Spinal surgery is a kind of surgery that involves the removal of vertebrae from the spine. A four-year-old accident left Alene Shaheed confined to a wheelchair and reliant on brief daily visits from home health workers to assist her in moving about.
This year, however, her support structure crumbled as a result of the extended coronavirus epidemic, and her usual medical treatment became uncertain. The significant lack of low-wage labour in her area of Jacksonville, Florida, caused four organisations servicing her community to fail to supply aides on a consistent basis.
“If no one comes for three days, I don’t get to take a bath for three days,” the 76-year-old said. “It’s like a punishment.” “I don’t have somebody to prepare meals for me, so I’m eating ramen noodles till someone arrives.”
Approximately 800,000 individuals are on waiting lists to get subsidised home care services, according to the government. The need for millions of Americans to obtain trustworthy and inexpensive support to remain at home — rather than relocating into a nursing home, where Covid-19 caused the deaths of tens of thousands of individuals — has never been more pressing.
In the legislative package offered by President Biden and Democratic leaders, expanding home and community-based services is one of the key components. At this point of congressional deliberations, the money allocated to such programmes under Medicaid — which is intended to help raise the historically low pay of home care workers — has been slashed from $400 billion over eight years to $150 billion over the same period.
Will the sum set out in the existing strategy be sufficient? In the opinion of supporters, the increased health-care funds will help to reverse Medicaid’s decades-long prejudice against nursing home care. Many experts are sceptical about claims that this wave of financing would be able to improve a system as flawed as home care, particularly as the baby boomer generation enters retirement and demands greater support to remain independent, putting a pressure on health-care resources.
Professor of health care policy at Harvard Medical School, David Grabowski, believes that “you have to be extremely honest about the level of need you have in the system right now.” Even if the $150 billion represents a huge infusion of capital, there are limitations, according to him: “Once you start doing the arithmetic, the numbers don’t go as far as you’d want,” he said.
States are expected to utilise Medicaid funds to pay for nursing home care, but under federal rules, states have wide discretion in determining how much money should be allocated to provide home and community-based services for Medicaid recipients.
People who need assistance with things such as eating themselves, dressing themselves, or taking medicine must often qualify for a Medicaid waiver in order to get home care. Medicaid, a federal-state programme that serves as the major source of coverage for long-term care, spends around $114 billion each year on these home and community-based services, accounting for slightly more than half of total expenditure on long-term care in the United States. According to the most recent statistics available in a research by the Kaiser Family Foundation, around 2.5 million persons earned exemptions from paying income taxes in 2018.
Home care is not covered by Medicare, which is a government insurance programme for the elderly and handicapped. In addition, Medicare has restrictions on the types of home care that may be provided.
It is generally known that the demand for home care for those who wish to live independently outstrips the supply in this field. Some individuals may be covered by private insurance, while others may have to pay out of pocket.
Because states have a restriction on Medicaid enrollment, the waiting lists for elderly and handicapped Americans who seek home care continue to rise as a result of this. According to a Kaiser Family Foundation research, the vast majority of those on the lists reside in states that did not expand Medicaid.
Raising the pay of home health aides has been a problematic issue for Republicans, who regard it as a gift to labour unions and as restricting the ability of states to use newly allocated monies.