A recent job report showed that unemployment fell sharply to 4.8% over the last 18 months. That’s good news for many Americans. But a new reality has also become visible – an unmet need for nursing staff.
Traditionally, most caregivers for children and the elderly have been women, and they continue to bear the brunt of that responsibility today. Yet with social and demographic change, the new reality is that other sources of care are increasingly needed to help working adults live up to their many different responsibilities.
It is becoming increasingly difficult to recruit a sufficient number of home care workers – we are missing 2.3 million based on a 2021 survey by the Office of the Assistant Secretary for Planning and Evaluation.
To address this issue, Congress is currently debating legislation to expand home health care. The Build Back Better framework is designed to permanently enhance affordable care by improving Medicaid home care services for seniors and people with disabilities, while supporting the well-trained professionals who provide this care. In addition, the premiums will be reduced for home care staff.
These are all good, but far more important is the long-term care policy that benefits the middle class and working families, the very group that is most likely to fend for itself. The state of Washington provides an example of a publicly funded long-term care effort, but in the end, only federal policy will suffice for the more than 78 million baby boomers now entering old age and the millennial cohort that follows.
There is also the issue of burnout. Many family carers work long hours and need time off, but often go without. The pandemic has also had a profound and profound impact on the psyche of people and the resilience of relatives. The adult day care movement is an example that can help reduce relatives’ stress and meet their professional needs. Perhaps more importantly, research shows that adult day care centers fill a gap to ease a potentially serious care burden.
These problems particularly affect the Latino population. A longitudinal study we did of Mexican-American care recipients who are in their 90s shows that their caregivers receive less help from non-Latinos in care. Consequently, the impact on caregivers – family, friends, neighbors – is immensely more difficult if we do not expand support and draw on community-based day care centers for adults and all other sources of support.
In Texas, Rider 157, DHHS Community Attendant Workforce Development Plan, includes specific strategies for recruiting, retaining, and ensuring adequate access to local caregivers and personal care services for elderly adults and people with disabilities in Medicaid and non-Medicaid programs. In addition to this improvement program, Medicaid State Plans offers adult day care as a benefit. By 2021, only 15 states covered adult health care with their Medicaid State Plan.
If an issue can be impartial or bi-partisan, it can certainly be a non-political creation of home- and community-based infrastructure for anyone who in due course will be endowed with the care of an aging relative or a disabled child. Our state legislators should enact legislation that will develop and implement strategies for housing integration as well as home and community-based programs for low-income seniors and their relatives.
And federal lawmakers should pass parts of the Build Back Better legislation that will promote a stable long-term care infrastructure in the home and community, as most programs are optional for states. Making permanent matching federal Medicaid funds available would offset many years of underinvestment in community care for those who need it most.
These would lead to modest improvements, such as greater Medicaid flexibility to fund care and home-based care. Legislative understanding and support is growing in Congress and in the state capitals for these important improvements, but much more is needed, including a universal long-term care policy that many nations – the EU, Taiwan, Korea and Japan – now deliver. We can do better here in the United States
Jacqueline L. Angel is a Wilbur J. Cohen Professor of Health and Social Policy and Professor of Sociology at the University of Texas at Austin.
Fernando M. Torres-Gil is Professor and Director of the Center for Policy Research on Aging at the University of California, Los Angeles
A version of this op-ed appeared in The Hill.