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Homecare in Crisis—and on the Ballot

Sarita Gupta November 2, 2018
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States with aging populations are pushing public homecare bills and policies that also create jobs, reshape economy.

As our nation ages, our care needs are growing at breakneck speed. As a daughter balancing care for my father with Alzheimer’s while raising my own daughter, I know all too well some of the real emotional and financial struggles many of us face as care is taking center stage in more of our lives. The question is no longer if caregiving will affect any of us—it’s when, and whether we are prepared for it.

Homecare in Maine the least affordable in the nation. Because the state is smaller, older and more rural, it is also a harbinger of things to come as the nation grows older. Grassroots organizers seek passage of Question One on Nov. 6 to offer universal home care to 21,000 seniors and disabled residents who are eligible for homecare services but currently don’t receive them.

The United Nations predicts the world population over age 80 will double by 2050 and the number of people over 60 is growing faster globally. The demand to age gracefully at home will create jobs for home healthcare workers, but they need to be paid—and fairly. Maine’s Question One and many other long-term care bills across the nation offer a generation-defining opportunity to create the sustainable, dignified care our families:

  • In Washington, the Long-Term Care Trust Act seeks to offer seniors dignity by providing a public long-term care benefit that would cover services like bathing, dressing, toileting and eating.
  • In Hawaii, the state’s Kapuna Caregivers Program seeks community awareness and legislative support to continue offering a $70 a day benefit (first offered in 2017) for caregivers who work outside the home. The supplement helps pay for everything from home health care workers and meal prep to transportation.
  • As Iowa ages, residents are reeling from the state’s privatized Medicaid, the largest support for long-term care services. Not only do seniors suffer, but people with disabilities feel the squeeze of funding that can put them in nursing homes too soon.

Nearly 20 percent of Maine’s population is over 65, a number that is expected to grow. The median annual cost for homecare in Maine is nearly $60,000, and nursing homes cost over twice as much. Reimbursement rates for Medicaid in-home care programs are so low employers have difficulty finding workers willing to do challenging work for so little in wages. For people with disabilities, in-home care waiting lists abound.

“Right now it’s far too difficult for Maine seniors to get the care they need to stay in their homes and it’s far too difficult for families like mine to make ends meet while doing this vital work,” according to Miri Lyons, a homecare worker from Boothbay Harbor. “No one should have to go deep into debt to care for a loved one. No one should be sent away because their family can’t afford to help them. And no one should live in poverty while doing the important work of caring for others.”

A generation of families, Democrat and Republican alike, will soon be forced to choose between spending down all their savings or their family members going without care. In such a polarized time, the fact that middle- and working-class families need more support to care for their own isn’t up for debate—it’s a fact.

Homecare workers currently make poverty-level wages, rarely have benefits, and many depend on public assistance for food security. Countless numbers of homecare workers are forced to leave a profession they are passionate about because they cannot sustain themselves or their families on these wages. This results in an annual 67 percent turnover rate of this workforce, which is not good for our loved ones who depend on the supports and services of these workers.

These dire turnover levels are reflected across the country. While the shortage may be being felt harder in Maine right now, as our nation continues to age, the need for workers will come into even sharper relief. By investing in these jobs now, we can secure the future of our aging loved ones and our nation’s families.

The program will be a model for states going forward: It will be funded through a payroll tax of 1.9 percent employees and employers on income above the Social Security tax threshold of $128,400, partially closing the loophole that allows the wealthiest 2.6 percent of Mainers to avoid paying Social Security payroll taxes. Unfortunately, wealthy special interests like the nursing home and real estate lobbies are trying to stoke confusion and fear by spreading misinformation about how much this would cost in taxes.

The truth is, unless you’re in the top 2.6 percent, you wouldn’t pay a cent more. By providing affordable home-based care options for individuals and families, and by creating and improving care jobs, Question One can promote a stronger economy, which can be replicated across the nation.

Homecare for all, will support continued labor force participation among family caregivers, and people like me will not have to choose between continuing to work outside of the home and caring for my loved ones. It’s time to invest in creating the care all our families need.

Read more from Sarita Gupta in our Q&A on Equity in Aging.
Sarita Gupta

Sarita Gupta is co-director of Caring Across Generations and an Encore Public Voices Fellow of The Op-Ed Project. Caring Across Generations is a national caregiving advocacy campaign working to bring our caregiving infrastructure into the 21st century, so people can age and care with dignity. The New York–based organization has supported state-led movements to create and implement solutions addressing the depth of families’ growing care needs.

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