The conversation highlights three primary themes surrounding initial implementation:

• Targeted infrastructure vs. comprehensive care: Initial grants focus heavily on expanding physical capacity, such as ventilator and in-house dialysis service lines at specific facilities, rather than broader operational supports needed to address an increasingly complex patient population.
• Workforce access bottlenecks: While state funds target Licensed Nursing Assistant development, broader health workforce tuition initiatives requiring multi-year rural commitments often fail to accommodate the non-traditional schedules and preparation required for existing facility staff to advance. That won’t be solved by the latest federal funding.
• New resources in aging settings. Physical equipment grants often overlook the costly building renovations and specialized staffing required to modernize facilities built decades ago.

Addressing the gap between capital equipment grants and comprehensive operational support remains a primary focus for state advocates trying to ensure that rural health spending truly converts to long-term success.

"Even if you can connect a need to a particular line in a grant-making opportunity, there's still a lot more that needs to come together to make that program successful," Labun notes in the episode. "It's not as simple as handing out some equipment to make some of these programs a success."

Listen in to the full episode of McKnight's Newsmakers for more insights on how rural skilled nursing facilities are navigating federal grants, workforce bottlenecks and continuing to advocate for complex care initiatives.
 

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A short-term home health and moratorium was a necessary action because of rampant fraud in the hospice sector, said Tom Koutsoumpas, founder and CEO of the National Partnership for Healthcare and Hospice Innovation (NPHI). Still, the moratorium, which is designed to contain and address egregious activities, is meant to be a short-term solution, said Koutsoumpas, who was involved when the benefit was created in the 1980s. There has been an overreaction during the moratorium, he noted, and acknowledged that some of his members have been subject to unnecessary audits. While the question of the moratorium has divided provider organizations, more imperative is that the community as a whole support and encourage the Centers for Medicare & Medicaid Services in their fraud-fighting efforts, he said. The organization’s support of the moratorium and may be one reason why NPHI has experienced a surge of new members of late. On another subject, he is excited about the attention palliative care has been receiving from CMS in rulemaking. NPHI has proposed a palliative care model that would be adjacent to the hospice benefit. More details are forthcoming, he said.

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Show contributors:
McKnight’s Home Care Editor Liza Berger; Tom Koutsoumpas, founder and CEO, National Partnership for Healthcare and Hospice Innovation (NPHI)

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As a house call firm, Ennoble Care brings the most skilled clinicians to a patient’s house to provide essentially a doctor's office inside, CEO Kush Das explained. That slowly progresses to more longitudinal care with nurses and social workers and care managers supporting patients. The company serves both Medicare and Medicare Advantage patients, depending on the market. About 1 of every 2 Medicare patients it serves is in the ACO REACH model, Das explained. He is proud of the work of the Complex Care Alliance, which has advocated for high-needs Medicare patients in accountable care. He is bullish on the LEAD model, which will take the place of the REACH Model starting in 2027. The latest physician fee schedule proposed rule reflects the work involved in operating a house call company, he said. The company, which doubled in the last 12 months, will continue on a similar growth trajectory, he said. The federal hospice moratorium — which he believes in — will hurt the company's efforts to grow hospice in the short term, he said. 

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he International Home Care Nurses Organization is a gathering of international nurses — ranging from RNs to clergy, aides and therapists — who come together to share what they know about home healthcare nursing. Susan Hinck, PhD, president of organization, and Marilyn Harris, RN, a board member, recently returned from a three-day global conference in London at which nurses represented 33 countries. It’s helpful to learn what other countries are doing in the area of home healthcare nursing, Hinck said. The Scandinavian countries —with their universal access to healthcare — in particular are an international model of strong home care nursing. Technology has allowed nurses in the home to provide more hands-on care, Hinck said.  And the increased focus on social determinants of health has helped to improve the health of home care patients, Harris noted.

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