Investing in Care in the Home

The National Association for Home Care & Hospice (NAHC) believes its most important role is to serve as untiring advocate for the millions of Americans who receive and provide the highest quality care in the home. Among the many lessons that must be learned from the current public health emergency (PHE) is that care in the home is a vital and irreplaceable part of the health care system. It holds the key to longer life, greater happiness and independence, and in times of crisis, it is a way to protect the most vulnerable citizens while also slowing the spread of contagion.

That’s why the time for greater public investment in providing care in homes and communities is now. Here are few of the priorities NAHC is fighting for.

Big Investment in HCBS Needed

NAHC believes that Medicaid home- and community-based services (HCBS) must remain part of any financial relief package that moves forward in Congress. A large investment is essential for building a sustainable HCBS infrastructure that can begin to address the magnitude of need by both increasing access to Medicaid HCBS and addressing the direct care workforce crisis.

The HCBS workforce provides vital services, and yet these workers—who are primarily women of color—have been devalued and underpaid for decades, leading to severe staff shortages that can result in crucial gaps in service availability, lengthy waiting lists, service line closures and additional obstacles to achieving a high quality of life for workers and recipients alike.

Due in large part to a long history of inadequate funding at the federal level, the system is not serving everyone who needs HCBS, even though research has shown that quality of life is significantly improved when individuals are able to live in the community. Further, people with disabilities of all ages have a legal right to receive services and supports in the most integrated setting, regardless of the source of payment for services. Yet, 31 years after the passage of the Americans with Disabilities Act (ADA), more than 800,000 people with disabilities sit on waiting lists for the Medicaid-funded services needed to make that possible, and many more are entering institutions against their wishes. These waiting lists leave people with disabilities, aging adults and their families waiting years or decades for services. The investments in the Build Back Better agenda are crucial to reach this unrealized goal of the ADA.

When older adults who want to age in place and people with disabilities are left waiting, the responsibility for care falls on unpaid family caregivers—who also need financial assistance. The costs of this inadequate system fall disproportionately on people of color with limited income and wealth. The workforce and earnings losses related to unpaid family caregiving are significant and well documented.

NAHC urges Congress to continue to include and prioritize the large investment in the infrastructure of Medicaid HCBS and the workforce that provides services as lawmakers negotiate any package moving forward.

Increase Funding for Programs Serving Elderly

The nation continues to face the economic, health and social impacts of the COVID-19 pandemic. Ending the reliance on continuing resolutions (CR) would allow Congress to fully fund programs that serve the nation’s elderly; relying on long-term CRs would result in flat and therefore inadequate funding, which in turn impedes the capacity of programs providing critical services to individuals across the country.

Federally-appropriated programs are essential to helping millions of older adults age with dignity. These discretionary programs include, but are not limited to, those provided by the Older Americans Act, the Administration for Community Living, fall prevention programs, initiatives and research that address chronic disease, workforce programs for participating older adults and the professionals providing care to them, AmeriCorps Seniors, person-centered trauma informed care and the Department of Housing and Urban Development’s housing programs.

In order to sustain current services throughout FY 2022, these federally appropriated programs need year-over-year increases. Without increased funding, as the FY 2022 bills provide, the programs will not have sufficient resources to continue current programs, not to mention expanding their reach to help older adults during a pandemic that has overwhelmingly impacted them.

After a decade of appropriation caps and austerity for most annually funded programs, and with the compounding impacts of the pandemic, increased investment through an omnibus appropriations bill is a critical step toward addressing existing shortfalls and expanding access to services for older adults and their caregivers. This, in turn, builds a stronger and more equitable American economy. Further, the COVID-19 pandemic exposed deep inequities and brought to greater light our nation’s most at-risk older adults living in food, transportation, affordable housing and health care deserts. If Congress fails to enact omnibus appropriations legislation, programs in desperate need of increased resources will be left with stagnant funding, restricting their ability to assist with recovery in communities across the country.

NAHC urges Congress to provide the highest level of funding for the programs and services that support older adults at levels that reflect the true and growing need in communities across the country. Long-term continuing resolutions would fail to address these needs and impede recovery when our country needs it the most.

Relief for Private Duty Homecare Providers

Congress should provide direct relief funds to personal care providers.

The CARES Act Provider Relief Fund (PRF) has been a lifesaver to thousands of health care providers across the country. Through the fund distributions, the Department of Health and Human Services (HHS) has been able to stabilize access to care during the PHE and help preserve the health care infrastructure for the post-pandemic future. We very much appreciate Congressional action creating the fund and the swift actions taken by HHS to prioritize the distribution of the funds.

Congress must take immediate steps to provide funds to an essential part of the health care system that, to date, has not received this crucial support. Homecare companies that serve millions of Americans with vital personal health care supports such as assistance with the administration of prescribed medications, exercise programs that maintain and improve functional capabilities, hygiene, feeding and numerous activities of daily living (ADLs) are a core part of community-based health care. These services and the dedicated caregivers that provide these services have been uniformly recognized as essential health care providers by state and federal policymakers. However, the companies that provide this care have not received any Provider Relief Fund support since the creation of the fund, except where those companies bill Medicare and/or Medicaid.

The companies that have been left out so far do participate in many government health programs such as the Veterans Administration and Administration on Aging, along with providing services funded by long-term care insurance and private payment from their patients. It is estimated that they serve several million senior citizens and persons with disabilities each year, avoiding the need for high-cost institutional care. The U.S. needs these companies to operate to meet the needs of the aged population.

Support from the Provider Relief Fund would be consistent with other distributions that have occurred so far. These include distributions to homecare agencies that provide this same care through Medicaid, Assisted Living Facilities and behavioral health providers. Similarly, HHS has provided funding supports beyond Medicare and Medicaid providers to dentists and behavioral health providers among others. As such, the standards and structures are in place to allow these companies to apply for funding.

As potential legislation is drafted to provide further COVID-19 relief, NAHC would like to see specific PRF funding be allocated for homecare providers that have not previously qualified because they are not Medicare and/or Medicaid providers. These providers have faced all the same challenges as their Medicare and Medicaid colleagues, including workforce shortages, added expenses for personal protective equipment and cleaning supplies, and lost revenue due to added caregiver time while performing COVID-19 precautions and increased overtime expense.

Continued Suspension of Sequestration

NAHC favors further relief to Medicare home health and hospice providers through continued suspension of Medicare sequestration. From the early days of the PHE, Congress took decisive action suspending sequestration, providing home health and hospice agencies vital financial relief to weather added expenses and lost revenue brought on by the pandemic. Since that initial relief was passed as part of the CARES Act, Congress has continued that suspension, most recently in December.

With the recent spread of the omicron variant and action by HHS to extend the PHE, it is clear we are not beyond the pandemic yet. As such, NAHC requests the full 2% sequester be suspended through the end of the COVID-19 PHE or Dec. 31, 2022. Homecare and hospice providers will continue to need financial stability through the pandemic and suspension of the sequester offers a simple and efficient means.