Skip to content Skip to search

Republish This Story

* Please read before republishing *

We’re happy to make this story available to republish for free under an Attribution-NonCommercial-NoDerivatives Creative Commons license as long as you follow our republishing guidelines, which require that you credit The 19th and retain our pixel. See our full guidelines for more information.

To republish, simply copy the HTML at right, which includes our tracking pixel, all paragraph styles and hyperlinks, the author byline and credit to The 19th. Have questions? Please email [email protected].

— The Editors

Loading...

Modal Gallery

/
Sign up for our newsletter

Menu

  • Our Mission
  • Our Team
  • Latest Stories
  • Search
  • Upcoming Events
  • Contact Us
  • Newsletter
  • Donate
  • Work With Us
  • Fellowships
    • From the Collection

      Changing Child Care

      Illustration of a woman feeding a baby a bottle
      • The full PUMP Act is now in effect. Here’s what it does for lactating parents.

        Chabeli Carrazana · April 28
      • 1 in 4 parents report being fired for work interruptions due to child care breakdowns

        Chabeli Carrazana · February 2
      • Washington, D.C., offers financial relief to local child care workers

        Orion Rummler · September 20
    • From the Collection

      Next-Gen GOP

      Illustration of a woman riding an elephant
      • Mayra Flores’ victory set a record for women in Congress. It also reflects the growing visibility of Republican Latinas

        Candice Norwood · June 21
      • A banner year for Republican women

        Amanda Becker · November 11
      • Republican women could double representation in the U.S. House

        Amanda Becker · November 4
    • From the Collection

      On The Rise

      Illustration of three women marching
      • Can Cheri Beasley build a winning coalition in North Carolina?

        Candice Norwood · October 11
      • Los Angeles has never elected a woman mayor. Karen Bass hopes to change that.

        Nadra Nittle · September 8
      • Judge J. Michelle Childs is confirmed to D.C. appeals court

        Candice Norwood · July 20
    • From the Collection

      Pandemic Within a Pandemic

      Illustration of four people marching for Black Lives Matter with coronavirus as the backdrop
      • Some LGBTQ+ people worry that the COVID-19 vaccine will affect HIV medication. It won’t.

        Orion Rummler · November 23
      • Why are more men dying from COVID? It’s a complicated story of nature vs. nurture, researchers say

        Mariel Padilla · September 22
      • Few incarcerated women were released during COVID. The ones who remain have struggled.

        Candice Norwood · August 17
    • From the Collection

      Portraits of a Pandemic

      Illustration of a woman wearing a mask and holding up the coronavirus
      • For family caregivers, COVID is a mental health crisis in the making

        Shefali Luthra · October 8
      • A new database tracks COVID-19’s effects on sex and gender

        Shefali Luthra · September 15
      • Pregnant in a pandemic: The 'perfect storm for a crisis'

        Shefali Luthra · August 25
    • From the Collection

      The 19th Explains

      People walking from many articles to one article where they can get the context they need on an issue.
      • The 19th Explains: How to ease the ‘loneliness epidemic’ and social isolation among older adults

        Sara Luterman · April 24
      • The 19th Explains: Who will be most impacted by Medicaid changes — and when

        Rebekah Barber · March 28
      • The 19th Explains: What we know about Brittney Griner’s case and what it took to get her home

        Candice Norwood, Katherine Gilyard · December 8
    • From the Collection

      The Electability Myth

      Illustration of three women speaking at podiums
      • Mayra Flores’ victory set a record for women in Congress. It also reflects the growing visibility of Republican Latinas

        Candice Norwood · June 21
      • Stepping in after tragedy: How political wives became widow lawmakers

        Mariel Padilla · May 24
      • Do term limits help women candidates? New York could be a new testing ground

        Barbara Rodriguez · January 11
    • From the Collection

      The Impact of Aging

      A number of older people walking down a path of information.
      • From ballroom dancing to bloodshed, the older AAPI community grapples with gun control

        Nadra Nittle, Mariel Padilla · January 27
      • 'I'm planning on working until the day I die': Older women voters are worried about the future

        Mariel Padilla · June 3
      • Climate change is forcing care workers to act as first responders

        Jessica Kutz · May 31
    • From the Collection

      Voting Rights

      A series of hands reaching for ballots.
      • Ranked-choice voting is gaining momentum. So are efforts to stop it.

        Barbara Rodriguez · April 24
      • Connecticut voters approved early voting. Here’s how their new secretary of state wants to make it happen.

        Barbara Rodriguez · February 13
      • Women lawmakers in Minnesota are in the vanguard of the democracy movement

        Barbara Rodriguez · February 3

    View all collections

  • Explore by Topic

    • 19th Polling
    • Abortion
    • Business & Economy
    • Caregiving
    • Coronavirus
    • Education
    • Election 2020
    • Election 2022
    • Election 2024
    • Environment & Climate
    • Health
    • Immigration
    • Inside The 19th
    • Justice
    • LGBTQ+
    • Military
    • Politics
    • Press Release
    • Race
    • Sports
    • Technology

    View All Topics

Home
  • Our Mission
  • Our Team
  • Latest Stories
  • Search
  • Upcoming Events
  • Contact Us
  • Newsletter
  • Donate
  • Work With Us
  • Fellowships

We’re an independent, nonprofit newsroom reporting on gender, politics and policy. Read our story.

The 19th News(letter)

News that represents you, in your inbox every weekday.

You have been subscribed!

Submitting...

Uh-oh! Something went wrong. Please try again later.

Become a member

The 19th thanks our sponsors. Become one.

Certified health care nurse Elaine James helps a her patient. (Amanda Voisard/The Washington Post/Getty Images)

Caregiving

Build Back Better’s investment in home care is big — but is it enough?

Disability and labor advocates are cheering proposed home care spending. But they're also worried insufficient investment could pit increased wages against greater capacity.

Sara Luterman

Caregiving reporter

Sara Luterman, The 19th

Published

2021-11-23 11:18
11:18
November 23, 2021
am

Share

  • Twitter
  • Facebook
  • Email

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 promised for home care, according to an internal memo circulated by advocates in July. During his presidential campaign, Biden pledged to clear waiting lists for home care and raise wages for workers. $150 billion, the memo said, may end up pitting workers, who are predominantly women of color, against disability advocates for access to limited funding. And because states also have to invest their own funds to get the federal matching amount, some may choose not to adopt the program at all. 

The home care industry has suffered from underfunding and neglect for decades. There are years-long waiting lists for people with disabilities and seniors to receive necessary care. Workers are poorly compensated, averaging $12 an hour. The work is emotionally and physically intense. Workers are responsible for maintaining their clients’ health and assisting them in their basic needs, like eating or showering. Two-thirds of home care workers quit within a year, according to Home Care Pulse, a market research firm.  

The 19th thanks our sponsors. Become one.

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. For years, labor unions were some of the staunchest opponents of closing asylums and segregated state schools for people with developmental disabilities. 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. But a fight over limited funding could damage this relatively new alliance. Ai-jen Poo, the executive director of the National Domestic Workers Alliance, warned of this potential outcome in the 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 not respond to a request for comment through communications staff.

A newsletter for the new electorate

Analysis and interviews from Errin Haines, delivered to your inbox every other week.

You have been subscribed!

Submitting…

Uh-oh! Something went wrong. Please try again later.

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 funding. Unlike the federal government, states cannot borrow money. If state legislatures need to cut costs, optional Medicaid programs are often first on the chopping block, according to an issue brief from the Kaiser Family Foundation. Multiple experts told The 19th that states with lower tax income per capita, such as Georgia or Alabama, are more likely to opt out of expensive optional programs. 

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. The prevailing sentiment among policy experts in D.C. was that some money is better than none. 

This was shared by home care workers themselves. TunDe Hector, a certified nursing assistant from Georgia and member of SEIU, praised Biden’s Build Back Better agenda, even with the cuts. 

  • More from The 19th
    Ylenia Aguilar looks out the window as she poses for a portrait in a cafe
  • What do women want from the Build Back Better plan? Democrats to deliver on promises
  • The 19th Explains: What’s going on with the Build Back Better plan in Congress?
  • Maggie Hassan makes a personal case for more caregiver funding in the reconciliation bill

“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 of home care workers. 

“Home care is the backbone. You need people who take care of people. We feed, bathe, brush teeth,” Hector said. 

Josue Rodriguez, an Texas organizer for disability rights protest group ADAPT, praised the funding. Rodriguez has cerebral palsy and uses home care services himself. Last month, he attended a vigil in D.C. last month to push for home care funding. 

“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.”

Share

  • Twitter
  • Facebook
  • Email

The 19th News(letter)

News that represents you, in your inbox every weekday.

You have been subscribed!

Submitting...

Uh-oh! Something went wrong. Please try again later.

Become a member

Up Next

Secretary of the Interior Deb Haaland waves to the crowd.

Politics

Interior Secretary Deb Haaland orders removal of derogatory terms from public land names

Haaland, an enrolled member of the Laguna Pueblo, said she is ‘proud to be in a position’ to start with a term offensive to Indigenous women on 650 different places on federal land.

Read the Story

The 19th
The 19th is a 501(c)(3) tax-exempt organization. Our stories are free to republish in accordance with these guidelines.

  • Donate
  • Newsletter
  • Events
  • Search
  • Jobs
  • Fellowships
  • Contact Us
  • About Us
  • Community Guidelines
  • Membership
  • Membership FAQ
  • Major Gifts
  • Sponsorship
  • Privacy
  • Twitter
  • Facebook
  • Instagram