Expansive Executive Order Aims to Improve Long-Term Care for Children, Older Adults, and People with Disabilities

On April 18, 2023, the Biden-Harris Administration announced a historic, expansive set of executive directives to improve the long-term care landscape. Lack of access to affordable and high-quality long-term care is a longstanding issue in the United States that crucially impacts the lives of children, older adults, people with disabilities, and both professional and family caregivers. While advocates have been calling attention to concerns about the country’s long-term care system for decades, the COVID-19 pandemic exacerbated many of these issues and uniquely highlighted the scope of the impacts.

Existing options for long-term care are plagued by a variety of challenges including lengthy waitlists, exorbitant costs, lack of information on quality, low pay and benefits for care professionals, and lack of support for family caregivers. Illustrating the challenges individuals face with waitlists, a study by the Kaiser Family Foundation found that in 2021, people on waitlists for home- and community-based services (HCBS) waiver services waited about 45 months before receiving services and people with intellectual and developmental disabilities waited even longer, 67 months on average. During my past career experiences as a direct support professional and program manager, these issues came up routinely for the individuals with disabilities we served and their families. While long-term care can be a rewarding and fulfilling career path, I observed that the field often lacks the adequate resources to create job quality and stability for its employees in order to prevent burnout and high turnover rates.

These well-documented issues in the long-term care system disproportionally affect certain groups. For example, nursing homes with higher concentrations of minority residents experience more issues with quality of care (Harrington et al., 2017). Furthermore, when individuals who need services are unable to obtain them, women are much more likely than men to exit the workforce in order to provide caregiving services for family members (Smith et al., 2020). Additionally, professionals providing long-term care services, a field with notoriously low pay and high turnover rates, are more likely to be women of color (Dill & Duffy, 2022).

To address these pervasive issues in long-term care, the Administration’s new Executive Order includes 50 directives to improve access to affordable and high-quality long-term care and provide support for long-term care professionals and family caregivers and builds on the successes of investments in child care providers and Medicaid home care programs made in the American Rescue Plan. It includes wide-ranging actions to improve job quality for professionals who provide long-term care services, to support family caregivers, and to expand availability of HCBS, including those types funded through Medicaid and the Department of Veterans Affairs. The 50 directives included in the Executive Order do the following:

• Make child care and long-term care more accessible and affordable for families, including military families.
• Improve access to home-based care for veterans.
• Boost job quality for early educators.
• Enhance job quality for long-term care workers.
• Support family caregivers.
• Advance domestic workers’ rights. 
• Ease construction of early childhood facilities for Tribes. 
• Engage affected communities.

Additional details about each of the areas covered in the directives is available in the White House fact sheet.

This Executive Order is extremely pertinent to the type of work that New Editions is engaged in related to people with disabilities and older adults. Several of our company’s contracts directly focus on long-term care services for these populations:

• Through a contract with the Centers for Medicare and Medicaid Services (CMS), New Editions provides technical assistance to states to ensure that beneficiaries are receiving HCBS to live and work in settings that are integrated into the community.
• Under another contract with CMS, New Editions provides technical assistance to state agencies on HCBS mechanisms, program design, service delivery systems and self-direction services for states seeking to develop or improve HCBS.
• Under a contract with the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), the primary federal agency on disability research, New Editions provides technical and logistical support for grantee meetings, some of which focus on research on long-term services and supports for people with disabilities.

The Administration’s new directives aim to address many of the persisting issues that individuals routinely experience when accessing long-term care services. The directives signal historic momentum and investment across the perpetually underfunded and underappreciated profession of caregiving. With continued prioritization of long-term care through increased respect and financial support, these vulnerable populations and their families will have improved access to the types of affordable and quality services that will create a meaningful change in their lives.

Related Resources

• Read the full details of the Executive Order in the White House fact sheet.
• View the Biden-Harris Administration’s proclamation that designated April as National Care Worker Recognition Month from March 31, 2023.
• Read the National Strategy to Support Family Caregivers from the Administration for Community Living (ACL).

References

Dill, J. and Duffy, M. (2022). Structural racism and Black women’s employment in the US health care sector. Health Affairs, 41(2). https://doi.org/10.1377/hlthaff.2021.01400

Harrington, C., Wiener, J. M., Ross, L., and Musumeci, M. (2017). Key Issues in Long-Term Services and Supports Quality. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/key-issues-in-long-term-services-and-supports-quality/

Smith, P. M., Cawley, C., Williams, A., and Mustard, C. (2020). Male/female differences in the impact of caring for elderly relatives on labor market attachment and hours of work: 1997 – 2015. The Journals of Gerontology: Series B, 75(3), 694-704. https://doi.org/10.1093/geronb/gbz026