For the past year, Scioto Analysis has worked with Northeastern University and Caring Across Generations on a report on home and community-based services in the state of California. This culminated in a report that was released last month.
On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (ARPA), which allocated a historic level of funding for Medicaid Home and Community-Based Services efforts in California.
Home and community-based services, also known as HCBS, are services that people with disabilities and older adults utilize to live independently in their own homes and communities. HCBS supports people with disabilities and older adults with activities of daily living, such as getting dressed, preparing meals, assisting with medications, maintaining employment, and using transportation. Over half of the $3 billion in enhanced federal spending sent to California was used to support the state’s caregivers.
Three years later, many of the ARPA funded programs are coming to an end, and this report finds that the specific programs funded that were aimed primarily at in-home caregivers would still leave in place a care system without sustainable investment.
Key findings of this report include:
• Caregivers supporting disabled people, despite state attempts to raise their pay, experience significant dissatisfaction with their pay and working conditions, even as caregivers continue to gain personal satisfaction from their work.
• Paid job training programs aimed at both In-Home Supportive Service (IHSS) and other care workers, were popular and effective but reached relatively few people and continue to overlook the need to make any changes to a system that fails to provide compensation reflective of the knowledge and skill of this workforce.
• Rushed implementation, contractual challenges, and short timelines hampered the effectiveness of new programs, making them more expensive to launch and operate. Spending deadlines approached just as the programs were reaching their peak effectiveness.
• Many family caregivers finally gained new opportunities to access training programs, respite care, and other services, but too few resources were directed at this large population, and these caregivers continue to be underserved by state and federal agencies.