The Fragility of the Caregiving Infrastructure

Home Care Magazine

On March 31, 2021, President Joe Biden proposed a sweeping $2 trillion infrastructure package dubbed the American Jobs Plan. The proposal includes funding efforts for highways, bridges, transit systems, water supplies, the electrical grid and more. An unexpected inclusion is $400 billion dollars for home- and community-based care for seniors and people with disabilities; the package would also increase wages for in-home caregivers.
 
During his presidential campaign, Biden had said he would devote $450 billion to allow more older Americans to receive care at home; homecare’s position in the package is described in a White House fact sheet as an administration effort to “solidify the infrastructure of our care economy.”
 
“It’s expanded services for seniors,” Biden said in a news conference about the proposal. “It’s homecare workers, who go in and cook their meal, help them get around and live independently in their home, allowing them to stay in their homes—and I might add, saving Medicaid hundreds of millions of dollars in the process.”
 
Care at Home
 
Fifty-seven percent of Medicaid’s long-term care budget goes to home- and community-based services; this amounted to $92 billion in the 2018 federal budget year. While all states offer some form of this service, 41 have waitlists totaling nearly 820,000 people, with an average wait of 3.2 years. The American Jobs Plan would expand these services in order to eliminate the wait list—and would treat in-home care like institutional care. One way the plan would do this is by expanding the Medicaid Money Follows the Person program, which aims to move seniors back into their homes.
 
“The past year has led to job losses and threatened economic security, eroding more than 30 years of progress in women’s labor force participation,” reads the White House fact sheet. “It has unmasked the fragility of our caregiving infrastructure.”

Caregiver Wages
 
The U.S. Bureau of Labor Statistics reports that the median pay for a homecare worker was $12.15 per hour in 2019. Homecare workers are often women and people of color, with immigrants making up nearly one-third of the workforce. Overall, nearly half of the homecare workforce lives in a low-income household, with 43% of workers relying on public health care coverage such as Medicaid. One-third don’t have insurance from their employer. A portion of the $400 billion would help workers receive “a long-overdue raise, stronger benefits and an opportunity to organize or join a union,” according to a statement from the administration. Homecare groups have said that Medicaid reimbursement will need to compensate for any increased wages, which the plan addresses.

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