Opinion | An answer to Michigan’s home care needs is right at hand

Everyone has the right to live in the setting they choose. This is equally true for those with intellectual and/or developmental disabilities, as well as for the aging. Competent, compassionate caregivers are required for loved ones to thrive in their own homes. This requires well-trained, properly compensated caregivers. These professionals are essential for the high-quality long-term support and services that are basic human rights.

We at the Arc have more than 70 years of advocacy experience as the world’s largest community-based organization of and for people with intellectual and developmental disabilities. We advocate for state and federal policies informed by firsthand insight into disability rights and supports.

The U.S. Centers for Disease Control and Prevention report that more than 2.3 million Michigan adults have some type of disability. Some 35,000 care workers are in Michigan homes assisting seniors and persons with disabilities. However, Michigan is in a home care crisis as the senior population booms and will have 115,500 home care job openings from 2020–2030. This shortage results in months-long waiting lists for home and community-based services. 

Experts say the high turnover rate and shortage of home care workers is due to low pay. Michigan’s Direct Care Workforce Living Wage and Turnover Cost Analysis, a 2021 report prepared for the Center for Health Care Strategies, says these workers are living paycheck-to-paycheck. It concludes that “direct care workers provide life-or-death services, and it is unfortunate that hourly wages are not commensurate with their responsibilities.”

Low pay is a fundamental flaw in an essential care system that must be addressed. Home care workers deserve enough pay to care for their own families. They deserve benefits to safeguard their health, as they perform physically challenging tasks like lifting people. They deserve to be properly trained to protect them, decreasing injuries, lessening turnover and ensuring continuity of care.

Training, better benefits and higher pay for home care workers through a home help authority, along with restoring their bargaining rights, will bring caregivers to these jobs, encourage continuity of care, relieve the burden of the high cost of a nursing home, and enable better health at home.

That is why Michigan is poised to act, to form a public authority to professionalize home care work to support the workers who provide essential medical and non-medical services. The legislation would establish a much-needed statewide authority to address the root causes of the persistent and worsening workforce crisis. It would provide the guidelines and safeguards needed for more high-quality, well-trained and fairly paid caregivers.

The state Legislature should act on Senate bills 790 and 791 to protect those who need home care. Relying on families to provide all needed support cannot be a substitute for creating a systemic solution to ensure that everyone with a disability who needs long-term support and services receives them. A comprehensive, effective system should include both private and public funding mechanisms because long-term support systems must be a shared societal responsibility.

Government intervention is also appropriate because home-based care ultimately saves taxpayer dollars. The public interest in professionalizing home-care workers with a state oversight body is even more important when we consider that nearly a quarter of Michigan's population will be 60 and older by 2030, according to U.S. Census Bureau estimates. We are clearly facing a continuing and worsening crisis of unmet need if the state does not act to erect a framework to guide public policy. 

It is clear, too, that the authority should emphasize self-direction, and be well-funded, responsive, and nimble as it guides workable, flexible public policy.  We find that the most effective policy is constructed with the input and involvement of people who are living with developmental disabilities. These are the individuals and families who are forced to navigate a patchwork of systems of supports and services that are complex and frequently uncoordinated. That is why we are actively calling for this state authority to promote skills and training and the adequate compensation required for recruiting and retaining quality professionals.

The persistent lack of a system of comprehensive community long-term support is a crisis requiring an immediate solution that a statewide authority can provide.