In homes across America, families are facing a silent crisis. Millions struggle to provide care for aging loved ones, often at great personal and financial cost. But what if there were a way to transform this challenge into an opportunity? Imagine a care system where a pre-med college student earns tuition money by spending afternoons caring for your father with Alzheimer’s, or where your recently retired neighbor finds renewed purpose in helping your mother recover from hip surgery. This isn’t a far-off fantasy. It’s a practical vision for caregiving that’s already taking shape, offering a glimpse into a future where quality care is both accessible and affordable.
Kamala Harris’ “Medicare at Home” plan brings us tantalizingly close to this reality, but falls short of truly revolutionizing home care in America. We’ve seen both the promise and pitfalls of our current home care system. One of us runs the fastest-growing care startup, recognized as one of LinkedIn’s Top 50 Startups in America, and sees the challenges family caregivers face around the country with lack of access to affordable home care. The other leads the palliative care division of a large health system, seeing families face these challenges every day in clinical settings, trying to ensure patients are safe and families well-supported. Harris’ proposal is a step in the right direction, but to truly solve our looming care crisis, we need to think bigger and bolder.
The demographic tsunami heading our way is undeniable. With 10,000 Americans turning 65 daily and the over-85 population set to double by 2040, we’re facing a care crisis of unprecedented proportions. Harris’ plan recognizes this shift, aiming to support the “sandwich generation” — adults juggling care for both children and aging parents.
By covering costs for in-home aides, the plan could alleviate financial burdens and delay costly nursing home admissions. It’s a win-win: respecting the dignity of older adults who wish to age in place while reducing long-term Medicare costs.
However, the proposal’s focus on “designated” Medicare aides risks doubling down on a system already buckling under workforce shortages and regulatory burdens. The home care industry, despite its importance, struggles with high turnover and unmet demand. Merely injecting more funds without addressing structural issues is like filling a leaky bucket without patching the holes.
The Harris proposal is also inconsistent with what people want and need. One of us led a study funded by NIH to understand the home care needs of people living with cancer. We interviewed 300 patients about a portfolio of services to see which were most important. In asking about caregiving at home, patients told us that they’d place a 50% higher value on vouchers that could be used to pay family, friends and informal caregivers, compared to home health aides through an agency.
To truly transform home care, we must pay attention to what people say they need. We must also embrace innovation and flexibility. The gig economy model, which has reshaped industries from ride sharing to food delivery, offers a compelling blueprint for caregiving. By leveraging technology platforms, we can create a more dynamic, responsive caregiver workforce that includes not just traditional aides, but also students, retirees and others seeking flexible work.
This approach expands the caregiver pool and has the potential to lower costs and increase accessibility. We’ve witnessed how tech-enabled caregiver matching can reduce overhead costs and allow for more personalized care. We’ve also seen how enthusiastic, energetic students can bring new life, energy and even joy to the caregiving experience. It’s a win-win-win: families get more affordable care, caregivers enjoy flexible employment and Medicare could realize significant savings.
To make this vision a reality, we need to rethink our regulatory approach. Current regulations, while well-intentioned, often create barriers to entry and stifle innovation. Of course we need mechanisms to maintain quality standards, but we also need to allow for more flexible training and certification, such as competency-based assessments and micro-credentialing.
Moreover, we must broaden our definition of caregivers. Family caregivers, the backbone of our long-term care system, should be eligible for compensation under this Medicare benefit. But why stop there? We should include college students, retirees, neighbors and others who may not fit the traditional caregiver mold. These informal caregivers often bring unique benefits: strong personal connections, understanding of local community dynamics and fresh perspectives on care.
Critics may argue that this approach could compromise care quality. However, with proper oversight and technology-enabled quality control, we can create a more responsive and accountable system. Real-time ratings, background checks, and ongoing training can maintain standards while allowing for a more diverse workforce. These challenges are eminently solvable. In fact, tech-enabled care platforms like CareYaya are already demonstrating the viability of this approach, having rapidly spread across the country over the past couple of years.
The economic impact could be substantial. By tapping into a broader caregiver pool, we could create new economic opportunities, particularly in areas hit hard by deindustrialization. Furthermore, more accessible and affordable home care could lead to significant savings in long-term healthcare costs as more seniors avoid or delay institutionalization. Finally, better and more accessible home care options can significantly reduce the hidden costs that family caregivers incur, such as missed work, changes in jobs, loss of promotions and lost income totaling hundreds of thousands of dollars when they need to reduce or eliminate paid work in order to care for a loved one.
Harris’ “Medicare at Home” plan is a crucial first step in addressing America’s looming care crisis. But to truly meet the challenges of our aging population, we need to think beyond traditional models. By embracing innovation, flexibility and a broader vision of caregiving, we can create a system that not only cares for our elders but also empowers families, creates economic opportunities and builds stronger communities.
As we debate this plan, let’s not lose sight of the ultimate goal: ensuring that every American can age with dignity, independence and support. It’s time to reimagine home care for the 21st century. Harris has opened the door — now let’s walk through it and create a care revolution that truly serves all Americans.
Neal K. Shah is the CEO of CareYaya Health Technologies and runs a social enterprise and applied research lab utilizing artificial intelligence, neurotech and workforce innovation to advance health equity. He has advanced AI projects to improve neurological care with support from the National Institutes of Health, Johns Hopkins AITC and Harvard Innovation Labs. Dr. David Casarett is chief of palliative care at Duke University and a health services researcher at Duke University School of Medicine.
