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According to a recent New York Times Article, “Home health care is the fastest growing major job category in the country, one of the most emotionally and personally demanding, and one of the worst paid.”

Families – and state governments – are struggling with a growing demand for long-term services and supports (LTSS) such as ongoing home health care. The “Baby Boomer” generation is living longer and seeking to “age in place” rather than in institutions, which has created “a demographic explosion” with which the home care industry has not kept pace. A January 2019 report by the Commonwealth Fund found that while “two-thirds of older adults living in the community use some degree of LTSS … many adults, particularly dual-eligible beneficiaries [those eligible for both Medicare and Medicaid], experience adverse consequences of not receiving care.”

Medicare payment policies continue to make it increasingly difficult to obtain long-term home care in general, and home health aides in particular, even for people who qualify for coverage under the law. Medicaid, therefore, currently “sets the standard,” for home care reimbursement, according to Robyn Stone, senior vice president for research at LeadingAge. However, Medicaid reimbursement rates for home care services are generally low, leading to low wages for home health aides. Indeed, 45% of full time home care workers are, themselves, on public assistance, adding to a lack of caregivers.

It has been proven that lack of access to adequate care at home not only hurts beneficiaries, it increases overall Medicare costs. The crisis in home care must be addressed.  One approach to dealing with the increasing need for home care is “Universal family Care,” as discussed in a new report from the National Academy of Social Insurance. The report presents three options for state-based family medical leave programs, and “explores what an integrated approach to supporting families in meeting their care needs might look like.” Further, Congress and CMS should ensure the Medicare benefit is actually available now for those who qualify under the law.

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