Home caregiver helping senior woman to walk

The Biden administration’s executive order to improve home-based and long-term care services received swift and positive reviews Tuesday by providers and associations representing the aging services and direct care industries.

“We face significant and growing challenges to meet the needs of our country’s increasing aged population that warrants improved access to home care,” National Association for Home Care & Hospice President William Dombi said in a statement. “We commit to work with the Administration as it carries out the president’s plan to secure high-quality and accessible home care through dedicated caregivers. This is an investment that will benefit all Americans.”  

President Joe Biden officially announced the executive order in the White House Rose Garden Tuesday afternoon. It includes more than 50 directives to Cabinet-level agencies to take steps to fix the nation’s long-term care and child care crisis.

The directives include improved access to home-based care for veterans through the Veteran Administration’s Directed Care Program; enhanced job quality for long-term care workers by leveraging Medicaid funds to support seniors and those with disabilities; support for family caregivers through respite care and the hospital discharge process; and a Labor Department initiative to ensure workers’ rights are protected.

Although Bayada Chief Government Affairs Officer David Totaro called the executive order “limited in scope,” he told McKnight’s Home Care Daily Pulse in an email it was a step in the right direction.

“In the past several years, the public has seen how vital home care is and why it will touch every individual and family at some point in their lives,” Totaro said. “It’s time that the government recognizes the need to expand access to affordable, high-quality care — and the need to pay in-home caregivers a fair wage. State and federal governments play a major role in ensuring home care is funded properly so that home health aides, nurses, and other caregivers are paid a wage commensurate with their role in society.”  

Praise for family caregiver support

Language supporting family caregivers in the executive order earned kudos from many, including Deb Oberman, senior vice president of government affairs for Help at Home.

“We are encouraged by the fact that it does not only encourage Medicaid dollars, but it speaks positively about the need for training and development and the support for both paid and unpaid caregivers,” she said in an email to McKnight’s Home Care Daily Pulse. “With the caregiver workforce shortage, it focuses on how to professionalize the jobs in addition to being paid at the appropriate level. Caregivers need support and training and that was a theme — it’s about the pay, but also more than that.”

She added, “We are very much looking at preferred or family caregivers as an opportunity that is one of the solutions to the caregiver workforce shortage. There are many people who are forced to make a choice between working and taking care of a loved one. With resources and a focus on the importance of creating professionalized caregiver career opportunities, those who want to work as a paid family caregiver don’t have to make a choice between the two.”

AARP commended the order as an important step in the National Strategy to Support Family Caregivers it released last fall.

“We stand ready to work with the administration to advance the important policies to support family caregivers and the long-term workforce,” AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond said in a statement.

Mixed reaction

LeadingAge President and CEO Katie Smith Sloan was dismayed that the executive order’s primary focus was limited to home care and didn’t extend to other care settings, such as adult day programs, hospice and assisted living. Still, she said the plan shows that the Biden administration has been listening to appeals to help solve the direct care crisis.

“LeadingAge has long advocated for an all-of-government approach to ensuring greater access to aging services — and addressing the workforce crisis must be the top priority,” Sloan said in a statement.

The Home Care Association of America told McKnight’s Home Care Daily Pulse it was still reviewing all 50 directives but was encouraged by the president’s order.

“The Home Care Association of America is appreciative of the Biden administration’s continued focus on home-based care, the agencies and caregivers who provide it, and the seniors and people with disabilities who rely on it,” HCAOA said in a statement.

The administration said the cost of long-term care for the elderly has increased approximately 40% in the past decade, while the cost of child care has increased roughly 20%. Meanwhile, the direct care industry has been struggling to attract caregivers due to low wages.

The administration, which also issued directives for nursing homes, said it will call for investments to support caregiving in its 2024 budget.