Atlanta-based Gentiva Health Services, the largest home health care provider in the country, said it is closing 46 of its office locations in the U.S. and laying off hundreds of employees.

The cuts were disclosed in a federal securities filing in which the company said clinicians and other health care professionals will lose their jobs in the shutdown. The company did not say Friday whether any employees in metro Atlanta or Georgia would be affected.

Gentiva provides home health and hospice services to patients at more than 500 locations in 40 states. Those services include skilled nursing care, physical and occupational therapy, cardiac care, disease and pain management, medication education and hospice care. The company employs about 47,000.

Many home health care providers are hurting financially in part because of the reduction in Medicare reimbursement rates set by the government.

Gentiva, which serves an elderly population, has said that home health care is a more cost-effective form of care than emergency room or hospital services.

The company gets about half its business from home health care services and about 40 percent from hospice care.

Company executives have said Gentiva’s longer-term prospects are sound because of the size of America’s elderly population and its need for home health care as an alternative to hospital visits.

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