Any knot in $S^3$ may be reduced to a slice knot by making some crossing changes. Indeed, this slice knot can be taken to be the unknot. We show that the same is true of knots in homology spheres, at least topologically. Something more complicated is true smoothly, as not every homology sphere bounds a smooth simply connected homology ball. We prove that a knot in a homology sphere is null-homotopic in a homology ball if and only if that knot can be reduced to the unknot by a sequence of concordances and crossing changes. We will show that there exist knot in a homology sphere which cannot be reduced to the unknot by any such sequence. As a consequence, there are knots in homology spheres which are not concordant to those examples produced by Levine in 2016 and Hom-Lidman-Levine in 2018.