Disability and labor advocates cheered when President Joe Biden’s Build Back Better agenda passed in the House of Representatives last week. The American Association of People with Disabilities praised the $150 billion investment in home care as “historic,” noting it is “the single biggest investment in the program’s history.” But privately, advocates are worried that the investment won’t solve problems like long waiting lists for home care and low wages for those who provide it.
The investment — less than half of what was originally promised, to be spent over 10 years — is unlikely to do much of what the Biden administration initially promisedAccording to an internal memo circulated in July by advocates, home care is a priority. Biden ran for president in 2008. pledgedTo reduce waiting lists for homecare and to increase wages for workers. The memo stated that $150 billion could end up pitting workers, mainly women of color, against disability advocates to access limited funding. Some states may decide not to adopt this program, as they will have to invest their funds to receive the federal match amount.
The home care sector has suffered from underfunding and neglect for decades. For seniors and people with disabilities, there are long waiting lists. Workers earn an average $12 an hour, which is low compensation. The work is physically and emotionally demanding. Workers are responsible for maintaining their clients’ health and assisting them in their basic needs, like eating or showering. According to Home Care Pulse (a market research firm), two-thirds of homecare workers leave within one year.
Some advocates worry that a fight over what gets funded — more capacity for those who need home care or better wages for those who provide it — will fracture a relatively new peace between labor unions and disability advocates. Labor unions were staunch opponents of closing state schools for persons with developmental disabilities and segregating asylums for them. Some still are: The American Federation of State, County and Municipal Employees, the largest union of public employees in the United States, has described deinstitutionalization as “yet another way to push the responsibility for service and funding into the private sector.”
In contrast, disability groups unequivocally celebrate deinstitutionalization as a victory for human and civil rights. As unions including the Service Employees International Union have expanded their efforts to organize home care workers, national labor organizations have largely backed off fighting deinstitutionalization. This alliance is relatively new, but a fight for limited funding could endanger it. Ai-jen Poo (executive director of the National Domestic Workers Alliance) warned of this possibility in a July memo. “A marked reduction in funding will not allow for the effective implementation of this policy, if states elect to participate at all, and will create grave tension within the broad-based coalition that supports this effort,” the memo reads.
Poo did no respond to a request by communications staff for comment.
The problem lies in the structure of Medicaid’s home care funding program, according to the memo. The federal government provides some funding but states must opt-in and contribute their own funds. States cannot borrow money, unlike the federal government. According to an issue brief by the The, the optional Medicaid programs are often the first to be cut if state legislatures need to reduce costs. Kaiser Family Foundation. Multiple experts shared their opinions The 19thThe likelihood of states with lower incomes per capita, like Georgia or Alabama, to reject expensive optional programs is higher.
Still, advocates for home care are relieved to have had their priorities included at all; a number of proposals didn’t make it into the version passed by the House. Policy experts in D.C. believed that some money was better than none.
This sentiment was shared by home-care workers. TunDe Hector, a certified nursing assistant from Georgia and member of SEIU, praised Biden’s Build Back Better agenda, even with the cuts.
“I think President Biden is doing a good job. He’s doing the best he can right now. Given the political climate, it’s very hard for him. This is his vision — of building back America and building it back better,” Hector told The 19th.
Hector stressed the importance home care workers.
“Home care is the backbone. People who take care of people are essential. We feed, bathe, brush teeth,” Hector said.
Josue Rodrguez, a Texas activist for the disability rights group ADAPT, praised funding. Rodriguez, who has cerebral palsy, uses home care services. He attended a therapist last month. vigil in D.C. Last month to push for funding for homecare.
“It’s a good starting point to relieve some of the issues that we’ve got,” Rodriguez said. “It’s not enough. But it’s a good starting point.”