Support Increased Public Investment in Home- and Community-Based Long-Term Care

We support President Biden’s overall plan to improve the care infrastructure of the United States, including his specific proposal to invest $450 billion in expansion and improvement of home and community-based services for the long-term care of those experiencing disability or the frailty of advanced age.

A large body of evidence-based research indicates that this investment will help:

  • Increase access to home and community-based services.1 Current Medicaid funding for such services falls far short of serving all eligible families, with elderly women representing a disproportionate share of those in need of assistance. While institutional care is also important, funding shortfalls sometimes lead to unnecessary placements in nursing homes that pose serious risks of exposure to Covid-19 and other infectious diseases.
  • Improve the quality of care provided.2 Low wages, stressful working conditions, stunted career ladders, and resulting high rates of turnover in the long-term care workforce limit workers’ ability to provide sensitive care, to collaborate effectively with unpaid family caregivers, and to take full advantage of new medical technologies. Higher pay for long-term care workers has been shown to improve patients’ health outcomes and life expectancy.
  • Reduce financial and time pressures on unpaid family caregivers. 3 A $5,000 tax credit for family caregivers and credits toward Social Security will validate the value of unpaid care services. Greater access to high-quality paid assistance will improve collaboration and facilitate respites from family caregiving responsibilities.
  • Help create better jobs and career opportunities for home and community-based care workers.4 The current long-term care labor force is comprised largely of immigrants and women of color. This group, many of whom are eligible for public assistance, includes some of the most underpaid and undervalued workers in the U.S. Increasing their financial security can have positive multiplier effects on family and community well-being.
  • Enhance the overall efficiency of our long-term care system.5 In recent years, most states have reallocated Medicaid funds from nursing homes to home and community-based care, because most people strongly prefer the latter. Cost savings depend largely on takeup rates and the quality of care provided. The Biden proposal includes funds for research on innovations that could pay off in improved health and reduced hospitalization rates.
  • Foster a dynamic, resilient economy by helping families balance care needs and paid employment.6 Unexpected care shocks often create significant downside economic risks for families caught between a rock and a hard place—trying to find time to provide direct care but also earn enough money to pay their bills. Increased employment can contribute to sustainable economic growth. According to one recent estimate, a $77.5 billion public investment in care services would yield 2 million new jobs and $220 billion in new economic activity.

Sooner or later, most of us will need help from others. As social scientists and health care researchers we urge Congress to increase investment in the care workforce and home and community-based care by supporting President Biden’s Build Back Better plan.


  1. Alison Earle, Principal Research Analyst, University of California Los Angeles
  2. Alyssa J Alexander, Ph.D. Candidate
  3. Alyssa Schneebaum, Assistant Professor of Economics, Vienna University of Economics
    and Business
  4. Amy Armenia, Professor of Sociology, Rollins College
  5. Andrea Ziegert, Julian Robertson Jr. Professor of Economics, Denison University
  6. Anna A. Amirkhanyan, Associate Professor of Economics, American University
  7. Arne L. Kalleberg, Kenan Distinguished Professor of Sociology, University of North
    Carolina at Chapel Hill
  8. Arthur MacEwan, Professor Emeritus of Economics, University of Massachusetts
  9. Barbara E. Hopkins, Professor, Wright State University
  10. Barbara R. Lowrey, Retired adjunct faculty member, University of Maryland
  11. Beth Almeida, Principal, Cove Research
  12. Betsey Stevenson, Professor of Economics and Public Policy, University of Michigan
  13. Bina Agarwal, Professor of Development Economics and Environment, University of
  14. Brenda C. Spillman, Senior Fellow, Urban Institute
  15. Brenda Powell, Independent financial adviser
  16. Brenda Wyss, Professor of Economics, Wheaton College
  17. Camila Bustamante Pérez, Consultant, United Nations Economic Commission for Latin
    America and the Caribbean
  18. Candace Howes, Ferrin Professor of Economics, Connecticut College
  19. Candidus C Nwakasi, Assistant Professor, Providence College
  20. Caren Grown, Global Director of Gender Group, World Bank
  21. Carmen Diana Deere, Distinguished Professor Emerita of Food & Resource Economics,
    University of Florida
  22. Carol Scotton, Associate Professor, Knox College
  23. Carole Joffe, Professor Emerita of Sociology, U.C.Davis
  24. Carrie R. Leans, George H. Love Professor of Organizations and Management,
    University of Pittsburgh
  25. Carroll L. Estes, Professor and Founding Director Emerita, University of California San
  26. Chiara Piovani, Associate Professor, University of Denver
  27. Chih-ling Liou, Associate Professor, Kent State University at Stark
  28. Christian E. Weller, Professor, University of Massachusetts Boston
  29. Christina Barmon, Assistant Professor, Central Connecticut State University
  30. Christina Matz, Associate Professor, Boston College
  31. Christine E. Bishop, Atran Professor of Labor Economics, Brandeis University
  32. Clare L. Stacey, Associate Professor of Sociology, Kent State University
  33. Colleen Wynn, Assistant Professor, University of Indianapolis
  34. Cybelle Fox, Professor of Sociology, UC Berkeley
  35. Dara Orenstein, Associate Professor of American Studies, George Washington
  36. Darrick Hamilton, Henry Cohen Professor of Economics and Urban Policy, The New
  37. Dean Baker, Senior Economist, Center for Economic and Policy Research
  38. Debra Fortune Tomasino, Ph.D. Student, University of Connecticut
  39. Diana Strassmann, Carolyn & Fred McManis Distinguished Professor in the Practice,
    Rice University
  40. Diane Archer, President, Just Care USA
  41. Diane Feeney Mahoney, Professor Emerita and Gerontechnologist, MGH Institute for
    Health Professions
  42. Doree Ann Ventura-Espiritu, MD, Medical Director, Henry Ford Health System
    Behavioral Health
  43. Douglas A Wolf, Professor, Syracuse University
  44. Ebru Kongar, Professor of Economics, Dickinson College
  45. Edith Kuiper, Associate Professor, State University of New York New Paltz
  46. Edward Alan Miller, Professor, University of Massachusetts Boston
  47. Eileen Appelbaum, Co-Director, Center for Economic and Policy Research
  48. Eileen Boris, Hull Professor and Distinguished Professor of Feminist Studies, University
    of California Santa Barbara
  49. Elena Kulikov, Professor and Chair of Department of Public Administration, California
    State University Dominguez Hills
  50. Elena O. Lingas, Associate Professor, Touro University California
  51. Elissa Braunstein, Professor and Chair of Economics, Colorado State University
  52. Emily Abel, Professor Emerita, University of California Los Angeles
  53. Emily Agree, Professor, Johns Hopkins University
  54. Emily Ellis, Ph.D. Student, University of Chicago
  55. Emily Franzosa, Assistant Professor, Icahn School of Medicine at Mount Sinai
  56. Emma K. Tsui, Associate Professor, City University of New York John Jay College
  57. Felicia Kornbluh, Ph.D., Professor of History and Gender, Sexuality, and Women’s
    Studies, University of Vermont
  58. Francesca Degiuli, Associate Professor of Sociology, Fairleigh Dickinson University
  59. Geert Dhondt, Associate Professor, City University of New York John Jay
  60. Girshriela Green, Senior Organizer, United for Respect
  61. Grazielle Figueredo, Graduate student, University of Massachusetts Amherst
  62. Gretchen Donehower, Academic Specialist, University of California Berkeley
  63. H. Elizabeth Peters, Institute Fellow and Professor Emerita, Urban Institute and
    Cornell University
  64. Hande Togrul, ParaEducator, Open Classroom
  65. Heather L Menne, Senior Health Policy Researcher, RTI International
  66. Heidi Hartmann, Distinguished Economist, American University
  67. Heidi Shierholz, Senior Economist and Director, of Policy, Economic Policy Institute
  68. Holly Reed, Professor, City University of New York Queens College
  69. Howard Stein, Professor, University of Michigan
  70. Iris Chi, Professor, University of Southern California
  71. Isaac Jabola-Carolus, Ph.D. Candidate, City University of New York Graduate Center
  72. Iveris L. Martinez, Director & Archstone Foundation Endowed Chair in Gerontology
    Center for Successful Aging, California State University Long Beach
  73. Ivy Ken, Associate Professor of Sociology, George Washington University
  74. Jacqueline Marie McGinley, Assistant Professor, Binghamton University
  75. James Heintz, Professor and Chair of Economics Department, University of
    Massachusetts Amherst
  76. Jamie L. McQueen, Director of Academics and Assistant Professor, Wayne State
  77. Jane L. Tavares, Research Fellow, University of Massachusetts Boston
  78. Janet C. Gornick, Professor of Political Science and Sociology / Director, Stone Center
    Graduate Center, City University of New York
  79. Janet C. Gornick, Professor of Political Science and Sociology and Director of Stone
    Center, City University of New York Graduate Center
  80. Jasmine Travers, Assistant Professor, New York University
  81. Jayati Ghosh, Professor, University of Massachusetts Amherst
  82. Jeanne Koopman, Researcher, Boston University
  83. Jeannette Wicks-Lim, Associate Research Professor, University of Massachusetts
  84. Jeffrey A. Hayes, Chief Data Analyst, Institute for Women’s Policy Research
  85. Jen S Lendrum, Assistant Professor, Aquinas College
  86. Jennie Kaufman, Research Associate, Hunter College
  87. Jennifer C Olmsted, Professor, Drew University
  88. Jennifer Cohen, Assistant Professor, Miami University
  89. Jennifer Craft Morgan, Associate Professor, Georgia State University
  90. Jennifer Heston-Mullins, Research Scholar, Miami University
  91. Jennifer Mendez, Associate Professor, Wayne State University
  92. Jennifer N. Fish, Professor and Chair of Women’s Studies, Old Dominion University
  93. Jhumpa Bhattacharya, Vice President of Programs and Strategy, Insight Center
  94. Jim Campen, Professor Emeritus, University of Massachusetts Boston
  95. Joan C Tronto, Professor Emerita, University of Minnesota and City University of New
  96. Joan Ilardo, Director of Research Initiatives, Michigan State University College of
    Human Studies
  97. Joanne Spetz, Director of Philip R Lee Institute for Health Policy Studies, University of
    California San Francisco
  98. Jocelyn Olcott, Margaret Taylor Smith Director of Gender, Sexuality & Feminist
    Studies, Duke University
  99. John L. Hall Ph.D, Director Behavioral Health, envoyatHome
  100. John Schumacher, Associate Professor, University of Maryland Baltimore
  101. Joy Swanson Ernst, Associate Professor, Wayne State University
  102. Joya Misra, Professor of Sociology & Public Policy, University of Massachusetts
  103. Judith Lorber, Professor Emerita, City University of New York Graduate Center
  104. Julie A. Nelson, Professor Emeritus of Economics, University of Massachusetts Boston
  105. Jun Li, Assistant Professor, Syracuse University
  106. Karen V. Hansen, Professor of Sociology and Women’s, Gender, and Sexuality Studies, Brandeis University
  107. Kasey Edwards, Helpr Founder, Member of Closing the Women’s Wealth Gap
  108. Katharine Ransom, Researcher, California Institute of Integral Studies
  109. Kenneth J. Meier, Distinguished Scholar In Residence, American University
  110. Keridwyn Spiller, Ph.D. Student, University of California San Francisco
  111. Kim Price-Glynn, Associate Professor, University of Connecticut
  112. Kimberly Christensen, Economics Professor, Sarah Lawrence College
  113. Kimberly Lucas, Senior Director of Civic Research and Innovation, MetroLab Network
  114. Kirenia Brunson, Clinical Psychology Doctoral Trainee, Nova Southeastern University
  115. Kristin Smith, Visiting Research Associate Professor, Dartmouth College
  116. Laura Mauldin, Associate Professor, University of Connecticut
  117. Laura Punnett, Professor, University of Massachusetts Lowell
  118. Leah M. Janssen, Doctoral Candidate, Miami University
  119. Leigh Phillips, CEO, SaverLife
  120. Len Fishman, Director of Gerontology Institute, University of Massachusetts Boston
  121. Lenore Palladino, Assistant Professor of Economics & Public Policy, University of Massachusetts Amherst
  122. Leslie Salzinger, Associate Professor of Gender and Women’s Studies, University of California Berkeley
  123. Lewis Faulk, Associate Professor, American University
  124. Lisa Binns-Emerick, DNP, MSN, RN CS FGNLA, Geriatric Nurse Practitioner, Wayne Health Wayne State University
  125. Lisa Levenstein, Director of Women’s, Gender, and Sexuality Studies, University of North Carolina Greensboro
  126. Loretta Anderson, Board Member, University of Maryland St. Joseph Medical Center
  127. Lori Simon-Rusinowitz, Associate Professor, University of Maryland
  128. Lygia Sabbag Fares, Core Faculty, Brooklyn Institute for Social Research
  129. Lynet Uttal, Professor, University of Wisconsin Madison
  130. Manuel Garcia Dellacasa, Graduate student, University of Massachusetts Amherst
  131. Marc Cohen, Professor and Co-Director LeadingAge LTSS Center, University of Massachusetts Boston
  132. Marci Cottingham, Assistant Professor, University of Amsterdam
  133. Margaret K. Nelson, Hepburn Professor of Sociology Emerita, Middlebury College
  134. Maria Rerrich, Professor Emeritus, Munich University of Applied Sciences
  135. Maria S. Floro, Professor, American University
  136. Maria T. Brown, Assistant Research Professor, Syracuse University
  137. Mark Brennan-Ing, Director of Research and Evaluation, City University of New York Hunter College
  138. Mark Paul, Assistant Professor of Economics, New College of Florida
  139. Martha Tepepa, Research Scholar, Bard College
  140. Mary C. King, Professor of Economics Emerita, Portland State University
  141. Mary C. Tuominen, Professor Emerita, Denison University
  142. Mary Catherine Hannah, Executive Director, Perry Farm Village & Presbyterian Villages of Michigan
  143. Mary Louise Pomeroy, Ph.D. candidate, George Mason University
  144. Melissa Hodges, Associate Professor, Villanova University
  145. Melissa Milkie, President, Work and Family Researchers Network
  146. Michael Ash, Professor of Economics & Public Policy, University of Massachusetts Amherst
  147. Michael Logan, CEO, Michigan Masonic Home
  148. Michal Engelman, Associate Professor, University of Wisconsin Madison
  149. Mignon Duffy, Chair of Sociology Department, University of Massachusetts Lowell
  150. Mindy Fried, Ph.D., Principal, Arbor Consulting Partners
  151. Molly Wylie, Ph.D. Student, University of Massachusetts Boston
  152. Namkee G. Choi, Professor, University of Texas at Austin
  153. Nancy A Naples, Professor of Sociology and Women’s Gender, & Sexuality Studies, University of Connecticut
  154. Nancy R Folbre, Professor Emerita of Economics, University of Massachusetts Amherst
  155. Naomi Lightman, Assistant Professor, University of Calgary
  156. Nathan Boucher, Dr.PH., Assistant Research Professor, Duke University
  157. Nina Elizabeth Banks, Associate Professor of Economics, Bucknell University
  158. Orion H. Bell IV, President & CEO, Benjamin Rose Institute on Aging
  159. Pamela Nadash, Associate Professor, University of Massachusetts Boston
  160. Patricia J Lopez, Assistant Professor of Geography, Dartmouth College
  161. Patrick C Cullinane, Immediate Past Director & Council Co-Chair of UC Berkeley Retirement Center, Member of Advisory Council Kaiser Hospital Oakland
  162. Paula England, Silver Professor of Sociology, New York University
  163. Peter S. Arno, Senior Fellow, University of Massachusetts Amherst
  164. Philip A Rozario, Professor and Associate Dean of School of Social Work, Adelphi University
  165. Pilar Gonalons-Pons, Assistant Professor, University of Pennsylvania
  166. Raelene Shippee-Rice, Associate Professor Emerita, University of New Hampshire
  167. Rakeen Mabud, Senior Director of Research and Policy, TIME’S UP
  168. Randy Albelda, Professor of Economics, University of Massachusetts Boston
  169. Raven Weaver, Assistant Professor, Washington State University
  170. Honorable Richard T. Moore, Co-Chair of Legislation Work Group, Dignity Alliance Massachusetts
  171. Rie Harding, Graduate Student, University of Massachusetts Amherst
  172. Robin Lynn Bartlett, Professor Emerita in Economics, Women and Gender Studies and Queer Studies, Denison University
  173. Robyn Stone, Senior Vice President for Research and Co-Director of LTSS Center LeadingAge, University of Massachusetts Boston
  174. Ruth Milkman, Distinguished Professor of Sociology, City University of New York Graduate Center
  175. Samara Scheckler, Postdoctoral Fellow, Harvard University
  176. Sandra S. Butler, Professor and Director, University of Maine
  177. Sara Bybee, Ph.D. Candidate, University of Utah
  178. Scott A. Bass, Professor and Provost Emeritus, American University
  179. Shawn Fremstad, Senior Fellow, Center for Economic and Policy Research
  180. Smita Ramnarain, Associate Professor, University of Rhode Island
  181. Spencer Watson, Executive Director, Center for LGBTQ Economic Advancement & Research
  182. Stacey Jones, Senior Instructor of Economics, Seattle University
  183. Stefani Boutelier, Associate Professor, Aquinas College
  184. Stephan Lefebvre, Assistant Professor, Bucknell University
  185. Susan J. Ferguson, Professor of Sociology, Grinnell College
  186. Suzanne Helburn, Emerita Professor of Economics, University of Colorado Denver
  187. Taryn Morrissey, Associate Professor, American University
  188. Tarynn Witten, Emerita Full Professor, Virginia Commonwealth University
  189. Ted Burczak, Professor, Denison University
  190. Thomas M. Gill, M.D., Professor of Geriatric Medicine, Yale School of Medicine
  191. Traci M. Levy, Associate Professor of Political Science, Adelphi University
  192. Verena Cimarolli, Senior Health Services Research Associate, University of Massachusetts Boston
  193. Vivian Ho, Baker Institute Chair in Health Economics and Professor, Rice University
  194. Yana van der Meulen Rodgers, Faculty Director, Center for Women and Work Rutgers University
  195. Yavuz Yasar, Associate Professor, University of Denver
  196. Zarrina Juraqulova, Assistant Professor of Economics, Denison University
  197. Zdravka Todorova, Professor of Economics, Wright State University