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The demand for home health care has never been greater.

An estimated 12 million Americans were seen by a home health nurse in 2009, reported the National Association of Home Care and Hospice.

But home health-care agencies have taken an 8.25 percent cut in payments since 2007 for treating Medicare patients, who make up almost half of their business.

"The biggest cuts loom ahead with health-care reform," said Bill Dombi, the association's vice president for law. President Barack Obama's new proposal "is expected to contain a $39.4 billion cut in funding for home heath care over a 10-year period. That's more than 10 percent of the total amount," he said.

Because so many home health-care patients have either Medicare or Medicaid, the only way agencies can deal with the cuts will be to reduce the amount of nurse visits, said LuAnne MacIssac, executive director of hospital-based outpatient services for Great Lakes Home Healthcare and Hospice.

MacIssac has already seen such reductions in service by Medicare Advantage plans, which approve only one-third the visits traditional Medicare does, she said.

"I think you'll see fewer visits a week, and patients receiving home health care for shorter periods of time," MacIssac said. "The patients' families will have to take over more of the care, and we'll see if more patients end up being readmitted to the hospital."

No matter what happens with health-care reform, MacIssac said home health-care agencies like Great Lakes will have to get even leaner.

"We will have to continue to learn how to do things more efficiently," she said.

Copyright (c) 2010, Erie Times-News, Pa.

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