On Wednesday, the Senate Special Committee on Aging Chairman, Sen. Bob Casey (D-Pa.), held a hearing to highlight the importance of home- and community-based services (HCBS) for seniors and people with disabilities.
He also attempted to explain the broader impact that investment in the sector can have.
“Underinvestment in caregiving affects all of us — it even hurts our economy,” Casey said during the hearing. “Without access to this care, many people, usually women, are forced to leave the workforce to care for a loved one. An investment in home-based care is an investment in families and our nation. It will help people get back to work. It gives families … peace of mind.”
Building on Casey’s point about informal caregivers often having to step in to care for seniors, Sen. Tim Scott (R-S.C.) — ranking member of the Special Committee on Aging — noted that these individuals provide over 75% of caregiving in the U.S.
In his opening remarks, Casey also exlpained that HCBS investment would address the issue of caregivers, the majority of whom are women of color, being underpaid.
“These workers provide essential care,” he said. “An investment in home- and community-based services would give these hard-working women, or I should say mostly women, the opportunity to better support their own families and their communities.”
Indeed, across the U.S., the median wage for caregivers is lower than that of other jobs with similar entry-level requirements, such as janitors, retail salespersons and customer service representatives.
In 2019, direct care workers earned a median hourly wage of $12.80, a small improvement from $12.61 in 2009, according to data from PHI.
In order to address the growing number of Americans who need assistance with daily activities, but who prefer to receive care in their home or community, continued bipartisan collaboration is necessary, according to Lisa Harootunian, associate director of the health program at the Bipartisan Policy Center (BPC).
Harootunian cited a BPC report which recommends “streamlining and simplifying Medicaid HCBS waiver and state plan authorities into a single state plan amendment.”
“This would reduce complexity in the system, while still providing states with budget predictability for HCBS,” she said. “Ultimately, this change should improve access to services for Medicaid beneficiaries by reducing administrative burden for states managing HCBS programs, making it easier for beneficiaries to navigate the system and helping to make services more uniform from state to state.”
During the hearing, Anne Tumlinson, CEO of ATI Advisory, also touched on how and why the HCBS infrastructure is vastly underdeveloped to meet the needs of the growing population.
Tumlinson noted that Medicaid spends more on institutional care than on home- and community-based services for seniors and people with disabilities.
Plus, out of the roughly 3 million Medicare beneficiaries living in the community who need support with activities of daily living, one-third live below the federal poverty level but are not on Medicaid. This means they can’t access HCBS support.
Additionally, unlike nursing home care, federal Medicaid law does not require states to offer HCBS benefits.
Though states received federal funds through the American Rescue Plan Act, this shouldn’t be where addressing this issue ends, according to Tumlinson.
“To stop here would be like bringing an umbrella to a hurricane,” she said. “The number of individuals in our country who are 85 years and older will double by the year 2035. That population is … much more likely to have high needs. At the same time, caregivers available to take care of them are declining. Much more federal investment is needed to galvanize and support states and communities in developing the infrastructure and systems along which a variety of publicly and privately funded HCBS can travel.”
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