U.S. Senator Ben Cardin

Letters From Ben

September 23, 2023


Dear Fellow Marylanders,

Myrna and I have lived in our home since 1993. We have welcomed countless family and friends and watched our granddaughters grow in this house. Our neighborhood is a community we treasure. For us, like so many families, our house is more than a physical structure but a sanctuary of comfort and solace, brimming with cherished memories. It truly is a place to belong.

As more Americans are living longer, more are choosing to make their home a central part of their retirement plans. They want to stay and receive health care in their home.

Whether you’re a senior preparing for retirement or a young adult who may need to care for an aging family member, home health is an issue that affects millions –and will impact almost everyone at some point in their lives. Although Maryland, and elsewhere in our country, has many excellent continuing care facilities, the preference for most seniors is to stay in a place that’s familiar and full of memories. This means home.

In a survey by AARP, 77 percent of adults 50 and older responded that they want to remain in their homes for the long term. For many seniors that I meet while traveling across Maryland, the number one fear is that they would not be able to stay in their homes and will be forced into an institution or nursing home because of a lack of other affordable options

It’s a painful dilemma but one that I am working to expand viable options. This week, I led an important hearing of the Senate Finance Subcommittee on Health Care on aging in place. The U.S. Centers for Disease Control and Prevention (CDC) defines aging in place as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” Our hearing highlighted several barriers to home care, like affordability and timely access to care, while also acknowledging the significant potential of home health if those challenges are overcome.

You may not be aware that Medicare allows over 65 million aging Americans to afford health services including aging in place. In 2021, approximately 3 million beneficiaries in traditional Medicare received Medicare home health benefits. In Maryland, more than 120,000 beneficiaries were supported. Despite those encouraging statistics, far too many Medicare beneficiaries have challenges accessing home health care, and the options are shrinking rather than growing as the potential user-base expands.

Many individuals who are eligible for both Medicare and Medicaid do not have their benefits appropriately coordinated to ensure they are getting the most out of the home care services they are entitled to.

Medicaid Home and Community-Based Services (HCBS) are a lifeline for millions, providing opportunities for Medicaid beneficiaries to receive services in their own home or community rather than in institutions or other isolated settings. HCBS programs address the needs of people with functional limitations who need assistance with everyday activities, and in 2021, they served about 1.9 million people. Unfortunately, many states have waitlists, which impede the ability for people to live in their local community. In 2021, more than 30,000 Marylanders were on the HCBS waitlist; one of the longest in the country.

The COVID-19 pandemic exacerbated workforce issues, and financial challenges for many home health agencies that are struggling to care for the rising number of people who are seeking care. In some cases, they are struggling just to stay open. These challenges are felt even more deeply in rural and underserved communities.

Additionally, the current policies and payment incentives in the home health benefit make it hard for individuals with chronic conditions, who need skilled care, to access it in their home. And often, Medicare beneficiaries are misinformed about their home health benefits and get cheated out of critical services.

At our hearing this week, Judith Stein, founder and Executive Director of the Center for Medicare Advocacy, outlined this particular issue in her testimony saying,

Access to Medicare home health aides is disappearing. Home health aides provide help with personal, hands-on care. The care is often key to the well-being of patients who want to age in place, as well as for their families and caregivers. Unfortunately, Medicare beneficiaries are often misinformed about Medicare home health coverage in general and home health aids in particular. They are told that it’s for a short term, for a few weeks, for a bath from the home health aide, just for one to three times a week. Under the law, Medicare authorizes 28 to 35 hours a week of personal aides’ home health care. Instead, this care is being shifted to state Medicare programs and families.”

At present, the Medicare home health program is not optimized, or well-suited, for aging in place for most beneficiaries. As more Americans retire each day, it is vital that programs, like Medicare Home Health, function as they should when people need them. We must create workable solutions. 

There are many examples across the country where we’ve been able to combine private resources with government resources to help seniors age in place.  Over a decade ago, Baltimore, for example, established a public-private partnership with The Associated for aging in place. It has since become a national model.

Home health provides so much promise to ensure that older adults and people with disabilities can safely age in place. Aging in place typically is less costly, provides individuals greater personal dignity and a relatively better quality of life.

Everyone should have control over their life decisions. This should include the option to spend the end of your life where your heart is – at home.

Thank you for your time. If you want to share your thoughts on this or any other topic, please reply directly to this email. I look forward to hearing from you.



Ben Cardin