For those who are part of the Sandwich generation (caring for aging parents while raising young kids), choices are not easy. High costs for college seem daunting until you see how much Assisted Living/Nursing Home care costs. Kids are borrowing tens of thousands to pursue degrees while aging parents watch their assets being drained by high costs for senior care.
The fastest growing segment of our population continues to be seniors; they represent a reliable voting block. When former DNC vice chair David Hoag is able to get the perentage of young voters to cast a ballot in the same numbers as senior citizens, I will take him more seriously. That’s why developing national policies that address America’s gray market is something Democrats can show leadership. Add improving elder care to our earlier list of a Democratic Contract with America.
By expanding federal investment, reforming reimbursement models, raising workforce standards, and embracing home- and community-based care (HCBS), Democrats can both improve the quality of life for older Americans and create hundreds of thousands of good-paying jobs. Here’s how to do it:
STRATEGIES FOR IMPROVED SENIOR CARE
- Expand Medicaid Coverage for Long-Term Care
Medicaid is the largest payer for long-term services and supports (LTSS), including nursing home care. Democrats could:
- Increase federal Medicaid matching rates (FMAP) for states that improve nursing home staffing and quality.
- Fully fund HCBS under Medicaid so seniors can choose home care instead of institutionalization.
Cost Estimate: President Biden’s original Build Back Better Act proposed $400 billion over 10 years for HCBS expansion.
- Set National Staffing Standards
- Require minimum staffing ratios in nursing homes (e.g., 4.1 hours of care per resident per day).
- Mandate living wages and benefits for caregivers to improve retention and care quality.
- Link Medicare and Medicaid payments to performance on quality metrics.
Cost: The Congressional Budget Office (CBO) has not provided a firm estimate, but better staffing would cost tens of billions annually — offset in part by reduced hospitalizations due to better care.
- Invest in Workforce Development
- Fund training and credentialing programs for Certified Nursing Assistants (CNAs), home health aides, and geriatric nurses.
- Offer tuition support for those entering eldercare professions, especially in underserved areas.
Job Creation: According to PHI (a nonprofit tracking direct care workforce), expanding HCBS and nursing care could create up to 1 million jobs over 10 years. The Healthcare Industry right now is the biggest job market in the US — greater than manufacturing, greater than professional services, and greater than tourism/retail. Good jobs at good wages.
- Improve Accountability for Nursing Home Chains
- Increase transparency on ownership and profit structures (many are run by private equity).
- Tie public reimbursements to spending on direct care, not administration or profit.
- Modernize Facilities
- Provide federal grants or low-interest loans for:
- Facility upgrades (air filtration, accessible design)
- Infection control measures
- Technology adoption for telehealth and monitoring
Cost: A national modernization plan could cost $50–$100 billion over a decade.
Here’s how we pay for it; finance these programs through a combination of revenue strategies that align with progressive values:
Revenue Options:
- Eliminate the Social Security payroll tax cap (currently $168,600 income ceiling) — generating ~$250 billion over 10 years.
- Impose a wealth tax or increase capital gains taxes on the top 0.1%.
- Close Medicare Advantage overpayment loopholes, which cost $83 billion in 2022 alone.
- Raise the federal estate tax threshold modestly to tax the largest inheritances.
- Levy surtaxes on private equity funds that own for-profit nursing homes but cut staffing to boost profits.