Increased Access To Care Choices


Author: Josephine Kalipeni

Originally published: Tuesday, August 2, 2016

As the Baby Boom generation reaches retirement at a rate of 10,000 people per day, and advances in health care and medicine extend our lifespans, American families need more care than ever before. At least 20% of our population will be over the age of 65 by the year 2030.

With these changing demographics, our country needs a big financial investment in developing a national, holistic long-term care system that works for all. We need a compulsory long-term care insurance program to ensure financial peace of mind and security for families in unexpected and unplanned situations. Such a program would increase access to care, distribute risk, and include a national plan for recruiting and retaining the workforce necessary to meet anticipated future long-term care needs.

We need federal policy solutions that address affordability, choice, quality of care, and quality of care jobs, including a path to citizenship for the immigrant care workforce. And we need strong leadership that will stand up for aging Americans, people with disabilities, family caregivers, and the workforce that provides care to us all.

In the meantime, as we move toward that long-term goal, there are interim state and federal policy solutions that can support families, caregivers, and consumers alike. Below are some of the ideas Caring Across Generations suggests supporters and partners adopt.


Nearly 90% of people desire to age and heal at home, connected to the people and places they love. Because of this, we believe that all people should have increased access to quality, dignified, and affordable care choices, particularly home and community-based services. In addition to protecting and improving Social Security and Medicare, Caring Across Generations supports:

  • Expanding access to home and community-based services. Many states are seeing increasing Medicaid expenditures for nursing home care. Despite studies that prove the cost of homecare is far less, public programs still default to institutionalized care.
  • Supporting states in planning and/or pilot programs. States need support to invest in creative, innovative solutions that address their long-term services and supports (LTSS) needs and care workforce development. The federal government can serve as both a monetary and technical resource to catalyze and build upon state innovation.


Today, family members are scattered across the country and the world. Many of the “sandwich generation” are stretched between work, caring for their family, and providing care for a loved one who is aging or has a disability. Still, 85% of care is provided by family caregivers. With more people desiring to age in community, the pressure on families to provide the necessary LTSS to enable aging with independence and dignity is only rising. Because of this, we support:

  • Increasing financial support for family caregivers. Affordability and income loss are major issues for consumers and family caregivers. Working families already struggle to care for themselves. Caring for an aging family member can force people out of work, leaving them even more financially insecure. Many impacted by this are women, primarily women of color. We advocate for policy that will:
    • Provide paid family and medical leave that includes caring for parents and grandparents.
    • Adjust the rates and caps of earned income tax credits to make care more affordable.
    • Provide income credits toward Social Security for individuals who reduce work hours or leave the workforce to provide care for a child or an ill, disabled, or aging family member.
  • Lifting asset requirements as a qualifier for Medicaid eligibility for long-term services and supports, and indexing asset limits to inflation. Medicaid, the primary payer for LTSS, limits eligibility to those with few or no assets, often for short-term public assistance. These asset limits often discourage anyone considering or receiving public benefits from saving for the future. Additionally, personal savings and assets are precisely the kinds of resources that help families support themselves and prolong institutionalized care.
  • Updating the national study on caregiving youth and eliminating federal age qualifiers associated with defining caregiving. As of 2004, there were more than 1.4 million youth caregivers in the U.S. Evenly split between boys and girls, they are defined as individuals 18 years of age or younger providing at least two hours of care a day. Youth caregivers are often in the shadows, balancing childhood, school, and the responsibility of caring for someone else without training opportunities, benefits, or special programs. Updating national data is a necessary first step to identifying how federal policy can best support this vulnerable population. Eliminating age qualifiers associated with defining caregiving would also increase access to public services and supports.
  • Documenting and training family caregivers. Family members provide care, often after a loved one has been discharged, with no access to medical information or training. Documenting a named family caregiver formally acknowledges their vital role as part of a care team, and providing family caregivers with training increases their confidence and supports quality and continuity of care for their loved ones.


At the same time that the national need for care is growing as our population ages, we are experiencing a shortfall in care workers. To meet this need, our nation must improve existing care jobs, create new jobs, and recruit and retain a robust care workforce. We believe that care workers should be valued, and their jobs should be high-quality jobs. Caring Across Generations supports:

  • Increasing the national wage floor for all jobs. Care jobs—nearly 90% of which are performed by women—are often low-wage jobs. With median annual earnings of $13,000 a year, the average pay for a home care worker is $9.61, leaving most unable to afford rent, food, utilities, and health and childcare expenses. The people we hire to care for our families should earn enough to take care of their own. We support increasing the minimum wage, with a goal of $15.00 per hour for home care workers.
  • Improving workforce training and career mobility. Existing federal training programs are not geared toward personal care workers who provide non-clinical services, particularly those serving clients through public consumer-directed programs. Improving training for direct-care workers is integral to ensuring the quality of LTSS.
  • Developing a path to citizenship for undocumented caregivers. The home care industry faces a rapidly growing labor shortage. A path to citizenship for undocumented caregivers who have already provided caregiving services helps fill the worker gap and provides security for families already receiving quality care from an undocumented caregiver.
  • Creating a national initiative to incentivize and recruit family caregivers into the paid workforce. Over 85% of long-term care is provided by family members, who are uniquely poised to understand the complexities of care. This makes them a robust pool of potential talent to help meet a growing shortage in the paid care workforce.

Caring Across Generations, with over 200 national partners and allies, calls for champions to stand in solidarity with the millions of care consumers, family caregivers, and workers who are already dealing with the complexities of care. Strong leadership paired with proactive solutions will lead to the care system we need: one based on fairness, equity, regard for multigenerational relationships, and protection of dignity in aging.

Join us in building the Caring Majority. Sharing your caregiving story today will make it possible to build a movement to change caregiving policy tomorrow. Add your story to the conversation by sending to [email protected], or join the Caring Across email list at

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