Will Harris's plan to expand Medicare and cover home care costs work?

P.S. Wilson, an entrepreneur in Atlanta, Georgia, knows what it’s like firsthand to care for an older family member. In the earlier stages of her dementia diagnosis, his late grandmother lived with him, which he described as both “rewarding and challenging.”

“Later, she moved to my uncle’s home in D.C., where he had access to additional resources to support her care,” Wilson said, adding that coupled with seeing his family care for his paternal grandmother, showed him “how difficult it can be for families without the manpower or resources to care for their loved ones.” 

“It truly highlighted the need for accessible, comprehensive care options for all families facing similar challenge,” he said, adding that now he is the founder of a professional home health care agency, P.S. Wilson Healthcare. “I have seen firsthand how the costs of long-term care place a significant burden on families.”

Earlier this month, Vice President Kamala Harris proposed a solution to ease this burden: expanding Medicare benefits to cover home health care, which would be a first for the United States, as Medicare currently only covers short-term care for rehabilitation.

Harris made the announcement Oct. 8 on the television show The View, in an attempt to capture the attention of a voter demographic who is likely caring for both children and aging parents. Also known as the “Sandwich Generation,” it’s estimated that about one in seven middle-aged adults provide financial support to an aging parent and a child. Nearly half of adults in their 40s and 50s have a parent age 65 or older, who has a 70 percent chance of needing some kind of long-term care in the future. An estimated 20 percent of 65-year-olds today will need long-term care for more than five years. 

“There are so many people in our country who are right in the middle,” Harris said on The View. “They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work.”

This predicament can cause major financial burdens, emotional stress, and even lead some people to leave their jobs to become full-time caregivers, often resulting in a family’s loss of income. In 2023, the average cost of private long-term care — meaning for a private room in a nursing home — was $116,796 per year. Currently, Medicaid, a program that provides medical and health-related services to low-income people, covers only 1% of total long-term care costs in the United States, in part because it has strict income limits and eligibility requirements.

However, by offering Medicare to cover more of those costs, using a government health insurance program that is aimed at adults who are aged 65 years or older, it could help millions of aging people ease the burden of long-term care, and provide the option to receive care at home. Notably, Harris indicated that recent reductions in Medicare drug costs, which were negotiated by the Biden Administration, would cover the costs of this proposal.

Many who have seen the long-term care crisis unfold were happy to hear Harris prioritize the crisis during this election season. 

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Nicole Jorwic, the chief of advocacy and campaign at the organization Caring Across Generations, said the reality is that the U.S. relies on unpaid family caregivers when caring for older and disabled people. 

“We do not have any sort of guaranteed support system for home care,” Jorwic told Salon. ‘So what that means is relying on unpaid family caregivers or spending every last penny you have to get the care you need.”

Expanding Medicare to cover in home care would “absolutely” help ease the financial burden, she added. While costs range by state, in-home care can cost between $30 to $40 an hour to $325 a day for live-in care. Some people have to pay over $100,000 a year for in-home care, out of pocket.

“Adding 20 hours, or whatever people need, in terms of home care would take a tremendous amount of burden off of families,” Jorwic said. “Family caregivers are providing a trillion dollars of unpaid care to the economy.”

Recently, the AARP called on legislators to expand services to help seniors remain in their homes as they age, in addition to providing paid family leave for people caring for seniors, and expanding “access to family caregiver support and respite services.” 

“Family caregivers are the backbone of a broken long-term care system, providing $600 billion in unpaid labor each year and saving taxpayers billions,” said Nancy LeaMond, AARP's executive vice president, said in a media statement. “It is long past time for lawmakers to enact commonsense solutions that support family caregivers and help older Americans live independently in their homes, where they want to be.” 

While some are supportive of the proposal, others are a little more skeptical. In an email statement to Salon, Clif Porter, president & CEO of the American Health Care Association/National Center for Assisted Living, said the organization is “supportive” of finding ways to make long-term care more affordable and accessible for everyone. However, the most “critical aspect is investing in the health care workforce.”

“The growing caregiver shortage is a looming crisis for our nation’s seniors,” Porter said. “Without proper resources and policies to help develop more nurses, nurse aides, CNAs [certified nursing assistants], and other caregivers, we simply won’t be able to meet the demands of our aging nation — regardless of the setting in which they need the care.”

“With a rapidly growing elderly population, there isn’t a moment to waste,” he added. 

While legislation would need to pass such an expansion if Harris won the presidential election, Jorwic said she’s hopeful it’s a bipartisan issue. 

“I think there is a recognition that care is something that everyone has in common,” she said. “It’s a multi-generational crisis that needs to be addressed for the financial reasons and also so that people can age with dignity.”