WASHINGTON—Two new bills introduced in the U.S. House promise to strengthen both access to homecare and the caregiving workforce.
The Home and Community-Based Services (HCBS) Access Act and the Long-Term Care Workforce Support Act are two separate piees of legislation, both introduced April 29 by Rep. Debbie Dingell, a longtime homecare supporter. The HCBS Access Act is co-led by Rep. Jan Schakowsky; the Long-Term Care Workforce Support Act is co-led by Rep. Doris Matsui.
“We know that the majority of individuals who require long-term care would prefer to receive it in their own homes and communities. No one should have to wait years to get the care they deserve, and no care worker should have to live below the poverty line to give this care,” Dingell said in a release.“Medicaid is the single largest payer of long-term care in our country. At a time when Medicaid is facing unprecedented, historic cuts, it’s more important than ever that we prioritize home and community-based services. This is the less expensive option for both families and the federal government, but the people who don’t want us to improve the system are the corporations profiting while Americans struggle. This legislation will provide much-needed investment in our care workforce, making it easier for those who need care to get it, and supporting the caregivers doing this crucial work.”
HCBS Access Act
The HCBS Access Act is designed to ensure eligible older adults and people with disabilities have a real choice of care and support options between home care and institutional care. The bill would, over time, eliminate HCBS waiting lists and the need for states to repeatedly apply for HCBS waivers. In a release, Dingell's office said the bill would put both institutional and in-home care on equal footing and give families an equal choice between home and community care or institutional care.
The bill would:
- Increase Medicaid funding for home- and community-based services (HCBS)
- Increase the federal match for state funding to expand their capacity to meet the needs of people who prefer HCBS
- Make steps to improve the stability, availability, and quality of direct care providers to help address the decades-long workforce shortage crisis
- Provide states with resources so that caregiving workers—who are disproportionately women of color—have stable, quality jobs and a living wage
- Provide training and support for family caregivers
- Create better evaluation measures to assess the quality of HCBS being provided
The legislation is endorsed by the American Federation of State, County and Municipal Employees, Justice in Aging, the National Health Law Program, the Service Employees International Union, Little Lobbyists, Partnership for Inclusive Disaster Strategies, Partnership for Inclusive Disaster Strategies, American Network of Community Options and Resources, ADAPT and PHI.
Long-Term Care Workforce Support Act
The other bill is aimed at stabilizing, growing, and supporting the direct care professional workforce, which Dingell's office said is essential to ensuring a strong, qualified pipeline of workers to provide needed services to older adults and people with disabilities. Ensuring that direct care professionals are fairly compensated and protected will also benefit them, their families, and their communities.
Studies estimate that, by 2031, 9.3 million direct care professionals will be required to meet the caregiving demands of older adults and people with disabilities. But 92% of nursing home respondents and nearly 70% of assisted living facilities surveyed report significant or severe workforce shortages. In 2022, a survey of nursing homes showed more than 50% of the facilities were limiting the number of new admissions due to staffing vacancies or shortages. Another recent survey of HCBS providers showed all 50 states experiencing home care worker shortages, and 43 states reported that some HCBS providers have closed due to worker shortages.
In 2022, the median hourly wage for all direct care professionals was $15.43, with home care aides earning $14.51. One in eight direct care professionals live in poverty, 75% earn less than the average living wage in their state, and 46% rely on public assistance, such as Medicaid, food assistance, or supplemental benefits. Most direct care professionals are women, immigrants, and people of color, further perpetuating racial, gender, and economic inequalities.
“Caregiving is the foundation of our economy. It allows for all other work to be possible. No care worker should have to live below the poverty line to do this work that millions of Americans depend on," Dingell said. "As many know, this is deeply personal for me—I was lucky to have my husband John receive care at home, but many others do not have the same opportunity. This legislation will make much needed investments in our care infrastructure and workforce, including family caregivers, to ensure they have the support they need, are paid a living wage, and are able to continue doing their critical jobs.”
The bill would:
- Increase the number of direct care professionals, including in rural communities
- Provide pathways to enter and be supported in the workforce for women, people of color, and people with disabilities
- Improve compensation for direct care professionals to reduce vacancies and turnover
- Ensure that the direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and provided fair compensation
- Improve access and quality of long-term care for families
- Document the need for long-term care, identify effective recruitment and training strategies, and promote practices that help retain direct care professionals
- Strengthen the direct care professional workforce in order to support the 53,000,000 unpaid family caregivers who are providing complex services to their loved ones in the home and across long-term care settings