Can Biden’s home care plan support families, draw paid caregivers?

Can Biden’s home care plan support families, draw paid caregivers?

If the scope of President Joe Biden’s social spending plan is too large to grasp, then consider Nancy Slomba of Western New York state.

She spends 84 hours a week caring for her son Joe Slomba, who has cerebral palsy and needs assistance to bathe, get in and out of bed and leave the family’s house.

The 59-year-old resident of a small Wyoming County town about 35 miles east of Buffalo gets paid $12.50 an hour to care for Joe through a New York state-based program. She and Joe’s twin brother, Ben, split the caregiving hours throughout the week.

But they’re making less per hour than they’d make working at McDonald’s. Joe’s care needs mean they can’t get other jobs, and there aren’t home care workers available in their rural county to share some of the caregiving duties.

“I’m exhausted,” Slomba said. “You’re not going to leave your family member, yet you’re not making enough money.” 

Joe Slomba has cerebral palsy and lives at home with his family.  His mother Nancy and twin brother Ben split time as his paid caregivers but Medicaid only allows for $12.50 an hour for that care. The family is struggling to keep up financially and would like the pay rate to be higher.

Slomba is one of millions who care for their loved ones in the United States. In 2020, 48 million people in the U.S. provided unpaid care to an older adult or individual with health or functional needs. Many live in old industrial cities in places like Upstate New York and Michigan. A significant number are persons of color.

Those who cannot care for their loved ones themselves hire home care workers — a profession that is adding more new jobs than any other field in the American economy this year, but which struggles to attract and keep workers due to a dismal track record of low wages and scant benefits. 

President Joe Biden made the untangling of this nationwide dilemma a top priority of his administration, earmarking a $400 billion chunk of his initial infrastructure agenda, titled the American Jobs Plan, to tackle home and community-based care. The funding would phase in over eight years. 

The plan is two-fold; it would expand Medicaid to open up home care options for more families, and increase wages and benefit opportunities for 2.3 million home care workers in the U.S. 

While Biden’s plan addresses some cries for policy change from caregivers and home care workers, it doesn’t necessarily carve a new path for home care — it addresses what has crippled long-term care across the country for years, like chronic underfunding and spending cuts, said C. Grace Whiting of the National Alliance for Caregiving, which supports family caregivers.

 “This is more of a repair effort than a new direction,” she said. 

Excellacare Care Provider Sarah Sutherlin helps her client Carmela Palamara, 92, of Brownstown stand up to stretch her legs after the two color and play a game of UNO at Palamara's home on April 14, 2021.

Furthermore, the plan leaves out a large swath of middle-class families in its attempt to target the most impoverished, and does not clearly detail how it will funnel funding to the home care workers who need it most. 

The New York & Michigan Solutions Journalism Collaborative, an endeavor involving a few dozen news organizations including the Detroit Free Press and Rochester Democrat and Chronicle, has vetted some of the solutions and shortcomings in the Biden caregiving plan.

Among the findings: