Biden promotes home health services as an infrastructure
The centralized approach replaces family and community with unionized federal home carers.
The Biden administration, as part of its somewhat misleadingly titled Infrastructure Bill, has proposed an enormous $ 400 billion program to expand home health services to capitalize on the legitimate dissatisfaction with nursing homes resulting from the many deaths in them during the COVID crisis revealed. The proposal implies that there is a binary policy choice between home health services and nursing homes and that increasing home health care staff will encourage deinstitutionalization.
However, only about 6 percent of the elderly live in nursing homes and long-term care facilities, and the current backlog in home health services that states are committed to providing is estimated at $ 150 billion. The proposal therefore provides for more participation in home health services and higher remuneration for those who provide these services. The plan includes a $ 5,000 non-refundable tax credit for families with a relative providing home health care. It also includes measures to facilitate the unionization of home care workers.
A notable peculiarity of the proposal is the renunciation of the middle class. Government-provided home health services are provided through the Medicaid program to those who have used up their assets and are effectively welfare recipients. The tax credit will only benefit those who, despite the recent tax rate cut and the large expansion of the standard withholding tax, pay significant income taxes. It benefits the relatively wealthy, but not the ailing lower middle class. The expansion of Medicaid benefits thus encourages greater government provision of home health care, greater “spending” and greater reliance on government for all but the wealthy.
Other countries have developed other approaches to promote home nursing within families or through mutual aid organizations for older people themselves. Most older people are not entirely frail, but most of the time fit for most purposes, although they are more affected by recurrent disabilities than the majority of the population. Idleness and boredom are a problem for many.
In Japan, community care for the elderly is organized at the neighborhood association level under a charity volunteer law. Volunteers are hired for three years, work two days a week with older people and receive a nominal scholarship. The organization of age clubs is encouraged with small tax reductions for members. The participation of people over the age of 60 in such organizations rose from 12.8 percent in 1962 to 47.2 percent in 1973.
While the United States has historically had a limited tradition of neighborhood organization below the city and town level, that situation has changed with the advent of shared apartments and condominiums since the early 1960s, when it was necessary to establish such associations to maintain infrastructure, a state mortgage insurance condition for new developments. Approximately 74 million Americans now live under the jurisdiction of private community associations, including 58 percent of homeowners. In 2019, 62 percent of the newly built apartments were in apartment owners ‘associations, a total of 351,000 such apartment owners’ associations. Many of these associations maintain facilities such as swimming pools and needs-based means of transport, so that they can easily organize aid associations.
Another aspect of foreign elderly care strategies is the promotion of the construction of secondary apartments, double apartments and mother-in-law apartments. There are tax credits for this in Germany, Japan and Finland. In Great Britain there is a “Rent a Room” program which provides tax exemptions for renting rooms in otherwise single-family homes. The advantage of these regulations is that the number of elderly people living alone in single-family homes is reduced who are dependent on outside help that could otherwise be provided by relatives or neighbors.
In general, the only areas in the US with abnormally high real estate prices have legalized secondary housing to provide housing for teachers, police officers, or domestic workers who would otherwise be excluded. Otherwise, single-family zoning effectively banishes older relatives to the next district – they either have to live directly with the relatives in the same residential unit or accept complete separation.
Senator Elizabeth Warren (D-MA) has proposed compulsory federal legislation to force or bribe local governments to liberalize restrictive zoning laws. Such top-down approaches are doomed because they amount to an attempt to push spaghetti through a keyhole. Much more effective would be a modest tax credit of a few thousand dollars for people installing secondary kitchens in their homes.
The restriction to owner-occupied housing would allay fears of neighborhood change, and the loans would be published and promoted by accountants, accountants, contractors, and home improvement chains such as Lowe’s and Home Depot. It is questionable whether local governments could withstand pressure from below to liberalize their zones.
The Biden government is likely to find that there is not much enthusiasm for creating their proposed army of impersonal, government-regulated and unionized home workers. When the choices are properly formulated, preference will be given to measures to encourage mutual assistance, complemented by family and neighborhood assistance.
George Liebmann is President of the Library Company of the Baltimore Bar and author of Neighborhood futures (Transaction books) and Vox Clamantis in Deserto: An Iconoclast Contemplates Four Failed Governments Administration (Amazon).