As more care continues to shift from hospitals and nursing facilities to home services, what do you think are the pros and cons?

Perry: Many of the patients we care for in nursing homes are Medicaid patients who may not have the community support they need. If they have a home, they don’t have a safe home to go to. We think so many social structures need to be built to ensure that we can greatly expand home care.

Reinhard: I started my career as a guest nurse, so overall I am very supportive of home care. But when so much needs to be done for these patients, there are concerns about moving very complex care to the home. Our concerns about all of this relate to family caregivers in particular. Do they have proper training and resources?

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Medicaid is the largest payer of nursing homes. What are some of the policy issues you are concerned about?

Perry:Governors across the country continue to underfund the program. Some states are doing pretty well. Alabama comes to mind, but we don’t operate there. The state of California has always valued their Medicaid program and paid handsomely. But in other cases, we lose $40 to $50 a day on Medicaid patients. …this should be a nonpartisan question.

Reinhard: We do a lot of work around training and safety issues. The president’s proposal includes that. One question is how much training paramedics should be allowed to go online. We’re looking at a lot of issues state by state, trying to make sure we have more workers. But we need to make sure they are prepared workers and that safety and quality remain a priority.