Joined by people with disabilities, family caregivers, long-term care workers, early educators, veterans, and aging advocates, President Joe Biden signed an Executive Order that includes more than 50 directives to nearly every cabinet-level agency to expand access to affordable, high-quality care, and provide support for care workers and family caregivers.

For veterans,  the Executive Order directs the Department of Veterans Affairs (VA) to improve access to home-based care for veterans who require support with activities of daily living, like bathing and getting dressed, by giving them more decision-making power over who delivers that care and when.

The VA is directed to consider expanding its Veteran Directed Care program to all 172 VA Medical Centers by the end of Fiscal Year 2024. This program provides veterans with a budget to hire personal care assistance including from family members. VA will also consider piloting a new self-directed care program in no fewer than 5 new sites that provides veterans with a budget for personal care assistance while reducing administration burdens related to managing care. Further, VA will consider adding 75 new interdisciplinary teams to its Home-Based Primary Care program to serve an additional 5,600 veterans in their homes.

For long-term care workers, the Executive Order directs HHS to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.

To provide greater support to family caregivers, the Executive Order directs HHS to consider testing a new dementia care model that will include support for respite care (short-term help to give a primary family caregiver a break) and make it easier for family caregivers to access Medicare beneficiary information and provide more support to family caregivers during the hospital discharge planning process. Additionally, VA will consider expanding access to the Program of Comprehensive Assistance for Family Caregivers and provide more mental health support for caregivers enrolled in that program. These actions build on the 2022 National Strategy to Support Caregivers.