President Biden announced the American Jobs Plan, a $2 trillion investment in infrastructure,
jobs, and home care. It includes a $400 billion investment to expand access to Medicaid home and community-based services (HCBS)
Why This Plan for Home-Based Care?
Only 15% of U.S. seniors 80 or older receive care at home. In Switzerland, Denmark, Mexico, and Sweden, that figure is above 30%, with numbers even higher in Israel and Lithuania.
Medicaid has slowly evolved over the years, placing a greater emphasis on home- and community-based services. But the ground gained has been relatively minor compared to investments in other settings like nursing homes.
In 1995, Medicaid spent about 18 cents out of every long-term care dollar on HCBS services. Today, that number has reached 57 cents per dollar.
The Scale of the Problem is Mamouth
The number of seniors is projected to grow by more than 40 million, approximately
doubling, by 2050, while the population older than 85 will nearly triple. Unlike most other industrialized nations, the United States does not provide a public long-term-care benefit for all older adults.
Only10-15% of Americans can Afford Private Duty Homecare
Because Medicare does not pay for home care, only the top 10-15 % can afford private duty home care, while in many other nations it is a right and free to all through the government. What Biden’s new plan does is take a giant step in making home care possible a greater number of Americans.
The plan calls for expanding access to and quality of HCBS to help more older adults and people with disabilities live in the community and extending the Money Follows the
Person program to help individuals who are in nursing facilities and other institutions return to the community.
What The Pandemic Has taught us about Aging and Dying
at Home
What the continuing pandemic has painfully taught us is when we are ill- we want to be home in the arms of our family. When we are threatened with or facing death, we do not want want to be in a sterile hospital with only anonymous caring nurses and zoom to comfort us in our last minutes in this world. We want to be at home- in the arms of our family and loving caregivers.
Long before the COVID-19 emergency, health care policy experts have increasingly recognized the value of home-based health care. A recent AARP survey found that three in four adults 50 years and older would prefer to age in their homes and communities. And a growing body of evidence suggests it is less expensive to deliver care in the home.
The Plague of Isolation on top of the Plague of COVID -in Locked Down Nursing Homes
Home-based care addresses negative health effects of social isolation and loneliness, which drive
poorer health outcomes that annually cost billions of excess health care dollars.
Isolation is also equal to 15 cigarettes each day. Elders in a nursing home during the pandemic were isolated from the families and their fellow residents so much so that despair may have led to the 174000 deaths as of March 2021.
So Biden has launched a bill the builds the infrastructure of home care for the lower 30% on Medicaid until in America’s future, Medicare and home care for all is reached.
it is important to involve elders who wish to celebrate the holidays. Religious rituals celebrated with family, friends, members of a congregation ( even on zoom in COVID)offer socialization and reminiscence thus the quality of life so many elders and can return joy to their lives especially in the pandemic that was like maggots to the wound of senior isolation.
about”. As we age this question becomes primal, as we face death coming at a rapid pace. We wonder- do I go to heaven, to hell, or just energy or dust. Will I meet angels- my wife in heaven.?
a seder or Easter brunch or dinner, with a small fully vaccinated group from a congregation 0f a local church or synagogue or through a zoom holiday meal event or service.
spirituality was the environment and he had been a lead volunteer to build a trail in Santa Clara California from Los Gatos up the steep winding highway 17 over the Santa Cruz mountains to the Lexington Reservoir. He had no family so the care manager asked the volunteers he had worked with if they would visit him at his home. They happily agreed and 300 volunteers took shifts, 24 hours a day to sit with him reminisce, tell stories and sing while he died over several weeks. This is what joy that bringing a spiritual quality of life can offer in dying.
visiting is allowed during COVID or post the pandemic, can give an opportunity to share old memories or look at old photos and give family respite. You may have thought those old photo albums should be dumped but 
Friends
and memories as you create the family tree that you would miss when they are gone.
Hanukkah. Geriatric Care Manager Julie Menack in her chapter “Long Distance Care Providers” in my book 