The Positive Aging Community recently hosted a discussion on the PACE (Program of All-Inclusive Care for the Elderly) program, featuring Ron Hess, Executive Director of Cherry Blossom PACE. The PACE program is a comprehensive healthcare solution designed to help older adults remain in their homes rather than moving to institutional settings. It provides a coordinated package of medical, physical, emotional, and social services, including transportation, delivered by a familiar team. Originating in San Francisco in the 1970s, PACE has expanded to over 180 programs across 33 states, offering a cost-effective alternative to traditional Medicaid services. The program is available to individuals aged 55 and older who meet specific medical and residency criteria. While most participants are enrolled in Medicaid, PACE also accommodates those with Medicare or private pay options. The discussion highlighted the program's adaptability, its role in facilitating proactive care, and its partnerships with various healthcare providers. For those interested in starting a PACE program, the National PACE Association offers resources and guidance. The session emphasized the importance of reaching out to local PACE programs for personalized assistance and information. 

• Ronald Hess [email protected]
• National PACE Association
• PACE Programs Nationwide: Comprehensive Directory of 186 Providers Across 33 States

Cherry Blossom PACE Contact Information

• Phone: 571-789-0770
• Toll-Free: 888-524-2060
• Fax: 571-775-3946
• Email (General): [email protected]
• Email (Enrollment): [email protected]
• Website: https://cherryblossompace.com
• Address: 1901 N. Beauregard St., Ste. 110, Alexandria, VA 22311

Who Is Eligible for PACE?

Eligibility for PACE is determined by four basic criteria:

• Age 55 or older

• Residency within a defined service area (determined by zip code)

• State-specific medical eligibility—typically requiring some assistance with daily living due to health conditions

• Ability to be safely served in the community

Each program performs its own assessment to determine if participants can be safely supported outside of institutional settings. The Cherry Blossom PACE program, for example, serves Alexandria, Fairfax, and Arlington counties in Northern Virginia and provides transportation and home services within those regions.

While most PACE participants are Medicaid recipients, qualifying for Medicaid is not a requirement. For those with Medicaid, care is typically covered in full. Participants without Medicaid may enroll via Medicare, or privately, paying a fixed monthly premium (often less than what a nursing facility would cost), with all specialty care, medications, and transportation included—no copays or deductibles.

PACE is designed to be efficient: on average, states spend about 12% less on PACE enrollees compared to other Medicaid services. Importantly, the program has shown resilience to Medicaid funding changes, remaining largely insulated from recent cuts.

PACE is much more than an adult day program or a simple provider network. It operates as both a health plan and provider, coordinating hands-on healthcare, specialty services, medications, and transportation. Cherry Blossom PACE, for instance, partners with local vendors, specialists, and service providers to deliver everything from home modifications to primary care, while maintaining a closed pharmacy model for safety and consistency.

Even continuity with outside primary care providers is possible if a contract is in place. The essential principle is flexibility and individualized care planning. Home care, for example, can include assistance with meals, exercises, and companionship—tailored to each participant’s daily needs and lifestyle.

Retirement is often envisioned as the reward at the end of a long career, but too many people find themselves adrift once finances are settled, lacking a sense of purpose and fulfillment. Cyn Meyer, author of "The Rewire Retirement Method: Ailing from Aimless to Amazing," and founder of Second Wind Movement, offers a transformative approach to redefining retirement—one built not on financial spreadsheets, but on neuroscience, clarity, and sustained personal growth.From Aimless to Amazing: Redefining RetirementTraditional retirement planning focuses almost exclusively on money—401ks, nest eggs, and the dream of untethered leisure—but the real challenge is psychological and emotional. Meyer’s experience as a life coach for retirees, combined with personal family events and a background in neuroscience, led her to create a system that unlocks genuine fulfillment after career ends. She saw firsthand retirees with substantial assets fall into a "retirement rut": losing momentum, purpose, and zest for living, which often gives way to anxiety, depression, and a sedentary lifestyle.The Rewire Retirement SystemMeyer’s method, built into a three-month program and distilled in her book, centers around clarity before action. Instead of rushing to fill time with stereotypical pursuits like pickleball or beach days, her system guides individuals to uncover their authentic identity for this new phase. The process leverages neuroscience, notably the reticular activating system (RAS), prodding the brain daily toward new, meaningful pathways that fuel purpose.The method breaks retirement into "Five Rings," each representing a part of this holistic journey:Giving Back: Community involvement, volunteering, sharing wisdom.Recreation: Physical, creative, and leisure pursuits.Connection: Building deeper relationships and family ties.Personal Growth: Learning new skills, overcoming challenges.Legacy: Creating impact and meaning, be it through family, professional boards, or artistic expression.Rather than an all-at-once overhaul, the program recommends microsteps—small, daily actions (about 20 minutes a day)—to incrementally build a life that is both unique and deeply satisfying. The approach emphasizes that retirement is a launchpad for upward growth, not a period of descent or withdrawal.Real Success and ResilienceThe outcomes of Meyer's approach are as unique as the individuals who use it. Some find renewed drive—like the client who, after severe health setbacks and mini-strokes, used the microstepping system to reconnect with family, grow stronger physically, and hike mountains by age 70. Others discover latent passions, such as joining professional boards, writing books, or grandparenting with deeper relationships.Importantly, Meyer notes that the age at which someone begins this journey is irrelevant—what matters is the internal search for what’s missing. Everyone is vulnerable to feeling "rudderless" if purpose is lacking, regardless of physical health or previous achievements. Her message is clear: when that subtle void appears, it’s time to act.Individuality Over ComparisonOne vital lesson Meyer shares is to resist comparing retirement journeys. Each person is an individual, with unique dreams, goals, and intrinsic motivators. The path in this new chapter should be drawn inwardly, not by keeping up with the societal or financial benchmarks of others.Getting Started: Tools and AccessFor those interested, Meyer offers entry points through her website, SecondWindMovement.com, which includes a free masterclass and courses such as the 14-day Purpose Jumpstart. Her book is available for deeper self-guided exploration. The goal is accessibility for anyone, not just those who can afford private coaching.

In a compelling virtual roundtable hosted by Steve Gurney on the Positive Aging Community platform, three seasoned Aging Life Care Managers (ALCMs) shared their expertise and personal journeys on September 10, 2025. Featuring Samantha McDaniel of Aging Individualized (Maryland), Leslie Mason of Seabury Care Management (DC metro area), and Annette Murphy of Spring Point at Home (New Jersey), the discussion offered a deep dive into the holistic role of ALCMs, addressing real-world challenges like dementia care, emergency preparedness, and family dynamics. Spanning 14 pages of transcribed insights, this session provided actionable strategies for families and professionals alike.

The panelists’ diverse backgrounds underscored the adaptability of ALCMs. Samantha McDaniel, a solo practitioner with over 10 years in senior living, founded Aging Individualized to deliver personalized care across Maryland and virtually. Her shift from community roles to home-based support was driven by a desire to "impact change" directly where clients live. Leslie Mason, a clinical manager at Seabury since 2004, transitioned from teaching and pediatric social work after a chance hospital encounter with a care manager, now serving older and disabled adults in the DC region. Annette Murphy, leading Spring Point’s home division, brought a geriatrics-focused career from therapy and social work, joining the field after mentorship from a national ALCM, seeking freedom to follow clients’ needs.

Annette Murphy clarified the ALCM role, noting that the term “Aging Life Care” is trademarked by the Aging Life Care Association (ALCA), requiring vetted members to adhere to a strict code of ethics. With backgrounds in social work, nursing, gerontology, or recreation therapy, ALCMs assess the “whole person”—physical, emotional, social, and environmental needs—crafting tailored care plans. Gurney likened them to “wedding planners,” “quarterbacks,” or “wing people” for aging, emphasizing their role in resource navigation and mediation. Leslie Mason added that ALCMs are “big thinkers” who dive into details to enhance quality of life, while the ALCA’s eight knowledge areas (e.g., health, housing, legal) guide their practice. Families can find local ALCMs via the ALCA website by zip code.

Dementia Care and Initiating Change (Samantha McDaniel): McDaniel noted a rise in calls from families struggling to start conversations with loved ones with dementia. In one case, a woman with mid-stage dementia, isolated and calling ambulances frequently, shifted to assisted living after McDaniel’s questions about quality of life—“What do you wake up for?”—led to a self-initiated respite stay where she thrived. She emphasized ALCMs as mediators, helping families navigate resistance objectively.

Young Onset Dementia and Dual Needs (Leslie Mason): Mason highlighted the growing challenge of young onset dementia (e.g., Alzheimer’s under 65), where resources for older or middle-aged adults fall short. Seabury’s information line addresses this “heartbreaking” gap, while she also supports parents of adult children with disabilities facing physical limits, requiring dual-age management.

Emergency Preparedness as a Gift (Annette Murphy): Murphy introduced a crisis planning kit, mandated for Spring Point clients, covering evacuation plans, water shutoffs, and “go bags” with emergency contacts. Inspired by her FEMA experience, she framed it as a “roadmap” for solo elders and out-of-state families, addressing power outages and snowstorms. This initiative, expandable to all ALCMs, offers peace of mind.

Handling Complex Family Dynamics (Tina’s Case): Tina’s question about a verbally threatening mother, despite a social worker’s involvement, led to suggestions: home-visiting physicians for documentation, psychiatric crisis intervention if needed, and building a professional network. The panel urged assessing competence and risk, offering post-call consultations.

Conversation on the Positive Aging Community platform, host Steve Gurney sat down with George Jerjian, an author, speaker, and thought leader specializing in life's transitions. Jerjian, whose latest book is Odyssey of an Elder, shared his personal journey from a life-altering health scare to embracing retirement as a profound opportunity for growth. The discussion delved into themes of identity, purpose, gratitude, and adventure, offering valuable lessons for anyone approaching or navigating later life stages.A Wake-Up Call: From Diagnosis to DiscoveryJerjian's transformative path began in 2007 when he was diagnosed with a bone tumor and given just six months to live. Contrary to expectations, the experience didn't fill him with fear of death itself but rather concern for his teenage daughters. Miraculously, the tumor proved non-cancerous, but the brush with mortality reshaped his priorities. "Time is the most important thing," Jerjian emphasized, prompting him to semi-retire after a successful career.However, after 18 months of leisure, boredom and resentment set in. In 2016, seeking clarity, Jerjian embarked on a 30-day silent retreat inspired by Ignatian spiritual exercises—a rigorous program of introspection, often drawing from Catholic and Buddhist traditions. Isolated from external distractions like news, TV, or books, he conducted a deep "audit" of his life, reflecting on past homes and experiences. This revealed a key insight: "None of the good things could have happened without the preceding bad things." Crises, he realized, are turning points rather than endpoints.This epiphany led to his first book, Spirit of Gratitude: Crises are Opportunities, where he profiled 12 stories illustrating how challenges foster growth. Jerjian challenged the cultural view of retirement as a "problem," arguing it's a fork in the road where one's work-tied identity must evolve. He also highlighted how physical spaces, like homes, can anchor identity, urging listeners to declutter—both materially and emotionally—to make room for new beginnings.The DARE Method: A Framework for ReinventionCentral to Jerjian's philosophy is his DARE method, an acronym standing for Discover, Assimilate, Rewire, and Expand. He described it as a courageous approach to unretiring and crafting a fulfilling next chapter:Discover: Understand retirement's history and essence—it's not just financial planning but life planning. Jerjian referenced ancient thinkers like Cicero, who viewed old age as life's "crown," countering modern society's dismissal of elders as obsolete.Assimilate: Absorb new knowledge about the mind, particularly the subconscious. Willpower alone fails; the subconscious often sabotages goals. Jerjian stressed that we are not our thoughts but observers of them, advocating for releasing unhelpful ones.Rewire: Rewrite limiting stories from childhood, family, or society. By "recording over" old narratives, individuals can foster positive change.Expand: Counterintuitively, retirement should involve growth, not contraction. Gratitude plays a scientific role here, connecting thinking and thanking to open doors for more abundance. Jerjian advocated shifting from consumerism's dissatisfaction to a service-oriented mindset, inspired by Samurai ethos.Jerjian ties this to broader societal benefits, noting that serving others alleviates personal troubles and infuses life with nobility.

In a recent discussion hosted by Steve Gurney of the Positive Aging Community, Lisa Pahl, a licensed clinical social worker and co-creator of The Death Deck, shared insights into her innovative tool designed to spark meaningful conversations about end-of-life decisions. With 18 years of experience in hospice care and eight years in emergency medicine, Pahl identified a critical gap in how families approach death and dying. Too often, the absence of prior discussions leads to conflict and distress when making healthcare decisions during a medical crisis. The Death Deck, created in 2018, aims to bridge this gap by encouraging open dialogue in a lighthearted yet profound way. Pahl, who became the sole CEO of The Death Deck after buying out her business partner in 2025, continues to expand its reach.What is The Death Deck?The Death Deck is a card game designed to make end-of-life conversations more approachable. By incorporating humor and multiple-choice questions, it helps individuals and families discuss sensitive topics without the heaviness that often accompanies them. Pahl explained that the deck was born out of her desire to reduce chaos and uncertainty at the end of life by empowering people to share their preferences well before a crisis. In 2023, Pahl and her team expanded their offerings with the EOL (End of Life) Deck, a professional tool tailored for hospice and palliative care settings. This deck adopts a softer tone with less humor, focusing on detailed end-of-life preferences.A third deck, the Dementia Deck, is set to launch on September 1st in collaboration with Compassion and Choices. This deck, inspired by their Dementia Values and Priorities Tool, helps individuals articulate care preferences for different stages of dementia, addressing a condition many fear more than death itself.Why These Conversations MatterPahl emphasized that discussing end-of-life wishes is like exercising a muscle—it requires practice to become comfortable. Many avoid these conversations due to fear, believing that talking about death might somehow hasten it. The Death Deck’s cards prompt reflection on personal and family attitudes toward death. For example, one card asks, “Growing up, my family dealt with death by: A) talking openly, sharing feelings, stories, and dark humor; B) in a no-nonsense sort of way—shit happens, you move on; or C) keeping it all bottled up and avoiding any discussion.” Pahl shared that her upbringing leaned toward options A and B, with humor often used to cope, while Gurney noted that his family leaned toward avoidance, but his professional work has shifted his perspective, encouraging more open dialogue.How The Death Deck is UsedThe Death Deck serves as a versatile tool for both families and professionals. For families, it provides a structured yet approachable way to discuss end-of-life wishes, often using humor to ease tension. Professionals, particularly in hospice and palliative care, find the cards useful for initiating conversations without making patients or families feel overly vulnerable. As Pahl noted, “It feels a little less vulnerable when I am reading something off a card than if I’m just staring into your eyes asking how you feel about visitors as you’re declining.”A Tool for Living WellUltimately, The Death Deck is not just about preparing for death—it’s about living more intentionally. As Pahl and Gurney discussed, reflecting on end-of-life preferences often prompts people to prioritize relationships and values in the present. For those interested in exploring this tool, The Death Deck and its companion decks are available at thedeathdeck.com, where additional resources and a blog provide further support for end-of-life planning. As Pahl’s work demonstrates, embracing these conversations can transform fear into empowerment, ensuring that both life and death are approached with clarity and connection.

Steve Gurney of the Positive Aging Community recently sat down with Tom Najjar, Co Founder & President, and Heather Najjar, Co Founder & Chief Clinical Officer of CarePlus Home Health, to reflect on the organization’s three decades of service, its deep roots in the community, and its vision for the future.A Personal Start Focused on QualityCarePlus Home Health was founded in 1995 when Tom Najjar was caring for his father during end-of-life. The experience inspired him to launch CarePlus not only as a business but as a mission to provide quality, compassionate care. From the start, Tom emphasized quality over growth: “We wanted to have a good reputation and rely on referrals rather than advertising. We built a reputation we’re proud of and made many partnerships within the community.”Leadership with Clinical StrengthHeather Najjar, a doctorally-prepared nurse practitioner with 32 years of experience, helms the clinical side of CarePlus. She leads a robust team, all registered nurses, ensuring education and professional development are continual priorities. “Our clinical leadership team is especially strong,” Heather shared, highlighting ongoing training and opportunities for caregivers to develop their skills.Flexible, Community-Based CareCarePlus stands out for its adaptable approach to home care. The organization has established close partnerships with a variety of residential settings, including independent and assisted living communities, and offers what it calls "flex care." This allows clients to receive services starting at just 30 minutes and up to full 24/7 care, making professional support accessible and affordable even for those who might only need occasional help.Heather noted the unique value CarePlus brings to independent living communities that lack in-house healthcare: “We fill the gap where there’s either no care or not enough care, providing everything from hands-on support to light housekeeping and transportation.”Commitment to Excellence in TrainingA key differentiator is CarePlus’s investment in professional training. All caregivers undergo an annual two-day skills event as well as in-person orientation and return demonstrations for new employees. The clinical team regularly refreshes caregiver skills and provides remediation when needed. Tom credits much of the company’s reputation and client satisfaction to this strong foundation of education and support: “The strength is the clinical team, making sure our caregivers are up to speed on what they need to know and do.”A Culture of Collaboration and Giving BackTom and Heather emphasized the importance of collaboration—both within their team and across the wider caregiving community. Tom reflected, “I don’t look at competitors as competitors. We refer to and rely on each other for services and information. It makes us all stronger.” This collaborative ethos extends to supporting other agencies and building a network of trusted providers.Looking Back and AheadWith staff members who have remained part of the CarePlus team for decades, Tom and Heather are proud of the supportive community they’ve built, not only among clients and families but also within their own organization. As Heather summed up: “I love the focus on training and a career path for our caregivers. It's a wonderful mission.”As CarePlus enters its fourth decade, the Najjars’ commitment remains unwavering: delivering personalized, quality care while supporting caregivers and the entire community. Their story showcases what’s possible when compassion, professionalism, and community engagement come together in service of others.

Wound care is a vital aspect of healthcare, particularly for people with chronic or complex wounds, such as diabetic foot ulcers, pressure ulcers, venous leg ulcers, and post-surgical wounds. In the United States, these wounds affect about 6.5 million individuals, with annual costs exceeding $25 billion. They commonly arise from diabetes, poor circulation, or immobility, and if left untreated, can result in infections, amputations, and reduced quality of life. Recently, mobile wound care has emerged as an innovative solution that brings specialized treatment to patients’ homes or care facilities. This article synthesizes the essentials of wound care, highlights the benefits of mobile wound care, and shares insights from a Positive Aging Community discussion with Ashley Harris (Advanced Mobile Wound Care of Virginia) and Andre Atkins (Alternate Solutions Home Health).

Watch the episodeWhat is Wound Care?Wound care comprises medical interventions to promote healing and avoid complications in wounds that don't heal naturally. It involves cleaning, debridement (removing dead tissue), dressing changes, infection prevention, and advanced therapies like biologic grafts or negative pressure wound therapy.Benefits of Mobile Wound Care1. Accessibility and ConvenienceMobile wound care overcomes logistical obstacles—patients no longer need to arrange transportation or travel long distances. Providers deliver care wherever the patient resides, ensuring consistent treatment for those with mobility or scheduling challenges.2. Advanced Technologies and ExpertiseMobile providers use advanced tools like biological placental grafts and ultra-mist debridement systems, increasing comfort and healing rates. These certified specialists focus only on wound management for high-level care.3. Improved Compliance and HealingPain, transportation, or dissatisfaction can lead to missed appointments and slow healing. Mobile care ensures regular visits, cutting down cancellations and enhancing adherence. Consistent care can reduce hospitalization rates and risk of reinfection.4. Personalized, Collaborative CareTreatment plans are tailored in collaboration with physicians, home health agencies, and caregivers. Providers like Harris emphasize close work with home health teams to ensure continuous care between visits.5. Patient Choice and EmpowermentPatients can request mobile wound care, especially when traditional options are inaccessible or ineffective, giving them more control over their healing journey.6. Support for Care FacilitiesMobile wound care reduces administrative burdens for care facilities by providing on-site expertise, letting staff focus on daily caregiving while residents receive specialized treatment.While mobile wound care offers notable advantages, some cases may still require hospital-based interventions. Availability can vary by location, and the post-pandemic loss of experienced clinicians has made these specialized teams even more valuable. Mobile wound care teams combine advanced skills with patient education, supporting effective wound management between visits.Overall, mobile wound care is a major advancement for patients with chronic or complex wounds who face barriers to traditional care. By delivering specialized, evidence-based treatments at home or facility, providers like Advanced Mobile Wound Care of Virginia and Alternate Solutions Home Health are improving healing, reducing complications, and elevating quality of life. As highlighted by Harris and Atkins, the combination of advanced technology, expertise, and patient-centered care makes mobile wound care a transformative option for those in need. To learn more, individuals can contact providers or consult their home health agency about available options, as mobile wound care continues to grow as a compassionate, effective solution.

The phrase "I'm not ready yet" is a common refrain in elder care, as Steve Gurney, founder of the Positive Aging Community, shared in a 2025 webinar. Heard daily for 35 years, it reflects hesitation to plan for aging, from housing to legal prep. A community-driven discussion, sparked by surveys and a concise PowerPoint, unpacked this sentiment's roots, risks, and solutions.What It MeansGurney’s slides listed key triggers: aversion to age-segregated living, affordability fears, emotional downsizing burdens, resistance to strangers in the home, and denial of health decline. Participants added depth via chat: Pam said, “We don’t see ourselves as old. I’m frozen at age 53.” Dixie noted, “Folks aren’t ready to face mortality.” These reflect self-perception and fear, often tied to ageism—prejudice against one’s future self.Why We HesitateEmotional attachment to homes, financial uncertainty, and independence fears drive delays. Gurney highlighted longevity concerns: with people living past 90, costs loom large. Health denial—“I’m fine now”—blocks planning for scenarios like dementia. Attendees like Wally feared becoming a burden, while Joe said it’s easier to imagine death than incapacitation.Risks of DelayProcrastination limits options, as Gurney’s slide warned. Health crises or emergencies force rushed choices, reducing control. Early planning ensures choice in living arrangements and access to benefits like social programs or peace of mind. Phyllis shared her mother’s 19-year dementia journey, showing aging in place is possible but tough without prep.Helping OthersTo counter “I’m not ready yet,” Gurney advised empathy: “I get it—I don’t want to leave my home either.” Encourage open talks about fears, share stories of regretful delays, and suggest gradual steps like adult daycare “test drives.” Legal prep—wills, trusts, advance directives, HIPAA forms—was urged by attendees like Florence.Moving Forward“I’m not ready yet” is human but surmountable. The webinar’s breakout rooms fostered candid chats, reinforcing community as key. Planning now—whether for housing, care, or documents—offers control and dignity. As Gurney’s platform, positiveaging.com, provides resources, the message is clear: readiness shapes a purposeful future.

Engaging discussion features Steve Gurney from the Positive Aging Community and bestselling author Jane Heller, focusing on her book "You'd Better Not Die or I'll Kill You: A Caregiver's Survival Guide to Keeping You in Good Health and Good Spirits." Jane shares her journey from a book publicist to a successful author, highlighting her personal experiences as a caregiver for her husband, Michael, who has Crohn's Disease, and her mother, who had dementia. The conversation delves into the challenges and strategies of caregiving, including the importance of humor, maintaining personal health, and building a supportive community. Jane emphasizes the necessity of having an advanced directive and shares insights on dealing with medical professionals and the emotional toll of caregiving. The discussion also touches on the unexpected friendships and personal growth that can arise from caregiving experiences. Jane's candid reflections offer valuable advice and encouragement for those navigating the complexities of caregiving.

More information: https://janeheller.com/

Book on Amazon: You'd Better Not Die or I'll Kill You: A Caregiver's Survival Guide to Keeping You in Good Health and Good Spirits

Recording Link: https://www.retirementlivingsourcebook.com/videos/you%E2%80%99d-better-not-die-or-i%E2%80%99ll-kill-you-a-caregiver%E2%80%99s-survival-guide-to-keeping-you-in-good-health-and-good-spirits

Howard Gleckman, a senior fellow at the Urban Institute and Forbes columnist, provided a comprehensive overview of recent public policy changes affecting older adults. Drawing from his expertise in aging and tax policy—stemmed from personal caregiving experiences—Gleckman analyzed the implications of the Trump administration's "big beautiful bill" and related executive actions as of August 2025. The focus was on Medicaid and Medicare reforms, which could reshape long-term care, costs, and access for millions of seniors and people with disabilities.

Medicaid, which supports about 7.2 million seniors and 4.8 million younger disabled individuals (dual eligibles), faces a $1 trillion reduction in federal spending over the next decade. Key changes include:

• Work Requirements and Paperwork: Starting potentially in December 2026, states must impose work mandates, though older adults and those with disabilities are exempt. Family caregivers' status remains unclear, risking benefit loss for those quitting jobs to provide care. Recertification is now required at least twice yearly, increasing administrative burdens and potentially deterring eligible recipients.
• Funding Reductions: Limits on state provider taxes (e.g., on nursing homes) will cut federal contributions by about $120 billion starting in 2028. Expansion states under the Affordable Care Act lose extra funding from January 2026, forcing tough choices: cut benefits, limit eligibility, or raise taxes. Gleckman warned that optional home and community-based services (HCBS) are most vulnerable, as nursing home care remains mandatory. While the bill allows states to expand HCBS for less needy individuals without lengthening waitlists, funding cuts make this unlikely.
• Staffing and Workforce Impacts: The bill repeals Biden-era minimum staffing rules for nursing homes until 2034. Combined with mass deportations, this exacerbates shortages of direct care workers, driving up costs for facilities and families.

Gleckman emphasized that states may prioritize institutional care over community-based options, potentially worsening outcomes for older adults preferring to age at home.

Despite campaign promises to protect Medicare, changes aim to curb fraud, boost efficiency, and emphasize prevention—but at the risk of higher costs and reduced access:

• Prior Authorization Expansion: For the first time, traditional fee-for-service Medicare will require prior approval for 17 procedures (e.g., back surgeries, pain injections) in a six-state demo (New Jersey, Ohio, Oklahoma, Texas, Arizona, Washington). CMS plans to use AI for reviews, with human oversight.
• Payment Adjustments: Skilled nursing facilities see a 2.8% payment increase for 2026, deemed insufficient by the industry. Home health agencies face a 6.4% cut ($1 billion+), sparking bipartisan opposition. The Labor Department repealed Obama-era rules, allowing home care workers to earn below federal minimum wage ($7.25/hour) and exempting them from overtime, per state laws.
• Enrollment and Programs: Easier enrollment in Medicare Savings Programs (for low-income beneficiaries) is delayed until 2034. The GUIDE program for dementia care navigation continues but with penalties if it fails to improve outcomes or save money. Value-based care is expanding, rewarding providers for quality over volume.
• Drug Pricing and Hospice: Trump favors "most favored nation" pricing to align U.S. drug costs with foreign markets, potentially supplementing Biden's negotiations. Hospice faces crackdowns on alleged fraud, though details are pending.

Gleckman noted deregulation of nursing homes (e.g., rolling back transparency rules) and potential reductions in Medicare Advantage supplemental benefits like gym memberships due to insurer financial pressures.