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Dear Congress: Direct Care Workers Need Federal Support

May 26, 2020

Since the start of the COVID-19 pandemic, direct care workers have been on the frontline, supporting older people and people with disabilities to navigate these unprecedented times. Despite the value of direct care workers—and the disproportionate impact of this coronavirus on older people, people with underlying medical conditions, people living and working in nursing homes, and communities of color—the long-term care sector has not received enough attention or funding to manage this crisis. In turn, this sector continues to suffer without reprieve in sight.

Two new federal bills could help alleviate this problem. “The Heroes Act,” (H.R. 6800), which the U.S. House of Representatives passed on May 15, includes an extensive slate of COVID-19-related measures, including relief payments for individuals, state and local government assistance, and supports for direct care workers and their employers, among many others.

Additionally, Congresswoman Jan Schakowsky (D-IL) introduced on May 5 “The Quality Care for Nursing Home Residents and Workers During COVID-19 Act” (H.R. 6698), which would significantly fund nursing homes to support their residents and workers during the COVID-19 crisis. COVID-19 has ravaged nursing homes in particular: The New York Times estimates (as of this article’s publication) that nursing home residents and workers account for one-third of COVID-19 deaths nationwide. In 14 states, 52 to 80 percent of COVID-19 deaths come from nursing homes.

Here are a variety of measures in these bills that would support direct care workers and their employers in responding to this pandemic.


The HEROES Act would boost Medicaid funding for state home and community-based services programs to provide home care workers with increased compensation, hazard pay, overtime pay, shift differential pay, paid sick leave, and paid family and medical leave, among others. These measures are sorely needed (for the entire direct care workforce) because home care workers earn a median wage of less than $12 an hour, and low compensation drives high turnover in this workforce, which has worsened over the last few months. (Notably, this bill proposes increasing the Federal Medical Assistance Percentage (FMAP) by 14 percent overall—and by an additional 10 percent for home and community-based services. The FMAP determines the federal government’s share of the cost of state Medicaid programs.)


The HEROES Act includes measures that would build training and recruitment programs among home care workers (including direct support professionals). The bill would also award “national dislocated worker” grants to assist local communities in recruiting, placing, and training workers into positions such as contract tracers and other related roles during COVID-19. If home care workers are categorized as “related” workers, home care employers and training providers could use these grants to bring much-needed workers into the sector and equip them with the skills to succeed, including COVID-19-specific skills. Likewise, the Quality Care for Nursing Home Residents and Workers During COVID-19 Act (“Nursing Home Act”) would fund and support COVID-19 training among all nursing home workers.


The HEROES Act has a strong focus on COVID-19 testing, tracing, and treatment, as well as on providing funding for home care providers to access personal protective equipment (PPE), infection prevention and control supplies, and educational materials. Without these measures, home care workers and their clients are at a continued risk of infection, which is already forcing workers to stay away from their jobs and compelling families to turn away workers. Similarly, the Nursing Home Act boosts PPE access for both workers and state surveyors. According to recent guidelines from CMS, nursing homes cannot re-open to visitors until they reach Phase 3—and that phase depends on strong testing capacity and other strict criteria that could be achieved by measures in this bill.


The HEROES Act would require nursing homes to report COVID-19 infections and deaths—including to residents, family members, staff, and public authorities; the number of clinical and non-clinical staff providing direct care to residents; discharge and admissions figures; and other important data. In the same spirit, the Nursing Home Act requires “facilities to report COVID-19 cases, including demographic information, all COVID-19 and non-COVID-19 fatalities, PPE available and projected need, staffing and testing data every 24 hours; requires facilities to inform residents, residents, their representatives, and workers within 12 hours of a death or confirmed case; and requires CDC and CMS to coordinate to publicly post COVID-19 data online.” The more transparency within the sector, the more it will be possible to quickly respond as needed to keep residents and workers safe.


The HEROES Act would support small businesses and nonprofits, mainly by strengthening and extending the Paycheck Protection Program, which incentivizes small businesses to continue employing workers during the pandemic. Because such a large proportion of home and community-based service providers are small businesses—78 percent of home care establishments and 87 percent of residential care establishments employ fewer than 50 employees—this sector and its workforce will particularly benefit from these economic supports during the crisis and through the economic downturn that will last well beyond it. Additionally, many direct care workers rely on community-based organizations and other nonprofits for services, training, and advocacy—and these organizations will also need additional financial support to weather this crisis.


The HEROES Act includes several measures that strengthen economic security and the social safety net for millions of people—which are crucial measures for low-wage direct care workers. Among the bill’s items are additional direct “economic impact” payments for individuals, health coverage supports, extended unemployment benefits, housing assistance, and food and nutrition help, among others. Forty-four percent of direct care workers live in or near poverty, and these supports will help these workers and their families make it through this crisis.


This country and the long-term care sector are entering a new phase in COVID-19 as the shutdown slowly lifts, spurring many questions that will need responses. How will our national response evolve at each stage of this crisis? What will be the short and long-term implications for federal and state budgets? How can policymakers support individuals with long-term care needs, their families, and the direct care workforce in particular? How will the economic downturn complicate the challenges we currently face?

We will need to answer all these questions and more as we move through this crisis. Regardless, there is no doubt that direct care workers are vital to the ongoing state and national response to COVID-19, and the long-term care sector needs as much federal support as possible. The next federal funding package on COVID-19 should integrate the measures from these two bills and move us to a better and safer reality.

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