When Efficiency Locks the Front Door
I ran the arithmetic on the Biden-Harris plan to expand home-based care versus the Trump policy freeze described around CMS, and the numbers have a familiar county-office quality: fewer new providers may look tidy on paper, but a locked door is not an appointment. Supporting family caregivers, improving care jobs, and helping seniors remain independent all require actual capacity—not merely a promise that capacity would be nice.
Fraud prevention matters. So does not confusing “fewer entrants” with “better access.” If legitimate home-health agencies and hospice providers cannot get through the front door, seniors wait, families absorb another unpaid shift, and care workers are asked to perform fiscal miracles before lunch. The spreadsheet may show fewer bad actors. It also shows a locked door, and the person outside still needs a caregiver.