One of the big investments of US President Biden's GoBig is the $2 trillion infrastructure investment, which includes two parts: one is to invest in domestic manufacturing, R & D, caring economy, climate infrastructure and roads, bridges and railways; the second part is childcare, health and education infrastructure. Among them, the second part of the investment is the most criticized by the Republican Party for “having nothing to do with infrastructure.” In response, the Democratic Party invented a new word to refute it - "human infrastructure". This "new concept" quickly became popular with the interpretation and promotion by media and politicians, because this investment is for children, the elderly and education, which is related to the interests of every family and is of course welcomed by the public.

The author is most concerned about what is included in the US$400 billion "health" investment bill, what problems it can solve, and what impact it will have on American eldercare services.

The US $400 billion investment, which has set a record in the history of the United States, is mainly allocated to homecare nurses, eldercare, and care for the disabled. In the next eight years, it will be invested in "long-term care for the elderly and the disabled, focusing on family- and community-centered care", with the purpose of promoting and improving "home health care services".

Why are we so anxious to put eldercare ahead of childcare? Why is it specially noted that it is limited to family- and community-centered care for the elderly and the disabled, and does not include nursing services in nursing homes or welfare homes?

In the fiscal year 2019, Medicare (the U.S. government’s health insurance for poor seniors over 65) spent $644 billion in total expenditures, accounting for 14% of the federal government’s total expenditures, an increase of 6.7% over 2018, while Centers of Medicare and Medicaid Services (CMS) expects that this expenditure will continue to increase at an annual rate of 7.6% during the ten years from 2019 to 2028, which is the fastest growth rate. At the same time, data released by CMS shows that the medical expenses of the elderly over 65 are more than five times that of children and three times that of the labor force. It can be seen that the cost of nursing care for the elderly is too high and the growth rate is too fast, which puts increasing pressure on the government. The Democratic Party believes that in terms of funding or the quantity and quality of nursing services, the United States is simply not prepared for the next surge of elderly population.

During the COVID-19 pandemic from 2020 to present, more than 170,000 elderly people living in nursing homes and nursing facilities have died of COVID infection, which has exacerbated Americans’ distrust of nursing homes. The main conclusion reached by a majority of Americans is that we can’t just rely on eldercare institutions. The second option in place instead of eldercare institutions is to allow the elderly to live at home while getting the nursing services they need. Therefore, in response to the voice of the public, the U.S. government decided to invest $400 billion to improve and enrich the quality and quantity of home-based long-term care services, hoping to effectively encourage eldercare at home, or at least delay their stay in nursing homes.

The purpose of this reform is to separate long-term care services from eldercare institutions, reduce the degree of dependence of the elderly and the government on eldercare institutions, weaken the pricing power of eldercare institutions, and contributing to reduction in prices and improvement of service quality in these eldercare institutions.

What's in the $400 billion investment bill? To put it more accurately, it is home long-term care services. This is a special fund that will be used to increase the quantity of home care services provided, increase compensation items, strengthen the training of nursing workers, increase the salaries of nursing workers, and improve the quality of nursing services. The contents included is still being refined. At the end of March, Biden announced that he would expand Medicaid (a public medical assistance system for people under 65) to include family medical care.

The content of home care service mainly includes: nurses or physiotherapists visiting home, helping individuals with life assistance services, such as eating and bathing, etc.; getting help from case managers; participating in adult daycare center to help do housework, including cooking, washing and cleaning; assisting in travels; helping to repair or transform elderly homes; helping to purchase medical equipment, such as wheelchairs or oxygen tanks; and coverage of services offered as a home care option will continue to increase.

How much is the demand for home care for the elderly in the United States? Statistics show that 70% of the elderly in the United States will need some personal services for 2 to 4 years of their lives, such as cooking, dressing, bathing and toilet, mobile, personal financial management, housework, etc. With the rapid aging rate of the population in the United States, it is estimated that there will be 74 million old people by 2030 and another 40 million by 2050, and the total number of people over 85 will be three times that of today. Coupled with the disabled population, the current number of nursing workers and the quality of nursing services cannot cope with this huge demand. According to data released by DHHS (U.S. Department of Health and Human Services), in 2018, a total of 820,000 elderly people in 41 states were on the "waiting list" waiting for applications for home care services, with an average waiting time of 39 months. Obviously, the huge demand for home care services and the insufficient supply of services are imminent.

The author Yoko Marikawa is an expert in the elderly care industry in Japan and a pioneer in the elderly care industry. She has long been committed to ensuring and improving the well-being of the elderly by improving the management of nursing homes and the quality of elderly care services. In recent years, in order to find effective solutions to the problems of poor medical services for the elderly, elder abuse, the surge of elderly dementia patients, and the shortage of eldercare workers, Yoko Marikawa has devoted a lot of energy in researching how to use high technology to help solve these serious and urgent social issues, including the use of nursing robots, quantitative management and monitoring systems, etc. This article is an article in Yoko Marikawa's newspaper column "Yoko Marikawa Talks about Eldercare".