The expansion of home- and community-based services has been an important milestone in the tenure of Margaret McDonald, associate vice president for the Center for Home Care Policy and Research at VNS Health. More work needs to be done to enforce the Omstead decision, a landmark case that found that people with disabilities have a right to receive supports in the community under certain conditions, said McDonald, one of this year’s McKnight’s Pinnacle Award winners. On the week of the 2025 Pinnacle Awards event, McDonald talked to McKnight’s Home Care for a Newsmakers podcast about HCBS and her research. Notes: In her role at VNS Health, Margaret McDonald works on conducting investigations to improve home- and community-based services (HCBS) and oversees the administrative functions of the Center for Home Care Policy and Research. Some of the center’s current research focuses on speech recognition to find out if audio recordings can be translated to help reduce the burden of caregiver documentation and explore whether the data collected can identify people who have early-onset of cognitive impairment. The rebalancing of long-term services and supports to HCBS and away from institutions means HCBS has to staff properly, she said. It also means HCBS needs to implement evidence-based practices of care in the home. Physician and nurse practitioner oversight may limit the move toward advanced services, such as hospital-at-home, into the home, she said. The federal government’s move to cut scientific research may affect the center’s work. But she is hoping that since her research informs clinical practice and healthcare policy including developing strategies to reduce rehospitalizations and delay nursing home admissions that the center will continue to receive support for her work. Follow us on social media: X (formerly Twitter): @McKHomeCare Facebook: McKnight's Home Care LinkedIn: McKnight's Home Care Instagram: mcknights_homecare Follow VNS Health on social media: X (formerly Twitter): @vnshealth Facebook: VNS Health LinkedIn: VNS Health Instagram: @vnshealth Show contributors: McKnight’s Home Care Editor Liza Berger; Margaret McDonald, Associate VP for Center for Home Care Policy and Research, VNS Health