Congress Addresses Direct Care Workforce Crisis and Invests in Home- and Community-Based Services

Better Care Better Jobs Introduced, Bill Addresses Direct Care Workforce Crisis
and Invests in Services for Older Adults and Disabled People

WASHINGTON (January 26, 2023)—Today, Senator Bob Casey (PA), Congresswoman Debbie Dingell (MI-06), Energy & Commerce Ranking Member Frank Pallone (NJ-6), Congresswoman Jan Schakowsky (IL-9), Congresswoman Doris Matsui (CA-7), and 40* cosponsors in the Senate introduced the Better Care Better Jobs Act (BCBJ) to make critically needed long-term investments in Medicaid-funded home and community-based services (HCBS).

The vast majority of Americans would prefer to receive services and supports as they age or address disability or illness at home. BCBJ would raise wages for direct care workers and ensure disabled people and aging adults can receive care in the location and setting of their choosing.

BCBJ, first introduced in the House and Senate in 2021, would enable more than three million additional people to access support in their own homes and communities, create hundreds of thousands of new, high-quality jobs and provide respite care and training for unpaid family caregivers.

More than 650,000 people who are eligible to receive care in their communities are currently on Medicaid waitlists for services, such as in-home direct care, meal preparation and adjustments to make homes more accessible.

Waiting times for these services range from a few months to over a decade, and are exacerbated by the direct care industry’s high turnover rate. As a result of dismally low wages, nearly one in five direct care workers — the majority of whom are women and people of color — live in poverty and many workers receive few or no job protections or benefits.

Below is a statement by Ai-jen Poo, executive director of Caring Across Generations:

“The Better Care Better Jobs Act represents a historic investment in a long undervalued and underfunded care industry and will address waitlists and other barriers that disabled people, aging adults and family caregivers face when trying to access the services they need in their homes and communities. We cannot expand access to services without addressing the fact that the direct care workforce is in severe crisis with workers who aren’t paid fairly even though they do the vital work of caring for our loved ones.

“In every state and every district across the U.S. there is overwhelming support for investing in home- and community-based services (HCBS). In fact, this issue is so widespread that 89% of voters want the federal government to increase funding for HCBS to allow aging adults and disabled people to live with independence and dignity.

“Too often policies and programs are centered on our needs as workers, rather than our needs as families and caregivers. This creates challenges that impact our quality of life – such as balancing work and childcare, needing time to care for a loved one, accessing support for long-term needs, and affording ways to age with dignity – and that families are left to navigate alone. People shouldn’t have to choose between doing well and living well. If Congress doesn’t take this issue seriously, millions of us will continue to struggle to do what matters most: care for the people we love.”


Caring Across Generations is a national campaign of family caregivers, care workers, disabled people, and aging adults working to transform the way we care in this country so that care is accessible, affordable and equitable— and our systems of care enable everyone to live and age with dignity. 

To achieve our vision, we transform cultural norms and narratives about aging, disability and care; win federal and state-level policies; and build power amongst the people touched by care. For more information, visit

* Release was updated at 12 p.m. ET to reflect additional co-sponsors to the legislation.