Home Health & Hospice Week

‘Caregiving squeeze’ could be helped by more funding, unions for workers.

Buckle up for a potential huge revamp to Medicaid home care programs, if Joe Biden wins the presidential election in November.

The presumptive Democratic nominee released a $775 billon health plan and gave a Delaware speech on the topic July 21. As usual for campaigns, the plan is light on specifics but does reference some ideas, including:

• Putting $450 billion toward clearing the waitlists for Medicaid home and community-based services, then allowing states to drop their existing Medicaid HCBS waivers in favor of a new program with more federal funding. “Right now there are 800,000 people who are eligible for home and community care through Medicaid who have already signed up for it. But they’re waiting for a … phone call back,” Biden said in his speech. “For some the wait is five years.” Later, he said “we have to make the long-term federal investments. We’ll have a major innovation fund that [will] allow states to test and expand successful ways to improve home and community care and increase prevention and reduce the cost of hospital­ization.”
• Thinking outside the home care box. In his speech, Biden cited a program where “a nurse, an occupational therapist, and a handyman come to the home that’s caring for an aging family member” and make the home safer with handrails, etc. “About $3,000 in program costs yield[ed] more than $20,000 in savings to the government from hospital­ization for other reasons.”
• Increasing home health worker wages. Biden’s health plan webpage links to a Health Affairs article on “upskilling” home care workers to achieve better outcomes. “To effectively manage … conditions and the costs they incur, health care systems must better train and use the workforce that provides more hours of paid care to patients than any other provider: home care workers,” says the HA blog post by Angelina Drake of direct care worker advocacy group PHI. “It’s about creating jobs with better pay and career pathways for caregivers and showing them that dignity and respect that they deserve,” Biden said in his speech. “They’re doing God’s work, but home health workers aren’t paid much, they have few benefits. Forty percent are still on SNAP or Medicaid,” Biden said. His plan “gives caregivers and early childhood educators a much needed raise. No one should have to work more than one job to make ends meet.” Biden also referred to ensuring workers have “an effective way to unionize and collectively bargain to protect their rights and earn benefits.”
• Offering a $5,000 tax credit and Social Security credits to unpaid caregivers who take care of family members.