Congress must fully fund home and community services

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As part of a revised framework for the Build Back Better Act, currently under intense negotiations in Congress, the President Joe bidenJoe Biden The White House unveils its strategy for the net zero goal in 2050. offers $ 150 billion in federal funding for home and community services across the country (HCBS), far from $ 400 billion that the president first proposed in the spring.

While dollars remain important, this reduced level of funding falls short of meeting the need or timing amid an ongoing pandemic, a national shortage of homeworkers, a fragile economy and an aging workforce. America. By 2030, one in four Americans will be 65 or older, compared to 15% of the current population.

Today, nearly 820,000 people find themselves on waiting lists for much-needed services, including home care, food and medical assistance, family caregiver support, transportation and nursing care. qualified. With an average wait time of over three years, many have become sicker and more fragile, and others have even died. These people are denied the opportunity to receive care and support at home rather than in retirement homes, a declared desire of the overwhelming majority of adults in America.

Beyond waiting lists, strong funding for HCBS would create thousands of new, better paying jobs for caregivers – the majority of whom are women of color – and mark a historic investment in an area of ​​care that has been neglected and neglected. underfunded for decades.

The Medicaid HCBS provision in the proposed Build Back Better program is a giant step in the right direction to address long-standing gaps in care for the elderly and people with disabilities. It would be the most significant investment in long-term care by a president since Lyndon Johnson signed legislation to establish Medicare and Medicaid in 1965.

But without significant investment in HCBS right now, and considerably higher than what is currently on the table, the human and economic toll will only increase and become more difficult, if not impossible, to manage. Experts believe that at least $ 250 billion to clear waiting lists for care and services alone.

Congress must exercise caution when considering the final price of HCBS. Every cut from the $ 400 billion originally proposed has immediate, medium and long-term consequences for individuals, their families and the economy.

Not only does the expanded HCBS have the potential to reduce emergency room visits, keep more people healthy and independent, and reduce admissions to nursing homes and hospitals, a recent Moody’s Analytics report notes that older people and people with disabilities “would receive better quality care from better trained and better paid direct care workers”.
In addition, over 40 million unpaid caregivers will be able to take other jobs, and “the economy will receive an immediate boost from this increase in government spending as well as increased long-term growth due to higher participation in the labor market “.

The impact of the pandemic, especially on the elderly, has heightened the urgency to fix a system that keeps essential care out of reach for far too many people. While emergency relief bills have helped, these funding increases are only temporary, pale in comparison to the inordinate need.

Deaths among residents and staff of long-term care homes now account for a third of all deaths from COVID-19 in the country, although it represents only 1% of the total population. These grim results have sparked a national awareness of the need for more home care options. At the same time, the national shortage of home health workers teaches us the hard lesson that without an adequate and well-resourced workforce, our entire long-term care system can collapse.

The overwhelming demand for services will only increase over the next several years as America’s population ages, and without government action, we will face an even more serious healthcare crisis than today. Insufficient funding will only serve as a dressing to the gaping wound in our HCBS infrastructure.

Shelley Lyford is the CEO of West Health, a family of nonprofit, non-partisan organizations dedicated to lowering the cost of health care and improving aging in America.


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