Homecare is Healthcare Report

Read the full report here.

Washington’s home care workers are a vital part of our State’s pandemic response. COVID-19 has sickened and led to the deaths of thousands of older adults and essential workers, and has disproportionately impacted low-wage workers, people whose primary language is not English, and Black, Indigenous and people of color. Home care workers are highly trained healthcare professionals who have helped protect their clients from exposure to COVID-19. 

Home care workers support medically fragile elders and people with disabilities in their homes, where people are safest during a pandemic. They are essential, low-wage workers who risk their own health and economic stability to protect their clients. Both caregivers and their clients are disproportionately immigrants, people whose primary language is not English, and Black, Indigenous and people of color. Even before the pandemic and its economic fallout, these communities already experienced higher rates of poverty and economic hardship, and, during the pandemic, have faced more severe health consequences. 

The following report examines the role of the Medicaid Home Care Program in promoting the health of Washington residents, equity among communities, and sustainability of state systems and safety nets. The analysis is based on academic and scientific literature, data from state agencies like the Department of Health, and interviews we conducted in 2020 with home care workers and clients across the state. We conclude: 

1. Home care workers reduce the spread of COVID-19. 

Staying home is the most powerful action any of us can do to reduce the spread of the virus. Home care workers help clients do this. 

  • Quality, skilled home care allows elders and people with disabilities to stay out of residential care facilities where more than 40% of the deaths due to COVID-19 in the U.S. have taken place. 
  • Caregivers are also coming up with creative ways to ensure their clients can leave their residence as little as possible, to decrease their exposure to the disease. They acquire clients’ basic needs, such as prescriptions, groceries from the store or food bank, and, during the pandemic, supplies like hand sanitizer and masks. 
  • Caregivers’ training includes knowledge of infection control protocol and caregivers’ practices with their clients demonstrate the seriousness with which they take their responsibility to protect their clients. 

2. Caregivers provide care at great risk to themselves. 

Compared to the general population, caregivers in Washington are more likely to experience COVID-19 and are more likely to live on the brink of crises, like food insecurity or homelessness. 

  • More than twice as many caregivers in Washington tested for COVID-19 were found to be positive, compared to people tested in the general population. 
  • Medicaid home care employment keeps caregivers afloat economically. However, low wages mean that many caregivers still depend on state and community safety nets and cope with precarious household finances. 

3. Investing in home care is an investment in Black, Indigenous and communities of color, communities most impacted by economic hardship and COVID-19. 

  • Black, Indigenous and people of color are at higher risk of exposure to and serious health consequences from COVID-19. Underlying health conditions, caused by factors like inequity in access to healthcare, are compounded by inequities in access to timely COVID-19 testing and care. 
  • People whose primary language is not English have also been more likely to contract COVID-19 and need hospitalization. Caregivers who speak the same language as the client become essential messengers of public health information and mitigate the risks of exposure. 
  • Black, Indigenous and communities of color in Washington experience poverty at higher rates than White communities. 
  • Medicaid home care is a financial lifeline for caregivers and clients. This is especially true for Parent Providers and other family caregivers who are limited in their ability to secure other employment because they are responsible for the well-being of their clients. 

4. A quality home care program reduces strain on hospitals, mental health care systems, criminal justice systems, emergency services, and state social safety nets. 

  • Caregivers have extensive training in client health and support. Through daily tasks like reducing client falls and reminding clients to take medications and eat healthy meals, caregivers maintain clients’ health and well-being. These efforts slow the decline of clients’ conditions and reduce their need for expensive emergency services and hospitalization. 
  • When people with mental or behavioral health needs have an in-home caregiver, they are less likely to experience relapses that could prompt more expensive medical responses, such as hospitalization. It also prevents increased criminalization and the costs, to the state and the individual, of courts, incarceration and re-entry. 
  • Medicaid home care is essential for the well-being and health of caregivers and their families. Health insurance allows caregivers to access care when they need it, before their health needs become an expensive emergency. Paid caregiving also reduces caregivers’ reliance on safety nets like unemployment, food assistance, housing assistance, and public health insurance. 

When the Medicaid Home Care Program is strong, providing quality care and livable jobs, it protects some of the communities hardest hit by COVID-19: elders, people with disabilities, Black, Indigenous and people of color, immigrants and people whose primary language is not English. 

Investing in home care saves the State money, by reducing institutionalization, hospitalization, and reliance on other systems and safety nets. Moreover, it saves and improves lives, keeping people most at risk of dying from COVID-19 away from possible exposure, reducing declines or relapses in clients’ conditions, and providing wages and benefits that increase caregivers’ access to basic needs for themselves and their families. 

As we work to keep our state’s most vulnerable residents safe and reduce inequities in health and well-being, Washington must continue to invest in this highly qualified workforce through wages and benefits that ensure clients receive the care they need and caregivers are able to sustain themselves in their essential work. 

Read the full report here.