Meeting the Integration Mandate: The Implications of Olmstead for the Home Care Workforce
In the 1999 ruling on Olmstead v. L.C. ex rel. Zimring, the Supreme Court upheld the right of all individuals to live independently in their own homes and communities and placed an explicit obligation on states to provide the supports and services that are required to fulfill that right. Progress toward fulfilling Olmstead has been hindered, however, by inadequate attention to building and strengthening the home care workforce—a workforce which provides the daily personal assistance that makes community integration possible for many individuals with disabilities. This Article describes the home care workforce and the drivers of growing demand for their services—in the context of the “rebalancing” trend in the long-term services and supports system—before discussing entrenched workforce challenges and policy solutions, focusing primarily on compensation, training and career development, and scope of practice. Along with other policy and practice interventions, action in these three areas is essential for improving home care job quality, stabilizing the workforce, and ensuring that community-based services are available for all those who seek them.
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