Home And Community-Based Care Supports Us All

Home And Community-Based Care Supports Us All


Every day, millions of workers enter people’s homes to provide care to those with disabilities and the elderly. These “direct-care” workers assist individuals with bathing and dressing, cooking and eating, taking medication, and getting exercise. For the people they help, they are lifelines to health, independent living, and economic stability.

Yet our system for providing this care is in desperate need of repair. Medicaid serves approximately 4.8 million Americans with home- and community-based services, but there are still nearly 850,000 people on waiting lists. They often wait years for crucial support.

At the same time, direct-care workers have been underpaid for decades, causing instability in their own lives. This situation was untenable even before pandemic-induced social distancing kept these workers from fulfilling their jobs, jeopardizing the individuals and families who rely on them.

President Biden proposed a fix for the industry in his infrastructure plan, which would add $400 billion in federal spending for Medicaid’s home and community-based services program. This would provide a sorely needed boost to the caregiving economy.

Yet the president and a group of bipartisan senators recently dropped this aid from a “compromise” they reached on infrastructure. That’s deeply disappointing. Lawmakers must do everything they can to work this aid back in — whether as part of this plan or a separate bill. Funding home- and community-based care for the most vulnerable Americans shouldn’t be a partisan issue.

In fact, the demand for home- and community-based care will only grow in the years ahead, given that one in four Americans today are living with a disability, and the average age of the U.S. population continues to rise. According to Harvard University’s Joint Center for Housing Studies, the U.S. population aged 74 and over is expected to increase by 48% in the next decade, to a total of 34 million people. And older Americans are increasingly cost-burdened. Among homeowners over age 79, just 3% owed mortgage debt in 1989, compared to 27% by 2019.

It all adds up to a situation where more people need services but have fewer options to access them.

The voting public recognizes this. An April poll from Morning Consult and Politico found that 76 percent of Americans support new funding to improve caregiving for people with disabilities and the elderly. And yet, some of our political leaders don’t seem to see the need.

Perhaps they don’t understand that care workers enable people to continue living in their own homes — or how important this is.  Aid recipients prefer to be cared for in their own homes and communities, and the law obliges public agencies to do so whenever possible.

Care workers themselves also need help. Though entrusted with their clients’ wellbeing, direct-care workers make $11 an hour on average. Approximately 15% live in poverty. It’s no wonder that there is 50% turnover every year among direct-care workers, which can make inconsistencies and interruptions in caregiving more likely.

The low wages also exacerbate gender and racial inequality, as women of color dominate the ranks of direct-care workers. And when we fail to support direct care, the burden of looking after family members typically falls to women, taking them out of the workforce across the economy.

Home- and community-based care makes it possible for millions of families to thrive. But without new expenditures, both the workers who provide these services, and the individuals and families who rely on them, will not. Our lawmakers need to make this investment now, assuring a sustainable system of services and support for our most vulnerable citizens, their families, and the professionals who care for them. 

Angela F. Williams is the president and CEO of Easterseals.





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