Vice President Kamala Harris outlined a new proposal for home health care on ABC’s “The View” on Tuesday, a plan for expanding Medicare coverage aimed at helping what is called the “sandwich generation” take care of their aging parents.
Many adults find themselves straddling the dual responsibilities of rearing their children at a time when their parents need more assistance to stay at home.
And millions of Americans struggle to find affordable home care for themselves or their loved ones as they become older. Medicare, the federal insurance program for older Americans, does not cover long-term care and will generally pay for a home aide only if a patient is recovering from an acute medical condition, like a stroke, and only for a short time, often just a few months.
While Medicaid will pay for a home aide if someone is poor or has no assets, there are long waiting lists to qualify. And in many areas of the country, there is a severe shortage of workers because of low wages and better, less stressful jobs in other businesses.
Most people have no choice but to rely on a family member to care for them because they cannot afford the cost of care, which can surpass the expense of an assisted living facility. Agencies can charge about $30 an hour, according to Genworth, a long-term care insurance company. Others end up spending most of their assets and seeking care in a nursing home, where Medicaid does not have waiting lists.
Judy Feder, a professor of public policy at Georgetown University, who published a recent paper on a possible Medicare home-care benefit, said such a policy would fill a major gap in Medicare, and relieve financial and physical burdens on family members. The private market for long-term care insurance has not functioned well, she said: “It’s a catastrophic, unpredictable event for which you need insurance.”
The Biden administration wanted to offer more help, including for home health care, as part of its big domestic policy bill, but the effort was axed from the bill during congressional negotiations. That approach, estimated to cost $150 billion over a decade, was more modest. It would have provided additional funding to state Medicaid programs to reduce waiting lists for home care.
The Harris proposal would be much broader because it would not be limited to Americans enrolled in Medicaid, who must be poor to qualify.
A Medicare benefit would be more universal, though that does not mean it would be free to everyone who uses it. A recent paper from the Brookings Institution sketched out some possible design considerations, including requiring higher cost sharing for families with more wealth and restrictions on paying family members to provide the care. The Brookings plan, which would provide a benefit targeted at lower-middle-class Americans, was estimated to cost around $40 billion a year.
Specifics of cost estimates for Harris’s plan have not been released, although her campaign has said that the program would be paid for by the savings achieved through expanding Medicare drug price negotiations. Depending on the scope of the new benefit, that would mean an incremental change in the existing policy or a major rethinking of how Medicare pays for drugs.
The burden of home-based care often falls on adult sons and daughters, many of whom are also trying to take care of their own children and juggling the balance between work and home life.
But the vast majority of people want to age at home, even when they need help with tasks like feeding themselves or using the bathroom.
Under current law, many older people who need help with those things receive services in a nursing home, even though they would prefer to be taken care of at home.
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