I am writing in response to Nina A. Kohn’s op-ed on May 31, “It’s time to care about home care.” As someone who has advocated on behalf of home and community-based care services (HCBS) providers, workers, and consumers for more than 20 years and currently heads up the largest trade association for non-medical home care agencies in the country, Kohn’s assertion that “America needs to prioritize and support alternatives to nursing homes so that older adults can lead healthier and more satisfying lives” is music to my ears!
During the COVID-19 pandemic, home became even more critical to all of us – especially the seniors, people with disabilities, and children with complex medical conditions who rely on home care. Home-based care was the prescription for all of us, and our industry responded. Our 4,000+ agency members rose to the challenge and kept people safe and healthy at home – where the vast majority of people want to be.
However, our current aging infrastructure requires most Americans who need long-term care to pay out-of-pocket, carry private insurance, which is unaffordable for most, or qualify for Medicaid, which strongly incentivizes institutionalization. As Kohn notes, Medicaid requires states to provide Medicaid coverage to pay for long-term care services provided in nursing homes, but allows states to decide whether to cover equivalent services in home and community-based settings. This HAS to change – the pandemic has shown us that.
While President Biden’s proposed $400 billion in funding for HCBS as part of the American Jobs Plan would not end Medicaid’s institutional bias, it could go a long way in expanding access to alternatives to nursing homes. The Home Care Association of America (HCAOA) strongly supports a focus on home-based care workforce recruitment to meet the growing demand for at-home care, paid leave and specialized payments, such as overtime and hazard pay, for home care workers, increased access to Medicaid HCBS services to reduce the risk of institutionalization in the first place, and support for the family caregivers who work alongside professional caregivers to keep their loved ones safe at home.
There has never been more of a focus on home-based care than there has been during the worldwide pandemic, the 2020 presidential campaign, and the months since President Biden was elected. We must keep this momentum going and bring care home. The desire and demand is already there, now we must ensure the infrastructure, the workforce, and the policy is in place to support it.
Home Care Association of America (HCAOA)