Biden's $400B plan to overhaul home care is 'more of a repair effort than a new direction'

Worker-owned home-care cooperatives are emerging as an alternative to the for-profit agencies that dominate America's direct-care sector. In these cooperatives, professional caregivers earn an average of $2 more per hour than the industry standard, share in business decision-making, and stay on the job at nearly double the rate of workers at traditional agencies. Patients also stay with co-op agencies twice as long, suggesting higher satisfaction and quality of care.

Medi-Cal is a Medicaid program for low-income residents regardless of their immigration status. As of October 2022, more than 300,000 older immigrant adults without legal residency enrolled in Medi-Cal, which was more than the state’s original projection. To continue expanding Medi-Cal’s reach, community health workers and educators are visiting senior centers, churches, markets and community events to encounter people who may not be aware of their eligibility in the program.

Program for All-Inclusive Care for the Elderly (PACE) provides care to elders including adult day care, home health care and supplies like bed rails, eyeglasses and access to medications, while simultaneously providing respite to family caregivers. Studies show PACE program participants have lower rates of hospital use and shorter lengths of stay compared to those participating in other programs or opting for general nursing home care. The PACE centers in Metro Detroit serve 1,600 adults across its seven centers. Statewide, there are 14 active PACE programs across 24 centers.

The Basic Health Care Provision Fund establishes government health facilities that allow people to access care for free. WHen the fund started in 2021, it had 16,000 enrollees and as of October 2022 there were 38,600 enrollees in the state.

REACH (“Reaching Everyone with Accessible Community Health”) provides preventive and curative healthcare through a community-based health insurance initiative that offers different packages of care. Community members pay a monthly fee for the insurance, which gives them access to treatment for all ailments including prescription medicines. About 11,000 people are served locally by 22 community health workers but are referred to health clinics and hospitals for more serious issues. Partnerships with pharmaceutical companies and the nonprofit arm of a local clinic helps make treatment costs affordable.

Although offering at-home care has been a practice for some time, the coronavirus pandemic has helped prompt more health insurance companies to allow health care workers to implement the practice at a larger scale. Treating patients in their homes doesn't just reduce the caseload for doctors in hospitals but also has been shown to have positive effects on the patient's overall health and well-being. Since the change in health insurance police, "interest in the programs has skyrocketed."

The Ohio District 5 Area Agency on Aging hires state-tested nursing assistants (STNA) to act as community care specialists and provide in-home care to seniors. This care provides respite for unpaid family caregivers and allows seniors to continue living independently in their homes. In 2023 alone, the program served 130 residents, providing 2,371 hours of in-home care.

Direct care workers, including certified nurse assistants and home health aides, provide personal care to help aging or disabled individuals remain independently at home. There are approximately 165,000 of these workers across the state that serve more than 100,000 families with daily activities like bathing and meal preparation.

The Veterans Health Administration's Caregiver Support Program offers resources to family caregivers looking after veterans, including a monthly stipend, medical services, counseling and mental health care, respite care and coverage for travel expenses. The Program launched in 2011 and by 2014 about 15,600 caregivers had been approved for support — greatly exceeding the Program’s original estimate of 4,000 people.

The Money Follows the Person is a federal program that increases access to Medicaid funds for home and community care services for people transitioning out of institutional care. The program has helped more than 101,000 people move out of long-term care facilities into community or home living. The program has also helped people save money by cutting taxpayers’ Medicaid and Medicare bills by about 23% for each person who was moved out of a nursing home or other institution. Based on the program’s success, the current administration is reviewing plans to extend or make Money Follows the