Our View: Support Home Care Programs to Protect Older Adults, Caregivers and Front-Line Care Workers

Home care worker

At the Health Foundation, we are committed to supporting efforts to ensure every older adult can live a dignified, independent, high-quality life in their community. Access to strong, sustainable home- and community-based care programs is a key part of making that happen.

Home care provides many benefits to older adults and their families. These services allow people to remain independent, are linked to better health outcomes and can reduce strain on health care systems. Still, challenges in delivering home care—staffing shortages, low wages, and increasing costs of care—have existed for some time, and are now being exacerbated by the COVID-19 pandemic.

We are calling on our elected officials to support legislation and funding to strengthen home care programs, ensure older adults have access to this care, and protect workers—not only as our community navigates the current crisis, but in the future as well.

How Home Care Helps Older Adults and Family Caregivers
For many older adults, home care programs are key to remaining in their own communities and avoiding the need for facility- or hospital-based care. Home care workers provide extensive, vital services, including assistance with activities of daily living, care coordination, wellness and safety help, and companionship that reduces the risk of social isolation.

Additionally, paid home care services offer important respite opportunities for family caregivers who otherwise attend to their loved ones on a daily basis, often for long hours. Family caregivers frequently face mental, physical, financial and emotional stress. In 2020, the National Alliance for Caregiving and AARP reported that 21 percent of family caregivers reported their own health as fair to poor.

Access to paid care providers can provide family caregivers with needed breaks, improve their quality of life and ensure a more sustainable, healthier approach to caregiving. In fact, a recent report by the Home Care Association of America noted that family caregivers using home care services reported better overall health, better ability to hold jobs, and fewer lost wages than those without home care access.

Protecting Workers and Strengthening the Home Care Workforce

COVID-19 has created new strain on an overextended home care workforce. A Home Care Association of New York State survey from early April found that many home care and hospice agencies were experiencing “worrisome workforce capacity issues.” Nearly three-quarters of respondents reported decreases of 1 to 10 percent in their home health workforce capacity.

Many home care workers had to leave their positions during the pandemic for a variety of reasons: some left to care for children after schools closed or attend to family members who were sick or at risk, and some left out of fear of catching the virus themselves. That fear was understandable as health care workers across the industry were facing inadequate supplies of personal protective equipment (PPE).  Some workers were forced to buy or make their own PPE.

But unsustainable work conditions for home care workers are not new problems. According to PHI, a national organization that works to transform eldercare and disability services, home care workers—a workforce made up largely of women of color—earn on average $13,300 annually, and one in four home care workers lives below the federal poverty line.

These statistics show us that providing fair wages and safe workplace conditions for front-line care providers is not only essential to improving health care systems, but also for moving closer to racial and economic justice.

How Our Elected Officials Can Help

Legislative and regulatory efforts can help bolster the home care landscape and address many of the issues mentioned here.

For example, New York State lawmakers and home care advocates recently called for new legislation known as the Essential Care Act that would strengthen home care access and provide new protections for workers. The act, a package of several bills, would take various approaches that include adjusting the Medicaid Redesign Team’s daily living threshold requirements so more New Yorkers can qualify for home care; requiring private insurance companies to reimburse the cost of personal protective equipment for home care agencies; and creating a task force to study and reimagine long-term care services in the state.

Additionally, the Health Foundation continues to call for a strong, fully funded Medicaid program at the state and federal levels that can help more people access home- and community-based care programs. Millions of New Yorkers rely on Medicaid for health care coverage, and that number has increased drastically since the start of the pandemic and resulting economic crisis. For many people, Medicaid coverage is essential to accessing home care services.

An aging population means the need for home care services will continue to increase for the foreseeable future, and the COVID-19 crisis has illuminated the many ways this system can be improved. Building a sustainable, equitable and comprehensive approach to home care services and staffing will help ensure a healthier community for all.