More than 63 million Americans spend significant hours each week caring for an aging or disabled family member, often while juggling jobs and other responsibilities. This caregiving crisis, driven by a rapidly aging population, has exposed a glaring gap in federal policy: nursing home care is a guaranteed Medicaid benefit, but home- and community-based services remain optional, leaving millions without access.
Aging at Home vs. Institutional Care
With life expectancy now at 79 years—up from 61 when Social Security was created in 1935—the population over 85 is expected to double by 2040. Most Americans prefer to age in their own homes, yet Medicaid currently mandates coverage for nursing homes while allowing states to limit or cut home care when budgets tighten. The result: over 600,000 eligible individuals languish on waiting lists, often for years, despite being qualified for services.
Two bills introduced in Congress aim to fix this. The Home and Community-Based Services Access Act would make home care a mandatory Medicaid benefit, eliminating waiting lists and funding better wages for direct care workers. The Long-Term Care Workforce Support Act targets the workforce crisis by raising pay, improving training, and creating more stable jobs for the 4.5 million direct care workers who earn poverty-level wages.
Workforce in Crisis
Direct care workers—the backbone of home care—often earn so little they can barely afford gas to travel between clients. Many hold multiple jobs, lack benefits, and face high turnover, leaving families without options. As Rep. Debbie Dingell (D-MI) and Ai-jen Poo, executive director of Caring Across Generations, argue, access to care on paper means nothing if no one is available to provide it.
The Long-Term Care Workforce Support Act would ensure that funding increases go directly to worker wages rather than administrative overhead. Fair pay, proponents say, reduces costly hospitalizations and unnecessary nursing home placements, saving money for families and the government.
A False Choice
Critics sometimes frame home care as a budget trade-off, but advocates insist it's a false choice. Home care saves money, and the two bills are complementary: the HAA guarantees access, while the workforce act ensures there are workers to deliver care. Without both, the gap will widen.
The political stakes are high. Medicaid, which pays for 70% of home- and community-based care, faces major cuts in ongoing budget debates. Meanwhile, a Pew poll shows 56% of Americans believe federal ethics have declined, adding urgency to legislative action. And as financial anxiety grips Gen X, the cost of care looms large for families.
Dingell and Poo urge Congress to act: “Caregivers are doing our best. It’s time for federal policy to catch up.” The bills represent a rare bipartisan opportunity to address a crisis that touches nearly every American family.
