By Thomas A. Parmalee
Asked about her transition from working in New Jersey state government to taking on the role of president and CEO of the Home Care & Hospice Association of New Jersey, which represents care providers and health care service partners across the state, Nancy Fitterer said it was “a curious journey, for sure.”
She previously served as chief of staff for New Jersey’s Division of Consumer Affairs, which is the licensing body for nurses, nursing aides, doctors, plumbers — “almost anything you could think of,” she said. Later, she became chief of staff for the New Jersey Office of Attorney General, which “touched everything.” She also served several months as the director of policy and personnel for the New Jersey Office of the Insurance Fraud Prosecutor.
When she met with the board of directors of the Home Care & Hospice Association of New Jersey, she admitted she had a lot to learn about home care policy. But she did have personal experience that would prove invaluable.
“My dad has Alzheimer’s, and he’s lived with me for four years,” she explained. “So, I knew what it meant being a caretaker — and I knew the importance of having someone at home if that is where a loved one wants to live. My dad does not want to live in a memory care center.”
The opportunity presented everything Fitterer was looking for in a transition to the private sector: a chance to channel her regulatory expertise toward a cause that had become deeply personal, advocating for families and navigating the same challenges she faced daily. She’s been leading the Home Care & Hospice Association of New Jersey ever since.
Bringing Regulatory Expertise to Complex Industry Challenges
Fitterer’s background in state government has proved essential to navigating New Jersey’s complex home care regulatory landscape. The association, founded in 1973, focuses on three types of home care providers: Medicare-certified home health agencies, hospices, and health care service firms. Each has distinct regulations and licenses, with health care service firms being the most numerous in New Jersey, followed by home health agencies and hospices.
“We represent all three — even though different licenses, different regulations and different rules apply to each of them,” she said. “We still think of all of it as home care regardless of the payor source, although there will be different rules and regulations. But in general, all these families need home care — and then it’s about whether their loved one has Medicare, Medicaid or private insurance.”
Fitterer’s personal caregiving experience has also deepened her understanding of the challenges families face. While Fitterer works mostly on a remote basis, she still relies on a home health aide to spend time with and help take care of her father.
Fitterer’s father, who grew up in Egypt but has lived in the United States for almost 50 years, feels most comfortable with an aide who speaks Arabic. “I know the profession is always looking for nurses and aides, and if someone’s parents speak a particular language, they are looking for aides that speak that language,” Fitterer said.
Promoting the profession as a career option has turned into one of Fitterer’s passions. “It’s a hard job taking care of someone, but we want to at least encourage people to explore the idea,” she said. “People are living with all different types of struggles, and people need home care for the same reason I need home care — my father wants to be at home.”
Multi-Level Advocacy: Policy Wins and Practical Guidance
Under Fitterer’s leadership, the association established the Home Care Caucus in the New Jersey Legislature with bipartisan, bicameral support. The caucus tackles one of the industry’s most pressing challenges: a severe shortage of caregivers demanding comprehensive solutions spanning compensation, career development, educational pathways, immigration policy and professional recognition.
When federal regulators issued new rules in April 2024 requiring 80% of Medicaid payments for home care services to go directly to worker compensation, the association pushed back hard. “While we support improved compensation to those essential caregivers, low Medicaid payment rates and operational costs make that impossible to meet,” Fitterer said. The association continues fighting this unfunded mandate that threatens provider sustainability.
The association also keeps a close watch on any proposed legislation that could have a negative impact on hospice programs. Often, Fitterer explained, cuts are proposed and implemented – and then short-term relief is provided, and the cycle repeats itself. So, the association is always advocating for funding or against funding cuts.
The Home Care & Hospice Association of New Jersey is also chiefly dedicated to advocating for change at the state level, where it has perhaps the most meaningful impact. Its advocacy has produced tangible wins for workers, including a dramatic increase in New Jersey’s home health aide rate — from less than $16 per hour to more than $25 per hour over seven years. Similar efforts have been made to secure hourly pay increases for licensed practical nurses.
Every Tuesday, Nancy has a Zoom call with providers. “We go over everything that has happened in a given week and remind our members what will be happening, including if it’s six months from now,” she said. “These things are important to know. Being a home care provider is hard, and there are a lot of things they need to focus on.”
She added that while it’s important to belong to a professional organization, agencies should also have someone on staff to focus on compliance. “You don’t need to belong to our association, but you should belong to a group that can answer your questions,” she said.
