Government subsidies for family members or others who provide in-home care to the infirm would re-create the same problems that existing subsidies for nursing home care create. They would place additional burdens on taxpayers, increase prices and steer recipients toward low-quality care.
Existing subsidies for nursing home care reward facilities that leave residents in what prosecutors have described as “heat, flies and stench.” One reason so many elderly people died from COVID-19 is that 50 years of subsidies favored nursing homes over less-crowded options like at-home care.
Likewise, subsidizing at-home care by relatives would steer the infirm to rely on family when that isn’t the best option — whether because family members would be happier working outside the home or would provide lower-quality care than trained professionals.
The least harmful way of subsidizing long-term care would be to take existing subsidies away from low-quality providers and give that money to the infirm as cash. Recipients could hire a service or a family member, because cash leaves the consumer in charge. No other subsidy could better ensure that future caretakers are competent and attentive.
But least harmful is still harmful. Before imposing additional burdens on taxpayers, government must eliminate the obstacles it creates to compassionate, affordable, at-home care.
For example, millions of potential caregivers would like to move to the United States and make a living by providing at-home care. Yet federal immigration restrictions — of which President Trump’s roundups are a part — prevent them from coming. By blocking immigrants from moving to this country and creating a large pool of competent caregivers, the government has made at-home care prohibitively expensive. As a result, families find it increasingly difficult to afford to hire outside assistance, requiring them to stay home to help aging family members. Removing immigration restrictions would increase affordable at-home care options.
State licensing regulations also increase prices by restricting supply, further preventing the infirm and their families from hiring competent, low-cost workers. Other state-level regulations raise prices and reduce quality by requiring that companies get permission from the government before opening new nursing homes and prohibiting certain businesses from owning nursing homes or home health companies.
Eliminating immigration, licensing and other regulatory obstacles would expand access to high-quality, affordable home care without costing taxpayers a penny.
