, or an aide meeting the mobility, nutritional, and bathing needs of a patient with dementia or disability, hand to hand, arm in arm.

This is demanding but vital work, and our surveys show that the vast majority of home care agencies in New York State are seeing at least a 10 percent decrease in their workforce capacity due to COVID-19 as well as near-term revenue losses of up to 30 percent or higher. We’ve appealed to Congress for funds to both stabilize home care providers and permit wage enhancements.

Most of home care is governed by regulations and payments from Medicaid and Medicare. New York State, in its administration of Medicaid, is allowing powerful tools like telehealth and other remote communications in place of home care visits, wherever feasible, so that home care providers get their own surge capacity relief. Home telehealth can maximize a clinician’s reach and help providers commit more resources to patients with the greatest needs. This includes the many thousand home care recipients deemed by state emergency preparedness procedures as having care requirements so critical that they cannot have any deviation from their physician-ordered plan of care.

Our state’s Medicaid program is also allowing providers to bill for these services. Not so for Medicare, where we need Congress to similarly respond on behalf of millions of beneficiaries nationally.

If a patient meets the Medicare home health eligibility criteria, home visits directed by the patient’s plan of care must be done in-person. And even if a home health agency elects to use telehealth as an unreimbursed addendum – in an effort to provide more robust care – the agency still faces documentation hurdles and the requirement for written, versus verbal, physician orders to do so.

Home care in New York has long led the country in use of telehealth to expand the reach of nursing and therapeutic care and clinical monitoring of patients at home. Our state elected leaders have employed a broadly flexible and visionary use of telehealth to promote patient care as well as worker and patient safety in the COVID-19 emergency. Washington should follow suit for Medicare.


Al Cardillo is President and CEO of the Home Care Association of New York State (, which represents nearly 400 health care providers that offer home- and community-based care to hundreds of thousands of New Yorkers each year.