Biden Announces Actions to Improve, Expand Homecare Access

WASHINGTON—On Tuesday, April 18, joined by people with disabilities, family caregivers, long-term care workers, early educators, veterans and aging advocates, President Joe Biden signed an executive order that includes more than 50 directives to nearly every cabinet-level agency to provide support for care workers and family caregivers.

As outlined in a fact sheet from The White House, many caregivers find themselves in low-paying jobs with few benefits. Care workers, who are disproportionately women of color, struggle to make ends meet, and turnover rates are high. In addition, at least 53 million Americans serve as family caregivers—including more than 5 million caring for service members or veterans—and many face challenges due to a lack of support, training and opportunities for rest.  

Amongst the directives includes securing “significant new federal investments to transform care in this country,” including:

Improving Access to Home-Based Care for Veterans

• The Executive Order directs the Department of Veterans Affairs (VA) to improve access to home-based care for veterans who require support with activities of daily living by giving them more decision-making power over who delivers care and when.
• VA is directed to consider expanding its Veteran Directed Care program to all 172 VA Medical Centers by the end of Fiscal Year 2024. This program provides veterans with a budget to hire personal care assistance including from family members.
• VA will also consider piloting a new self-directed care program in no fewer than five new sites that provides veterans with a budget for personal care assistance while reducing administration burdens related to managing care.
• Further, VA will consider adding 75 new interdisciplinary teams to its Home-Based Primary Care program to serve an additional 5,600 veterans in their homes.

Enhance Job Quality for Long-Term Care Workers

• The Executive Order directs HHS to consider issuing several regulations and guidance documents to improve the quality of homecare jobs, including by leveraging Medicaid funding to ensure there are enough homecare workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.

Support Family Caregivers

• To provide greater support to family caregivers, the Executive Order directs HHS to consider testing a new dementia care model that will include support for respite care (short-term help to give a primary family caregiver a break) and make it easier for family caregivers to access Medicare beneficiary information and provide more support to family caregivers during the hospital discharge planning process.
• Additionally, VA will consider expanding access to the Program of Comprehensive Assistance for Family Caregivers and provide more mental health support for caregivers enrolled in that program.

The executive order has already received support from the industry. 

“NAHC applauds President Biden’s vigorous efforts to support home and community-based care through a series of executive orders affecting Medicaid, VA health benefits and more,” said William Dombi, president of the National Association for Home Care & Hospice (NAHC). “We face significant and growing challenges to meet the needs of our country’s increasing aged population that warrants improved access to homecare. We commit to work with the Administration as it carries out the President’s plan to secure high-quality and accessible home care through dedicated caregivers. This is an investment that will benefit all Americans.”

The FY 2024 President’s Budget includes $150 billion over the next decade to improve and expand Medicaid homecare services. This funding would improve the quality of jobs for homecare workers and support family caregivers. The Administration is also promoting the use of apprenticeship programs and partnering with employers, unions and others to recruit, train and keep long-term care workers on the job while also helping them advance their careers as registered and licensed nurses. Just this month, Biden also signed the first-ever proclamation designating April as National Care Worker Recognition Month, to honor the efforts and sacrifices of our child care and long-term care workers.