Top Home Care Trends For 2025

The spotlight on personal home care has gotten brighter in recent years, and that will continue in 2025. The population will continue to age, while payment models, regulatory policy and technological innovation will continue to enable more people to receive care in their preferred setting – their own home.

But despite these tailwinds, the path toward achieving long-term business success is not straightforward. Providers will be seeking the right strategy for business sustainability in the new year as the change in presidential administrations creates a shakeup at the federal level, while certain ongoing trends – including in labor and tech – continue to shape the market.

In this week’s exclusive, members-only HHCN+ Update, I’m pleased to share the top home care trends for 2025, as identified by the Home Health Care News Team.

Curious what we forecasted for last year? Revisit our 2024 predictions here.

Minimum hours become an outdated business model

To appeal to more clients, private-pay providers will eliminate minimum-hour thresholds, which will drive diversification and alternative business models in 2025.

For decades, agencies have operated simple business models. Broadly, that goes like this: charge a certain amount for services per hour, with half going to the caregiver and half going to the agency.

But caregivers becoming more expensive has significantly increased the billing rates that clients and their families have to pay. With that, more Americans are being priced out of home care.

The wealthiest Americans can afford home care. Those that qualify for Medicaid can access home care. But it’s those in between that get left behind.

That’s why providers will look to change things up in 2025, specifically when it comes to minimum-hour thresholds.

“I think you have to diversify,” Senior Helpers COO Mari Baxter told HHCN in 2024. “You have to look at all avenues. And we’re trying to get to all clients, not just the people that can afford care.”

Traditionally, home care providers have raised rates with the market and also required clients to commit to a certain number of hours per week.

Senior Helpers – and others – are moving away from that.

“At one point, you had to have at least eight or nine hours of care per week, or maybe even 20 hours per week,” Baxter said. “You had to have a minimum, and that minimum is no longer part of what we believe is the fair and the right thing to do. So we’re encouraging no minimum hours.”

Home care ‘Trump Effect’ includes end of 80-20 rule

Like in home health care, personal home care will see a demonstrable regulatory shift with Donald Trump taking back the Oval Office.

Most likely, that shift will come from an axing of the Medicaid Access Rule, or at least some of its provisions. The Medicaid Access Rule, finalized in 2024, aimed to standardize accessibility and quality in HCBS.

The aspect of the Medicaid Access Rule that drew the most scrutiny and attention from providers was the 80-20 provision. Broadly, 80-20 – which was set to be implemented closer to 2030 – would force providers to direct 80% of reimbursement to frontline worker wages.

Provider leaders argued that a blanket provision would actually reduce access to care.

But, after much discussion over the positives and negatives tied to it, the rule could be discarded.

“Our government relations folks have been working with our various associations as we’ve talked to the Trump administration,” Addus Homecare Corp. (Nasdaq: ADUS) CEO Dirk Allison said in December. “What we understand now is that during the first year of the administration, we believe that he will do away with the Medicaid Access Rule, which is what we expected. That is definitely, I think, a tailwind for us.”

For the future of HCBS broadly, that may be a hit. Industry insiders generally thought the Medicaid Access Rule – overall – was good regulation. The 80-20 provision, however, drew a lot of criticism.

The 80-20 provision going away would be good news for HCBS providers, but also private-pay providers, given their expectations for what the provision would do to the cost of labor.

Greater regionalization creates market imbalances

Regardless of federal policies such as the Medicaid Access Rule, state-level variations in policy will be a powerful force shaping the sector in 2025.

This trend already began in 2024. Addus, for example, left New York. But that wasn’t because the organization planned to downsize.

“New York authorizes about four times as many hours, per month, as any other state in which we operate,” Allison said, explaining the move. “So normally where we’d get about 50 hours a month, we’re seeing 200 hours a month in New York. It was a program that’s very expensive to run. Their answer was to continue to reduce pricing. For us, while it’s $100 million in revenue, it’s really zero on the bottom line — we were making nothing.”

Around the same time, the company agreed to acquire Gentiva’s home care assets for $350 million. That entered Addus into new states where company leaders expect to generate a meaningful bottom line.

Part of the reason why providers didn’t like the 80-20 provision was because of how varied reimbursement and regulations are in different states across the country.

Providers will continue to expand in 2025, but will look to build out density in markets that are easy to do business in and – as was the case with Addus in New York – exit less favorable areas.

Take Village Caregiving, for example. The provider is a rapidly growing, nationwide provider. It would like to be in all 50 states, taking all payer sources, but that’s not currently a sustainable business plan.

“We went to one state where we had to wait over a year to even be able to begin to provide service,” Village Caregiving CEO Jeff Stevens told HHCN last year. “That’s nuts to me. We’re coming to your state. We want to take care of people, give jobs, pay taxes and provide great care. We wait 13 months for you to even look at the application. We’ve learned some lessons like that. Let’s make sure we know the licensing and regulatory issues that the state has.”

If the incoming presidential administration enacts Medicaid policy changes aimed at reducing spending – which is a possibility – that could further differentiate markets, as various states would react in particular ways to, say, reductions in federal Medicaid contributions.

While growth-minded home care businesses chafe at the barriers keeping them out of certain markets, consumers ultimately will suffer from reduced access. So policymakers should be alert to this trend and how their constituents could suffer, as home care advocates press the case for friendlier payment and policy frameworks.

Unionization sweeps the nation

Despite the significant differences in home care operating environments across different states, one nationwide trend is caregivers unionizing.

Last year saw caregivers in Michigan fight for the ability to form a union. Last year also saw recently unionized Alaska home care workers approve their first contracts.

Plus, many University of Rochester Medicine Home Care (URMHC) workers joined 1199SEIU United Healthcare Workers East this past spring, after striking the previous year.

It is likely that home care workers across the country will continue to ramp up unionization efforts in 2025.

In March, Angelo Spinola — co-chair of the home health and home care industry group at law firm Polsinelli — noticed more clients reaching out about issues related to unions.

“There’s so much more activity with our clients,” he previously told HHCN. “They are reaching out because there’s a campaign going on, or soliciting for a union going on.”

Generally, caregivers looking to form unions are advocating for better wages and benefits that will improve working conditions, such as health care or paid parental leave. In 2021, the median hourly wage for direct care workers only increased by $0.07 per hour. It increased by $0.02 per hour in 2022, according to data from PHI.

Though some home care agencies already offer comprehensive benefit packages and competitive pay, this isn’t the case at all companies.

Spinola noted that in general unions have focused on larger businesses in the past, but this is starting to change, leaving room for home care to enter the picture.

“We’re seeing systems being targeted, and individual businesses within a system being targeted,” he said. “Unions are targeting caregivers – more than we’ve seen in the past – because a lot of the time they work for multiple agencies. And they’re effectively using that caregiver as a seed to bring others in and start to generate interest.”

Trump’s electoral victory might seem to pour some cold water on this trend, given that in his first term, he generally backed policies making it more difficult for workers to unionize. But Trump enjoyed rank-and-file union member support in the election, and Teamsters President Sean O’Brien spoke at the Republican National Convention (though he did not endorse a candidate officially).

Furthermore, the president-elect’s pick to head the Department of Labor, Lori Chavez-DeRemer, was an “enthusiastic” supporter of the PRO Act, which was a Biden-era policy making it easier for workers to unionize at the federal level.

Union leaders are still skeptical about what policies Trump’s DOL will pursue, but signs suggest that home care providers should prepare for the unionization trend to continue.

Technology will augment personal home care services

The increasing number of older adults who wish to age in place, combined with staffing shortages in the home care sector, make technology adoption imperative in 2025.

Integrating technology into home-based care is transforming how caregivers deliver services, leading to efficiencies necessary for managing the volume of patients needing care.

Remote patient monitoring is projected to be used by more than 70 million Americans by 2025, according to Insider Intelligence. This technology connects in-home medical devices to smartphone applications, providing a continuous flow of information to caregivers.

“AI and predictive analytics will continue to be game changers in home care, helping with early detection of potential health issues and allowing for more proactive care,” Homewatch CareGivers President Todd Houghton told Home Health Care News earlier this year.

Houghton highlighted voice-activated technology and wearable devices as two innovations that will benefit seniors in the coming years.

Industry leaders continue to emphasize the role of artificial intelligence, bots and smartphone applications in collecting and aggregating data more quickly and easily. This allows caregivers to return to the core of care: meaningful face time with patients.

“We spend more time looking at our devices than we do looking into the eyes of our patients,” Michael Johnson, chief researcher for home care innovation at Bayada Home Health Care, said in an interview with HHCN. “I challenged my team to find technology that enables staff to spend more time with patients.”

Home care providers plug into the clinical continuum

In 2025, home care providers will find ways to plug themselves into the larger home-based care continuum.

Payment mechanisms have traditionally kept Medicare-certified home health care and personal care services apart. While many home-based care providers offer both services, they’re rarely wrapped into one service bundle.

That’s increasingly changing, as providers see ways to combine the two services to keep patients out of the hospital. Especially when viewed through a risk- and value-based care lens, the combination of those care types makes sense.

“I would love to have a chronic disease management program where we can combine forces and utilize nursing therapy, but also hourly care, at least those first few days when these high-risk patients come home from the hospital,” Amy Harrison, the president of Vanderbilt Home Care Services, recently told HHCN. “And I think that is my dream, just to really mold our services together and get that reimbursable. That’s going to keep these folks out of the hospital. That supportive care and the interdisciplinary team being intermittent and hourly together.”

Elsewhere, Addus is also heavily investing in this idea.

“When we look at home health, we don’t want to get caught up in the fact that the next year or two may be a little tough,” Addus CEO Dirk Allison said in 2023. “We think long term, and it’s a really good part of the business that we need to have at Addus.”

In Addus’ largest markets, the company is layering home health care services over personal care. That, the company believes, is the key to unlocking value-based care contracts with Medicare Advantage plans.

“There will be an ongoing focus on better integrating clinical care with home care services and supports,” Help at Home President Tim O’Rourke also told HHCN, as he forecasted the future of the home care industry.

In addition, as hospital-at-home and SNF-at-home models become more prevalent, home care providers will find places to step in. Those models need to provide all of the oversight that brick-and-mortar facilities do, and therefore, need wraparound services and help from caregivers.

Those high-acuity models won’t be able to rely just on family caregivers. Instead, they’ll need to form partnerships with high-quality home care providers to keep patients safe and comfortable.

HHCN Senior Reporter Joyce Famakinwa and HHCN Reporter Audrie Martin also contributed to this article.

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