Health systems are pushing more care into patients’ homes. At the same time, several systems in 2026 have closed, suspended or reduced services across the broader home-based care landscape.
While some health systems have launched and expanded hospital-at-home programs this year, Becker’s has also reported closures, service suspensions and workforce reductions involving traditional home health, hospice and hospital-at-home operations.
The cases do not, on their own, establish an industrywide retreat from care at home. They involve different models and health systems have cited different reasons for the changes. But together, they highlight the different financial, regulatory and operational considerations health systems face as they expand, maintain or scale back care delivered in the home.
The latest example comes from Rockledge, Fla.-based Health First. The four-hospital system is laying off 214 employees and ending its hospital-at-home program as part of broader program and workforce reductions.
The job cuts represent about 2% of Health First’s workforce and primarily affect administrative, management and clerical support roles. Some clinical positions are also affected by changes to specific programs and services, according to the system.
The organization did not specify how many of the 214 cuts are directly tied to hospital at home. Health First is also closing the Viera, Fla., location of its Integrated Care Program and ending its standalone comprehensive health assessment program.
Health First is not alone in pulling back from a form of home-based care this year.
Grand Forks, N.D.-based Altru Health System discontinued home health services Sept. 1, citing regulatory pressures.
“Evolving regulatory standards have been a burden for this type of care,” an Altru spokesperson told Becker’s.
But Altru did not leave home-based care altogether. The health system said it would continue offering home-based therapy, remote monitoring and medical home visit programs.
Altru’s decision illustrates the distinction among different forms of home-based care: A health system can discontinue one home-based service while continuing to operate others.
Aspirus St. Luke’s in Duluth, Minn., also announced plans to close its home health services division this year. Wausau, Wis.-based Aspirus Health said the decision was made in response to a rapidly changing operating environment and increasing pressure to strategically allocate resources.
The change would affect 29 employees, with Aspirus working to identify other roles and opportunities for them across the system. Current patients would continue receiving care, but the organization would stop accepting new home health patients.
In February, Minot, N.D.-based Trinity Health said it was suspending home health and outpatient hospice services following a review of its operations.
Trinity said it was exploring opportunities with community providers to transition the services and that affected employees would have opportunities to move into open positions elsewhere within the organization. At the time of Becker’s report, Trinity said a final timeline for the change would be communicated once plans were finalized.
Workforce reductions have also reached home-based services.
Burlington-based University of Vermont Health began implementing a workforce reduction affecting 199 positions in September and is creating 55 new roles, for a net reduction of 144 positions.
The reductions include employees across UVM Health’s hospitals, home health and hospice services and skilled nursing facilities. The organizaiton did not break out how many of the affected positions are specifically within home health or hospice. UVM Health said the reductions are part of efforts to reduce expenses, improve efficiency and address a projected $300 million in reduced revenue over the next few years.
The home health sector is also navigating changes to Medicare reimbursement. CMS estimated total Medicare payments to home health agencies would decrease by $220 million in 2026 compared with 2025, a net reduction of 1.3%.
The reduction reflects a 2.4% payment update offset by several downward adjustments. The Becker’s reports on the individual health systems do not establish the CMS payment change as the cause of their decisions, and the organizations have cited different factors in explaining their moves.
At the same time, Becker’s has reported expansion among hospital-at-home programs.
Hospital at home entered an expansion cycle this year after the federal government extended the CMS Acute Hospital Care at Home waiver through 2030. Baptist Health in Jacksonville, Fla., launched its program in February, Saint Francis Health System in Tulsa, Okla., launched one in January and Cleveland Clinic expanded its program into Northeast Ohio in March.
Somerville, Mass.-based Mass General Brigham also entered a new phase of growth for its Home Hospital program following the waiver extension through September 2030.
Since 2022, the program has treated nearly 10,000 patients and expanded from two academic medical centers to five hospitals. Mass General Brigham leaders said the longer waiver gives health systems greater stability to plan and invest in hospital-at-home programs.
Other health systems are pursuing different approaches to care in the home.
Stanford Health Care in Palo Alto, Calif., developed an ambulatory-based transitional care model after California regulations prevented the system from fully operating under the CMS Acute Hospital Care at Home waiver model.
By May, Stanford’s program had enrolled more than 1,000 patients in its first year and reached a daily census of 45.
Taken together, 2026 reporting presents a mixed picture for care in the home. Some health systems are expanding acute hospital-level care at home, while others are closing or suspending traditional home health and hospice services, reducing positions that touch those operations or, in Health First’s case, ending a hospital-at-home program.
The moves raise a narrower question than whether health systems are retreating from the home: which home-based care models will health systems continue to operate themselves as the care setting evolves?
