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How the American Rescue Plan Transforms Long-Term Care

By Amy Robins (she/her) | January 9, 2024

The American Rescue Plan (ARP) has helped to fuel much-needed innovation in America’s long-term care system.  According to data recently released by the Centers for Medicare and Medicaid Services (CMS), ARP has brought unprecedented resources — $37 billion across all 50 states — to help enhance care for older adults and people with disabilities. The ARP’s investment addresses a critical gap in our long-term care system. At the center of these strategies are investments in the direct care workforce, a clear acknowledgment of their essential role in meeting the urgent demand for home and community-based services.

Recognizing the need to compensate workers fairly, states including Colorado, Maine, North Carolina, and Pennsylvania implemented significant wage increases.  In addition, Maine provided bonuses of nearly $3,500 to increase retention. North Carolina and Ohio established innovation funds to drive new approaches to recruitment and retention challenges.  Wisconsin established a Certified Direct Care worker credential and launched a worker registry, moves that will help standardize training and elevate the profession. Beyond direct care workers, states used the ARP resources to strengthen other critical elements of the long-term care system, including support for family caregivers and access to housing and community-based care. For instance, 29 states have invested in training and support for family caregivers, and 21 states have worked to reduce HCBS waiting lists. These efforts remain crucial for expanding services and improving the quality of life for tens of thousands of people.

A recent White House convening featured prominent speakers, including HHS Secretary Xavier Becerra, Senator Bob Casey, and several governors, celebrating the ARP’s significant investment in HCBS. This event underscored the Administration’s continued dedication to long-term care and the direct care workforce. As we celebrate these advancements, we must also recognize that they are but initial steps. These initiatives represent just the beginning of what is needed to truly support direct care workers, the backbone of our long-term care system.

Drawing from our decades of experience in the field, we urge continued investment and innovation in five key areas:

  1. Quality Training: Direct care workers must receive comprehensive, ongoing training that is relevant to their roles and the needs of their clients. This training should not only cover the technical aspects of care but also the interpersonal skills necessary for providing compassionate, person-centered care.
  2. Fair Compensation: Advocating for living wages and benefits that reflect the skill and importance of direct care work is essential. This is not just about fairness; it’s about recognizing the value of this work and ensuring that it is a viable, attractive career option for many.
  3. Quality Supervision and Support: Direct care workers need supportive supervision and the resources they need to perform their jobs effectively. This includes access to adequate protective equipment, mental health support, and opportunities for professional development.
  4. Respect and Recognition: The critical role of direct care workers in the healthcare system must be recognized and their voices heard in policy and practice. This workforce, predominantly comprised of women and people of color, has long been marginalized. It’s time their contributions are fully acknowledged and valued.
  5. Real Opportunity: Creating career advancement opportunities for direct care workers is crucial for improving retention and job satisfaction. This includes clear career pathways, opportunities for specialization, and recognition of advanced roles within the sector.

The role of policymakers, healthcare leaders, and the public is crucial. We must collectively push for policies that further these goals, support initiatives that empower direct care workers, and foster a culture that values and respects the vital work they do. It is also essential to engage in a broader dialogue about the future of long-term care in America, including the voices of those who provide and receive care.

The ARP’s investment opened the door to possibilities that were previously unimaginable in the realm of home-based care. It is an opportunity to reimagine and design a system that truly meets the needs of those who need supports and services.

Amy Robins (she/her)
About The Author

Amy Robins (she/her)

Director of Public Policy and Advocacy
As PHI’s Director of Advocacy, Amy Robins is responsible for designing and leading PHI's historic and growing nationwide advocacy approach.

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