The Caring Class: Home Health Aides in Crisis by Richard Schweid

Author:Richard Schweid [Schweid, Richard]
Language: eng
Format: epub
Tags: Medical, Health & Fitness, Health Care Issues, Labor & Industrial Relations, Political Science, Health Care Delivery
ISBN: 9781501754128
Google: -ZD3DwAAQBAJ
Goodreads: 54711748
Publisher: ILR Press
Published: 2021-02-01T00:00:00+00:00

But in 2019 the public balance sheet was facing a loss of some of this free home care because of a growing scarcity of informal caregivers. A reduction in the number of people willing or able to provide informal care, happening at the same time as need grew, augured poorly for the future.37 More and more people did not have the time or energy that long-term home care required. A lower birth rate, combined with a higher number of people remaining or becoming single with only their own earnings to depend on, and the need for women in families to work and contribute a salary toward their households, were all reasons why fewer people were providing informal care. Ironically, the economic collapse driven by COVID-19 may have postponed the effects of this shortage. With high unemployment, families are more likely to have someone out of work who can stay home and perform caregiving duties. Once the economy recovers, however, these informal caregivers will have a chance to return to the labor market, and formal caregivers will, again, be in high demand.

The $100 billion spent annually on home health would go a long way toward meeting the expenses of publicly administered statewide systems of home health care and raising the wages of those doing the job. Well-trained home health aides would be available to all older Americans who needed them. For those clients earning more than twice the federal poverty line, fees could be calculated on a sliding scale, as was done in the Reagan demonstration project, so that out-of-pocket costs would be reduced to a manageable level.

Training would be required for HHA certification, and a certificate would, in turn, be a requirement of employment. This would provide an additional revenue stream of taxes from the women who decided to enroll and become certified rather than working on their own in the gray market, not paying taxes. While some unregistered freelancers might still provide home care, demand for them would be reduced. Paul Osterman’s recommendations for an expanded scope of practice would be easy to integrate into such a system.

For those Americans to whom any sort of government-managed entitlement program is anathema, a different system is already in place, which allows Medicaid-eligible clients who need home care to bypass agencies as well as scope-of-practice regulations. Every state’s Medicaid program offers some variation of what is called “consumer-directed” care. While the structure of the program varies from state to state, the basic idea is that a client can name her or his own caregiver as long as it is not a spouse. Parents, children, siblings, other family members, or friends are acceptable. This person is then paid at the hourly Medicaid rate for HHAs. Enrollment in these programs has grown more than 40 percent since 2011. In 2018 more than a million people were participating in over two hundred self-directed Medicaid and Veterans Administration programs across the country.38

Consumer-directed programs originated in the community of younger people with disabilities and are designed to allow people to take control of their own care to the greatest possible extent.

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