Biden Executive Order to Help Long-Term Care Caregivers

President Biden has taken action to help caregivers providing long-term health care, both professional and family caregivers. The President signed an executive order yesterday (April 18, 2023) to expand access to affordable, high-quality care and provide support for care workers and family caregivers.

The directive includes more than 50 specific actions to enhance the well-being of family caregivers who provide uncompensated care to around 53 million Americans with disabilities, chronic illnesses, or elderly parents.

Some of the key provisions of the order include:

• Expanding access to respite care which provides temporary relief to caregivers so they can take a break.
• Making it easier for caregivers to access information about their loved ones' care plans and to communicate with their loved ones' doctors and nurses.
• Providing more support for caregivers during the hospital discharge planning process.
• Expanding access to mental health services for caregivers.
• Investing in research on dementia care.
• Improving the quality of home care jobs.

The order is a significant step forward in the Biden administration's efforts to support family caregivers. The order is estimated to benefit over 50 million Americans, including 30 million family caregivers. The order is also expected to save the federal government billions of dollars in health care costs.

Medicaid is the Primary Payer for Long-Term Health Care

Medicaid is the primary payer of long-term care services in the United States. Medicaid is a federally funded program that provides assistance to low-income individuals with medical expenses. This includes funding for long-term care services, such as nursing home care, in-home care, and other services for those who require help with chronic illnesses and aging problems.

Medicaid is designed for those with little or no income and assets. While Medicare, the federal health insurance program for people over 65, does not cover most long-term health care services, Medicaid will cover these services for those who qualify.

Long-Term Care Insurance will pay for this type of care, but those with low incomes generally would not purchase LTC Insurance. 

President Biden said that he said in his State of the Union address he wants to improve long-term care by strengthening staffing standards in nursing homes and increasing pay for caregivers. 

I've also instructed the Department of Health and Human Services to figure out how to get home care workers the pay they deserve with the money already allocated.

President signs executive order (White House photo)

The President has expressed a commitment to improving the quality of long-term care jobs in the United States to ensure that Americans receive the reliable, high-quality care they deserve, regardless of whether they receive care in their homes and communities or in nursing homes. 

Improve Home Care Jobs

The President's Executive Order directs the Department of Health and Human Services (HHS) to explore the possibility of issuing several regulations and guidance documents to enhance the quality of home care jobs.

One of the proposed regulations seeks to leverage Medicaid funding to guarantee adequate home care workers to provide care to seniors and individuals with disabilities who are enrolled in Medicaid. The order also suggests building on the minimum staffing standards for nursing homes and conditioning a portion of Medicare payments on how well a nursing home retains its workers. These measures aim to ensure that Americans receive the high-quality care they deserve from competent and dependable caregivers.

In an effort to provide greater support to family caregivers, the President's Executive Order directs the Department of Health and Human Services (HHS) to consider testing a new dementia care model. The model will include support for respite care, which offers short-term help to give a primary family caregiver a break. The order also proposes making it easier for family caregivers to access Medicare beneficiary information and provide more support during hospital discharge planning.

Family caregiving can often have negative consequences on the caregiver's physical and emotional health and contribute to financial strain, especially when inadequate resources are available. Women, who make up nearly two-thirds of family caregivers, are particularly affected, with higher rates of dropping out of the workforce than men.

Vets Benefit from Order

Veterans who need long-term care will also benefit from this order. The Executive Order issued by the President directs the Department of Veterans Affairs (VA) to enhance access to home-based care for veterans who require assistance with activities of daily living, such as bathing and dressing. 

The order seeks to accomplish this by giving veterans greater autonomy in deciding who provides their care and when. To achieve this objective, the VA must explore expanding its Veteran Directed Care program to all 172 VA Medical Centers by the end of the 2024 fiscal year. This program grants veterans a budget to engage personal care assistants, including family members.

Furthermore, the VA will explore piloting a new self-directed care program in at least five new sites, providing veterans with a budget to pay for personal care assistance while minimizing administration-related difficulties associated with managing care. Additionally, the VA will consider adding 75 new interdisciplinary teams to its Home-Based Primary Care program to support 5,600 veterans in their homes. 

Praise from Policymakers

The order has been praised by caregivers, advocates, and policymakers. 

John Thoburn, president and CEO of the National Alliance for Caregiving, says this is a historic day for family caregivers.

The Biden administration has made it clear that they understand the challenges that caregivers face and are committed to providing them with the support they need.

Thoburn says the order is a welcome development, but it is just a first step. He says there is still more work to be done to ensure that family caregivers have the support they need to provide quality care to their loved ones.

The President's Budget includes $150 billion over the next decade to improve and expand Medicaid home care services. The administration has also said it is committed to working with Congress to pass legislation providing additional support to caregivers.

In a statement, AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond said the AARP applauds the Executive Order, which recognizes the need to make family caregivers a national priority to meet the rapidly growing needs of families across America.

Family caregivers are an essential but often invisible part of almost any care team, who are often in desperate need of more support. Millions of Americans provide care to their family and friends, totaling an estimated $600 billion in unpaid labor per year. Someone turning age 65 today has almost a 70% chance of needing help in their remaining years—most of us have been caregivers, are caregivers, will be caregivers, or will need a caregiver one day.

Order Doesn’t Impact Those Paying for LTC With Savings or Insurance

This order does not affect the millions of Americans who must pay for long-term health care out-of-pocket since they don't qualify for Medicaid. Some of these people have Long-Term Care Insurance. In 2022, the top insurance companies paid over $13.25 Billion in benefits from LTC Insurance policies.

Long-Term Care Insurance pays for comprehensive benefits, including in-home care, in addition to adult day care centers, assisted living facilities, memory care, and nursing homes. Although many people are unaware of the insurance or delay looking into it until they experience health needs.

Every insurance company has its specific underwriting standards, so anyone needing care or having substantial health issues would not be eligible for coverage. 

How Does Your Health Impact Your Ability to Obtain Long-Term Care Insurance?

Most people obtain LTC Insurance in their 50s. 

As the cost of long-term health care continues to increase, the impact will be felt by American families and taxpayers. The cost of care is expected to increase rapidly nationwide.

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