Legislation

The Caregiver Stabilization Act

Addressing home care reimbursement

BY CAMEO ZEHNDER, JD

You know your patient should be experiencing all the first-year milestones in their own home, surrounded by family and friends cheering them on and supporting the parents through all the hardships a medically fragile child brings. But yet, as holidays and milestones roll around, the family spends their days and nights in their child’s small hospital room. They’ve voiced their concerns that they are emotionally and financially at the end of their rope and how their lives are being so drastically impacted by the lack of home care nurses in the area.

Unfortunately, this isn’t fiction. This scenario is playing out in hospitals across the country every day.

Home care nurses are paid significantly less than what nurses in hospitals are paid.

Nationwide Workforce Shortages

Workforce shortages have been plaguing industries across the board for several years, but the home health care industry seems to be taking one of the bigger hits. Home care nurses are a vital part of the health care industry, but do not reap the same benefits other hospital health care workers do. Home care nurses are paid significantly less than what nurses in hospitals are paid—35-55 percent less to be exact. This makes recruiting and retention nearly impossible in an already competitive job market. Home care nurses are caring for a child who was one day in the NICU being cared for around- the-clock, and the next day is ready for discharge but needing that same care at home. The level of care the child needs hasn’t changed, just the environment in which that care is taking place.



Home care nurse wages are limited by reimbursement levels established by Minnesota Medicaid. All agencies providing this service must work diligently to streamline all internal processes and operational costs to allow the maximum wage possible for the nurses. Even so, the reimbursement does not leave room for competitive wages when compared to hospital or clinic settings.

While the home care nurse workforce shortage is a challenge statewide, the impact is felt even more for families living in rural parts of the state. Patients in Greater Minnesota can see longer delays in discharging to home and less coverage once there, as the workforce is already limited in these areas, and competition with clinic jobs is untenable.

As of 2022, a survey from McKinsey & Company stated that about 32 percent of registered nurses are considering leaving their direct patient care roll. Their reasons for leaving the profession included insufficient staffing and pay, lack of support at work and the emotional toll the job takes on a person. It is time home care nurses are supported, valued and equally compensated members of the health care team. Organizations, doctors, families and legislative officials are ready to take a stand to combat this crisis by rolling out legislation that will increase the reimbursement rates for home care nursing services. This legislation can put new measures into place to help recruit and retain workers in the home care health industry.

Advocating for Patients

For many years, home care companies and representatives of the Minnesota Home Care Association have been advocating for improvements in the reimbursement rate, or more aptly, the pay for home care nurses. Currently, home care nurses’ wages are locked in based on the amount of reimbursement they receive from Medicaid and other private insurance companies. Over the past year, Minnesota lawmakers like Senator John Hoffman have been working toward finding ways to bridge the pay gap between home care and hospital care nurses. “Thousands of Minnesotans are struggling to live their lives with the dignity they deserve because they cannot get the daily care they need,” said Senator Hoffman. “Without this care, these Minnesotans are often unable to work, unable to get the medical care they need, and for some, are put into life-threatening situations. It’s a crisis that we must address as soon as possible.

Senator Hoffman has introduced a solution to the State Senate regarding the crisis facing the health care industry with the Senate File 1830. This bill will help reform the reimbursement model and allow nurses to be paid for their skill set, not the environment where they practice. The bill focuses directly on home health care, but there are other areas of health care that are also lobbying for reimbursement increases, such as long-term care, personal care assistants and support for the disabled community. If passed, the proposed legislation will increase the reimbursement for these services by 55 percent, which will allow for a significant increase in the wages for nurses caring for these complex patients at home.

Children‘s medical outcomes improve when they can be at home.

In 2023, Minnesota has a projected record budget surplus of $17.6 billion. The increase in reimbursement rates could be funded through this surplus. It is understood that these rates have a significant economic impact, but investing this way now will bring long-term stability, savings through reduced hospital stays, and ultimately, serve as a step in the right direction to solving this health care crisis. Most important, however, it will allow the complex children in need of nursing care to live in the comfort of a loving home as a family instead of in a hospital. “We have a historic opportunity to make sure those who provide essential care are receiving the wages they deserve,” said Senator Hoffman. “Now with an unprecedented budget surplus, we must boldly lead and live up to our responsibility of one Minnesota.

Transitioning from Hospital to Home

Supporting families throughout their whole home care journey—from the day they first go home to the day they no longer need home care services— is the aim of many providers. Bringing an infant home with a tracheotomy, a ventilator and a gastrostomy tube is an overwhelming experience for parents. Supporting these families with knowledgeable, confident nurses who can care for the child and let the parents be parents allows the child and family to meet and exceed medical milestones and outcomes. It has been proven time and time again that children‘s medical outcomes improve when they can be at home in a familiar environment with their family surrounding them.

These children can’t go home without nursing support. In the current state of the home care nursing crisis, hospital discharges are sometimes delayed over 90 days. In the NICU, costs are as high as $5,000 per day, which means a family could accrue upwards of $450,000 in avoidable health care costs if the appropriate nursing care was available at home. According to a study conducted by the Minnesota Hospital Association, a single week in December 2022 demonstrated a staggering 2,000 patients who were eligible for discharge but unable to transfer due to lack of capacity in post-acute care settings. Other studies show children with medical complexity represent only 1 percent of the pediatric population, but account for an estimated 30 percent of pediatric health care costs and 86 percent of hospital charges in US children’s hospitals. However, only 2 percent of Medicaid spending is attributed to home health care. We can do better by investing in home care services.

While Medicaid and commercial insurance plans help with the financial burden, the economic and emotional costs are significant. Home care is not only the more cost-effective option for medically complex patients, but it also allows the family unit to be in an environment where everyone succeeds. When nurses are available at home, parents don’t need to sacrifice their career and split their time between hospital visits, work and home.

It is very important to see the Caregivers Stabilization Act move forward so that home care nursing will have the ability to competitively recruit and retain these exceptional nurses for our families in need and get these children at home where they belong. This bill addresses the critical flaw in a system that has undervalued the importance of experienced, knowledgeable and professional caregivers in a home setting and instead keeps children in the hospital.

Dr. Brooke Moore, a pediatric pulmonologist at Children’s Respiratory and Critical Care, understands how the home care nursing shortage is affecting not only the families, but the hospitals as well. She is advocating for change in hopes of turning the crisis around. “With the lack of home care nurses, it is difficult to send our medically complex children home where they will thrive when they are stable enough to do so,” says Dr. Moore.  “This shortage has a ripple effect on the health care system. It’s keeping children in the hospital longer than necessary, and it’s preventing admitting other children who need specialized care due to space restraints in hospitals. We must be the voice for this change, so these children and families, present and future, can improve medical outcomes with quality care in a home-based setting by nurses who are compensated fairly and equally for the level of care they provide.

Working Together for Change

In a medically complex world, many advocates for those who are affected is the key to making sure their voices are heard and a sustainable change is made. Passing the Caregiver Stabilization Act will allow home care nurses to be recognized for the care and skill they bring as opposed to the environment where they practice. It will help children transition out of the hospital as soon as they are medically stable, ultimately saving valuable state healthcare dollars.

To support this critical legislation (SF 1830/ HF 2087), please contact your representative and senator to share the importance of this reimbursement increase. This topic has support in both the House and Senate, as well as from both political parties. Medically fragile children’s lives depend on these changes. Please reach out today. 

Cameo Zehnder, JD, is the chief administrative officer at Pediatric Home Service.