- October 20, 2026
- By Fid Thompson
Among the increasing number of women who live through breast cancer, many older, long-term survivors remain frail. A study published Monday in the Journal of the National Cancer Institute shows that in a given year, nearly 60% of these highly frail survivors had no Medicare home health care.
Traditional Medicare covers personal care at home only when it is tied to a skilled need, and only for people who are homebound. Survivors who mainly need help with bathing, dressing and other personal care, or who are not homebound, fall outside of this coverage, said lead author Xuanzi Shirley Qin, an expert in access to cancer care and Medicare, and assistant professor at UMD’s School of Public Health. Although the study does not directly address potential consequences, this group could face heightened risk of falls or hospital stays without adequate support at home, Qin said.
“When you beat cancer, it’s a powerful moment – often a bell is rung on the ward and everyone celebrates,” Qin said. “But once home, survivors face health challenges compounded by aging to the point where a lot of them still need help at home, even years later.”
Qin and colleagues, including Professor Jie Chen, chair of the UMD’s Department of Health Policy and Management, studied 347,953 “survivor-years” of 134,410 women who were 66 or older with invasive breast cancer, from two to ten years post-diagnosis. The study used cancer registry records from the Surveillance Epidemiology and End Results (SEER) Program linked to Medicare enrollment and claims, as well as the assessments nurses and therapists complete when home health care starts – the Outcome and Assessment Information Set (OASIS). All data dated from 2017 to 2020. The team did not include Medicare Advantage in the research.
Researchers built a “frailty score,” relating to problems like difficulty bathing or dressing, trouble walking, falls, memory problems, incontinence and exhaustion, and applied it to every survivor to see if those with high frailty used Medicare home health care.
In a given year, about 7% of breast cancer survivors were defined as highly frail and about 40% of this group used Medicare home health care. Among all survivors, 11% used Medicare home health care.
About one in eight women will be diagnosed with breast cancer, , with 4 million breast cancer survivors living in the U.S. Home health needs for this group will likely only continue to grow and policies should also evolve to meet their needs, including routine frailty screenings and Medicare coverage for home health care, said Qin.