Older adults and people with disabilities often need services and supports to allow them to live safely in their homes and communities, but in many places, they cannot get the help they need. This unmet need is fueled by limited eligibility for support and a shortage of workers who can provide the necessary care and services. Without a robust workforce, people who need care at home can be forced into institutions such as nursing homes. A new bill introduced in Congress last week, the Better Care Better Jobs Act (BCBJA) (S. 2210), offers a partial, and much-needed, solution. It would expand eligibility for care at home and bolster the workforce, giving people more options to age in place.
Medicaid is the nation’s largest payer for home- and community-based services (HCBS)—services that allow people to remain in their homes while receiving assistance with personal activities or help around the house. Access to and funding for such services is limited, however, leaving many people who need HCBS on waiting lists or without any options but to enter a nursing home. As the COVID-19 pandemic has shown all too well, institutionalization can put people at heightened risk of isolation, infection, and despair.
The BCBJA would help by expanding eligibility for Medicaid HCBS and, at the same time, increasing funding to support states and the workforce needed to provide the care.
At Medicare Rights, we strongly support investing in the caring economy. This includes building up a talented and trained workforce who can provide the services older adults and people with disabilities need to live their day-to-day lives with dignity in the setting of their choice. Beyond the BCBJA, more must be done to increase access to HCBS in Medicaid and to expand and clarify access to home health in Medicare. These efforts require long-term thinking about the future of care, the infrastructure needed to make that future possible, and needs and well-being of current and future generations.