Why we need to support innovation in our states


By Caring Across Co-Director Ai-jen Poo

We’re in a moment of tremendous change in the country. The demographics are changing, the economy is changing, and families are changing. Four million people turn 65 per year in our nation. And because of advances in health care and technology, people are living longer than ever. By 2020, one out of every six Americans will be over the age of 65. This shift is changing a lot about the way we live in America.

Multi-generational families are living together again. Millennials are closer to their grandparents than any other generation in history. People are staying in the workforce longer, holding second, sometimes third careers. Home care work is the fastest growing occupation in the nation, not only in healthcare, but across all occupations.[i] By 2018, demand for home care workers will increase by more than 90%.[ii] Much of the change that’s taking place is complex – both challenging and full of opportunity, the opportunity for a good life in 21st century America; the potential to strengthen our families, communities, and the economy.

There are a lot of things we don’t know and can’t predict about the future. But there’s a lot that we do know. We know that:

  • People overwhelmingly want the option to stay in their homes and communities as they age, over going to nursing homes. My grandmother will be the first to tell you she would never want to be in a nursing home.
  • We know that the home care workforce will continue to grow to meet that need. We know we will need a strong and well-prepared home care workforce.
  • We know that when people with disabilities simply have access to home and community based services and supports, they are able to go to school, work, care for others, and live full lives, in their communities.
  • We know that technology can play a huge and helpful role in coordinating the care and support that people need.
  • We know that we will need to find cost savings in our system.
  • We know that innovation and experimentation will be necessary, because our new reality as a nation with an unprecedented older population is still unfolding. There are no silver bullet solutions yet.
  • We know that every single family is going to face a care crisis at one point or another. This issue is both urgent and important for millions of Americans.
  • And we know the needs across an enormous, diverse aging population differ tremendously by region, depending on rural versus urban conditions, and by culture.

We know a lot, and yet there’s still much that we don’t know. This is why Caring Across Generations is proposing the creation of a state innovation fund – to support innovations in home care that bring all the stakeholders to the table to create more choices for older adults, people with disabilities and their families, and more opportunity, better jobs for the workforce. We believe the matter is urgent and important, and that the most important thing we can be doing at this moment is supporting innovation where it’s already happening – in states. We must pilot, experiment, document, listen to people in communities around the country and learn.

There’s already tremendous creativity happening at the state level, because of the demographic changes we’re experiencing as a nation. The “silver tsunami” hit some states earlier than others and they have had no choice but to take this on. Many states are seeing the opportunity to develop new and exciting models of multi-stakeholder collaboration, to expand home care, boost the economy and create jobs, and create new efficiencies in the health care delivery system.

Some examples include:

  • A state of the art homecare workforce training program in Washington State, the second largest educational institution in the state, second only to the University of Washington, which trains 40,000 home care workers every year — with language access in 13 languages. They also offer continuing training and education for caregivers on chronic disease management through distance learning enabled by new technologies,
  • In Maine, the speaker of the House created an Aging Council with a 10-point agenda that covers aging in place, family support, disability rights, transportation, and workforce standards,
  • More than a dozen states are bringing together key stakeholders to form long-term care commissions to study the issue and develop state level solutions incorporating the perspectives of families, consumers, workers and experts in health care and gerontology. These commissions are testing new ideas such as:
    • The creation of consumer care teams that help to reduce avoidable emergency room visits, re-admission rates, and nursing home placement;
    • Programs to support diverse consumers to receive culturally appropriate care from the growing number of immigrants in the direct care workforce in ways that benefit our entire healthcare system by reducing health disparities across patient populations; and
    • Tax credits for private pay employers who pay a living wage.

We believe that through encouraging and learning from the ongoing initiative of states, we will start to see the models that can be scaled, save our system money, create good jobs for the care workforce, and more choices for consumers.

We will then begin to see the contours of a federal solution that could work for the future. Now is the time to make the investment in the future of care, where it’s being innovated and developed in real time.

Join us in calling on Congress to take action and support our states.


[i] Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010‐11 Edition, Home Health Aides and Personal and Home Care Aides, on the Internet at http://www.bls.gov/oco/ocos326.htm

[ii] PHI (February 2010) Occupational Projections for Direct‐Care Workers, 2008‐2018, FACTS 1. Available at: http://directcareclearinghouse.org/download/PHI%20FactSheet1Update_singles%20(2).pdf

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