The HCBS crisis in America:

CW: Abuse, Neglect, & Death:

A state Senate study committee has proposed that Georgia include 2,400 positions in next year’s budget for serving people with intellectual and developmental disabilities in their homes and communities. More than 7,000 people are currently on the waiting list. According to Sen. Sally Harrell, the state is looking to eliminate the waiting list in the next three years.

Medicaid waivers provide support services for people with intellectual or developmental disabilities. Examples of home and community-based services include skilled nursing care, physical therapy, direct support professionals, and funding for home modifications such as wheelchair ramps and accessible showers. These services and supports allow disabled people to stay in their homes and communities rather than being institutionalized. Care in these settings is also much more expensive, with an average cost of over $7,000 per month.

Increasing program funding so the waiting list can be dissolved has long been a priority of the disability community. The committee’s suggestions may be the critical first step toward reducing the waiting list length. The committee also made many recommendations to address the state’s shortage of direct-support professionals who assist disabled people with activities of daily living. Millions of disabled people in America rely on home healthcare providers to help them function every day including me.

I have received PCA services for over a decade. These services allow me to live in an apartment like many 23-year-olds. I wouldn’t be able to live in my apartment without my PCA. He helps me with tasks such as dressing, showering, and toileting. He also prepares my meals, drives me to the grocery store, and takes me to doctor’s appointments.

Low pay contributes to the shortage in the field. The committee in Georgia suggested raising wages during the fiscal year of 2024. They want to see wages increased to $15 an hour, stressing that wages should cover workers’ transportation and housing costs.

Low wages are a nationwide problem. The average home healthcare worker in the U.S. made just $13.02 per hour last year, per the Bureau of Labor Statistics. Additionally, one in five home healthcare workers lives below the poverty line, according to the New York Times.

Sometimes, it is possible to earn more at a fast-food restaurant. In New York, home healthcare workers received a raise of $2 per hour in October. The raise was part of a statewide effort by politicians and advocates to address the home care crisis. The new minimum wage for home healthcare workers is $17 per hour in New York City, Long Island, and Westchester County. In the rest of the state, it is $15.20 per hour. However, fast food workers in NY have been making $15 an hour since last summer.

Medicaid must be expanded, and waiting lists must be eliminated. Without help, people are frequently forced into dangerous situations, which can have devastating, if not fatal, consequences. Tragically, a disabled woman died in January in Philadelphia at a long-term care facility. Cheryl Yewdall had Cerebral Palsy and intellectual disabilities. Yedwall spent the majority of her life at the facility where she died. On Jan. 26, the 50-year-old was discovered face down on the floor in a puddle of urine. She had suffocated after choking on a piece of paper towel that was pushed down her throat.

Yedwall is far from the only person to die in an institutional setting. In Connecticut, a woman died in February after staff at her nursing home failed to administer her medications. A 30-year-old resident of the Glennwood Resource Center in Iowa also died in February from acute dehydration after staff failed to monitor his fluid intake.

Medicaid enables millions of disabled Americans to exercise their right to live in their homes. Most disabled people have more freedom at home than in long-term care facilities. Medicaid serves as a lifeline for people like me. Without Medicaid, I might have to live in a long-term care facility. In other words, if Medicaid did not exist, life as I know it would be gone instantly.


Altimari, Dave. “Report: Nursing Home Resident Died after Not Receiving Medication.” CT Mirror, Bruce Putterman, 17 Mar. 2022,

Donovan, Liz, and Muriel Alarcón. “Long Hours, Low Pay, Loneliness and a Booming Industry.” The New York Times, The New York Times, 25 Sept. 2021,

Grapevine, Rebecca. “Legislative Committee Recommends Funding Care for More Georgians with Disabilities.” Moultrie Observer, CNHI LLC, 15 Dec. 2022,

“Home Health and Personal Care Aides : Occupational Outlook Handbook.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 8 Sept. 2021,

Kauffman, Clark. “State-Run Glenwood Resource Center Fined for Resident Death.” Iowa Capital Dispatch, Iowa Capital Dispatch, 9 June 2022,

McKay, Morgan. “NY Minimum Wage for Fast Food Workers Raised to $15 per Hour.” Spectrum News , Spectrum News , 1 July 2021,–15-per-hour.

Parker, Tim. “The Median Cost of a Nursing Home.” The Balance, The Balance, 25 Oct. 2021,

Robinson, David. “NY Home Aides Get Minimum Wage Increase as State Faces Caregiver Crisis.” The Journal News, Gannett, 18 Oct. 2022,

Rubinkam, Michael. “Suit: Care Home Resident Died with Paper Jammed in Windpipe.” AP NEWS, Associated Press, 27 Sept. 2022,

Serres, Chris, and Glenn Howatt. “’Geography Is Destiny’ for Families Living with Disabilities in Minnesota.” Star Tribune, Star Tribune Media Company, LLC, 16 Sept. 2019, 

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