The Age wave. The Elder Boom. The Silver Tsunami. Whatever you call it, we all know there’s something happening in America, because we feel it in our own homes and communities. At least 63 million of us are spending significant amounts of time each week, doing our very best to care for an aging or disabled loved one, on top of work and other responsibilities.
When the Social Security Act passed in 1935, life expectancy in America was 61 years. In 2024, thanks to advances in health care and technology, it’s 79 years — the highest it has ever been. Many of us will live beyond our 80s — in fact, the population over the age of 85 is expected to more than double by 2040.
We have extended our lifespan considerably, changing many aspects of life in our intergenerational families and communities, especially when it comes to caregiving. Rather than transition to nursing homes when we need assistance, most of us would prefer to age at home, connected to our families and communities. Families are coming together in new ways to support community living. Our needs have changed and we’re all doing our best; what hasn’t changed is our federal policy.
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Federal policy must change, too. Two long-overdue pieces of federal legislation, the Home and Community-Based Services Access Act and the Long-Term Care Workforce Support Act were introduced. Together, they offer a proactive path forward toward the support working families need, especially when it comes to care in the home and the community. In the face of major cuts to Medicaid, which pays for 70 percent of home and community based care in America, these bills offer much needed hope for relief.
Right now under Medicaid, nursing home and institutional care are guaranteed benefits, while home-and community based services under Medicaid are optional. This means states can limit enrollment or scale back services when budgets tighten. The result is long waiting lists, barriers to access, significant gaps in care, and inequities that leave too many older adults and people living with disabilities without the care they need.
Nationwide, more than 600,000 people are waiting for access to home-based care — often for years, despite being eligible for services. The Home and Community-Based Services Access Act would make these services a guaranteed Medicaid benefit, turning eligibility into real access. It will ensure people can receive essential support like home health care, transportation and caregiver assistance when they need it.
The bill would also eliminate waiting lists for home and community based services, and would fund better wages and job supports for direct care workers. It’s time we cared for the workers who care for us.
The truth is, access to care on paper means very little if there is no one to provide it. Direct care workers are the backbone of our care system and the people who make it possible for older adults and people with disabilities to live and age with dignity in their homes and communities. Yet today, with wages so low there’s hardly enough money for gas to drive from one client to another, without benefits or job security, too often forced to hold multiple jobs to survive, the workforce is in crisis.
The Long-Term Workforce Support Act invests in the people who provide care by improving wages, strengthening training pathways and creating more stable jobs. For too long, care workers have been undervalued and underpaid, leading to shortages that leave families without options. This bill would help ensure that when funding increases, dollars go toward worker wages, not administrative overhead. And when workers are paid fairly, care improves — reducing costly hospitalizations, and unnecessary nursing home placements.
These are not competing proposals, they reflect a simple truth: access to care for families and a strong workforce go hand in hand. The HAA makes home care a real option for more people while the Long-Term Care Workforce Support Act ensures that there is a strong workforce in place to deliver that care. One without the other leaves a critical gap and without action, that gap will only continue to widen. And it is a false choice to suggest home care requires us to give something up in order to afford it. Homecare saves money for both families and the government.
While caregiving can feel overwhelming at times, we know when we take it one day at a time, we find a way forward. Good policy can transform our ability to navigate the pressures of work, family and care. Across the country, we value our independence, dignity, and looking out for one another. Strengthening home and community based care and investing in the workforce behind it, reflects those values. Caregivers are doing our best, it’s time for Congress and our federal policy to catch up.
Debbie Dingell, a Democrat, represents Michigan’s 6th Congressional District in the U.S. House of Representatives. Ai-jen Poo is executive director of Caring Across Generations.
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