Three Predictions for Home-Based Care in 2026 (and Why This Year Feels Different)

Every January, many industry press outlets and vendor newsletters fill up with grand and bold predictions. Some are thoughtful, some can feel recycled. If I’m being honest, most feel a little detached from what the operators I’m working with are actually dealing with day to day.

So rather than forecasting shiny new products or sweeping policy reform, I want to talk about what Transcend thinks will actually shape 2026 for hospice and the broader home-based care world. These aren’t moonshot ideas. They’re already showing up in boardrooms, on field staff laptops, in budget conversations, and during hallway debates inside agencies.

If you’re leading or supporting a hospice, home health, palliative or home care organization, I don’t think any of these will surprise you. But I do think 2026 is the year they stop being “trends” and start being fully woven into everyday life.

1. The pressure on cost, waste, fraud and abuse is not easing up.

If you were hoping for a policy breather, I wouldn’t plan on it. Transcend sits on multiple committees for the National Alliance for Care at Home and these pressures seem to be steadily increasing.

The focus on waste, fraud and abuse in home-based care is going to continue and likely intensify in 2026. We are already feeling it in the ongoing Medicare home health rate cuts and we are seeing it play out in Medicaid pressures that directly impact HCBS funding. MedPAC is looking like they’ll recommend either cuts or no updates for hospice.

What feels different now is tone and focus. The conversation has shifted from news outlets to CMS and the Hill. CMS Administrator Dr. Mehmet Oz is directly involved in these efforts as of this month, hosting listening events in Las Vegas and Los Angeles. Policymakers are increasingly questioning growth patterns, utilization and new agency applications for home-based care. We all know the next step – even providers who are playing by the rules and acting appropriately can expect more oversight, regulation and audits.

For leaders, I think this means a few things:

• First, “we’re mission-driven” is no longer sufficient insulation. Regulators and payers expect clean documentation, defensible eligibility decisions, and operational discipline regardless of intent.
• Second, margin pressure is becoming structural, not cyclical. This isn’t a one-year adjustment you can wait out. It’s a signal that organizations need to rethink growth strategy, scale, cost structure, service mix and productivity expectations in a more permanent way.
• Third, data matters more than ever. Not flashy dashboards, but the ability to explain your census mix, length of stay patterns, live discharges and referral conversion in plain language. If you can’t clearly tell your own story, someone else will do it for you (and eat your market share).

The organizations that will hold steady in 2026 are the ones that stop hoping policy will swing back and instead build resilience into how they operate today.

 

2. AI adoption goes organic, and that matters more than new products.

I think 2026 is the year AI stops being something providers wait for vendors to “solve.”

Over the last year, a lot of leaders have told me the same thing in different ways: “We see the potential, but we’re waiting for our EMR to build it,” or “We’ll use AI once there’s a compliant, turnkey solution designed for home-based care agencies.”

Some of that caution makes sense. But here’s what I’m seeing more and more often. Your teams are almost certainly already using AI quietly and internally to make work easier and faster. Regardless if your leadership team is sanctioning it or not, I guarantee you that it’s happening. Microsoft certainly wants me to use CoPilot – it’s shown up in all of my applications whether I want it to be there or not. Staff will take advantage of this.

If you want to start cautiously experimenting with AI, I believe the lowest-risk, highest-impact use cases are internal. For example:

• Leadership using AI to draft and refine internal communications so messages are actually read
• Clinical leaders turning dense policy updates into practical summaries for staff
• Admissions and intake teams organizing call notes, follow-ups and talking points
• Marketing and growth leaders accelerating content, persona-drafting and referral source education without adding headcount

None of this requires waiting for a vendor roadmap. It requires leadership permission and guardrails.

The organizations that get real value from AI in 2026 won’t be the ones that buy the fanciest tool. They’ll be the ones that treat AI like a utility for thinking, writing, summarizing and organizing work that already exists.

Step one for leaders will be learning about AI. I strongly recommend the Marketing AI Podcast for growth leaders, which covers weekly advances in the field in an approachable way.

Step two is to build a set of guiding principles for your agency to experiment within. Convening working governance/resource groups, defining use cases and guardrails, and aligning your use of these tools within the framework of your mission/vision/values are good ways to ensure your team understands the company’s AI rules and feels comfortable experimenting and sharing their successes. If you don’t, they’ll likely experiment anyway, leaving the risks to be uncovered only when a potential line is crossed (HIPAA breach, anyone?).

3. Growth gets harder, and standing still becomes a decision.

Competition for growth in hospice and home-based care isn’t easing. If anything, it’s getting sharper.

Referrals are sicker and more fragmented. Hospital systems are under their own pressure. Community referral sources are stretched thin. And nearly everyone is being asked to grow with fewer resources than they had three or four years ago.

In this environment, organizations that don’t have a clear strategy for increasing market share are unlikely to maintain momentum. “We’ll grow if we do good work” is no longer a strategy. It’s a hope. This ain’t Field of Dreams.

What Transcend sees working are organizations that answer a few uncomfortable questions honestly:

• Where are we actually winning referrals today, and why?
• Where are we losing them, even when we think we shouldn’t be?
• Do our growth roles have clarity, tools and accountability, or just activity expectations?
• Who are our actual competitors, and what are they doing that we aren’t?
• Can we articulate our differentiation in “what’s in it for me” language for our referral sources?

The reality for 2026 is simple. Growth will not come evenly across the market. Some organizations will gain share. Others will quietly fall behind, often without a dramatic crisis to point to.

Having a strategic roadmap for growth doesn’t guarantee success but not having one almost guarantees stagnation.

So, what does this mean heading into 2026?

For me, the common thread across all three predictions is agency.

2026 feels like a year where waiting carries more risk than trying. Not reckless trying. Thoughtful, grounded experimentation paired with operational discipline.

Hospice and home-based care have always adapted under pressure. This year just asks leaders to be more intentional about how they do it. I’m looking forward to seeing which organizations lean into that challenge.

Transcend can help.

If you need a strategic growth partner to help develop an actionable plan for growth and teach your team how to implement it, Transcend is here to help. We advise clients on achievable growth operations across the home-based care continuum. Even if you just want a sounding board for early discussions, we’re here to help. Reach out to us today at [email protected] to start a conversation.