Senate Bill Seeks to Create New Home-Based Care Delivery Systems, Boost Caregiver Wages

In an effort to address the growing demand for home care services and worsening labor crunch, one U.S. lawmaker has introduced a bill that could help providers raise wages for their caregivers.

Sen. Bob Casey (D-Pa.) introduced S. 3277 — the Home and Community-Based Services (HCBS) Infrastructure Improvement Act — into the U.S. Senate on Wednesday.

The HCBS Infrastructure Improvement Act is designed to provide one-time federal funding to states allowing them to create new programs and initiatives focused on improving the lives of older adults. The bill would give states new flexibilities for how they deploy and support their home- and community-based services, including funding for possible wage and benefits increases for home-based caregivers.


The median wage for direct care workers is $12.27, according to the U.S. Bureau of Labor Statistics.

Under the HCBS Infrastructure Improvement Act, federal funding would be awarded as seven-year grants determined by each state’s current spending on home and community-based services.

“We must invest in home health care,” Casey said during a special home health Senate hearing on Wednesday. “That is why I am introducing the Home and Community-Based Services Infrastructure Improvement Act. This bill will provide Medicaid grants to all states to support existing service providers and encourage the creation of new delivery systems to meet the needs of older adults and people with disabilities.”


So far, the bill has drawn support from the National Council on Aging (NCOA), the National Association of Home Care & Hospice (NAHC) and SEIU. The bill has also already gained the support of home care workers.

One worker, Francis Adams, provided testimony during Wednesday’s hearing.

The 70-year-old Adams has been a caregiver for more than 20 years, an acting member of United Home Care Workers of Pennsylvania, a joint program of SEIU Healthcare PA and the American Federation of State, County and Municipal Employees. During testimony, Adams shed light on some of the causes of the national caregiver shortage.

“Many home care workers don’t have affordable health care and go years without seeing a doctor,” Adams said. “More than half of all home care workers rely on public assistance. We’re unable to meet our basic needs.”

In 2018, the average turnover rate for home care workers was 82%, according to Home Care Pulse. Meanwhile, home health industry turnover checked in at an average rate of 21.89%, according to a 2019 Home Care Salary & Benefits Report.

“When I was younger, you could quit your job at the steel mill, walk across the street to another mill and get another job in 10 minutes,” Adams said. “Today, that’s home care. There are so many open jobs, but it’s hard work and people aren’t going to fill open positions if they can get paid more at a CVS.”

To keep caregivers in home-based care, Adams called for wages to be raised to at least $15 per hour.

“We can’t truly improve the long-term care that seniors and people with disabilities rely on unless we tackle the major obstacles that are holding working people back, including low wages, a lack of benefits and basic worker protections and inadequate training,” Adams said.

The HCBS Infrastructure Improvement Act is a federal effort meant to boost home-based care labor conditions across the country. So far in 2020, several state-level policymakers have tried to carry out similar measures as well.

For example, officials in Maine recently explored a new type of state-wide caregiver wage increase. Earlier this month, the state’s Commission to Study Long-term Care Workforce Issues called for caregivers to be paid at least 125% of the state’s existing minimum wage.

Additionally, at least 21 states began 2020 with higher minimum wages than the previous year.

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