Workforce development programs and immigration reform are among the potential solutions to staffing challenges that senior living advocates presented to lawmakers seeking options to address the crisis.
The industry advocates detailed their workforce-related challenges, along with potential answers, to Sens. Bernie Sanders (I-VT) and Bill Cassidy, MD, (R-LA), chair and ranking member, respectively, of the Senate Health, Education, Labor and Pensions Committee.
The committee leaders had asked for input from healthcare providers and other stakeholders following a committee hearing in February. The committee plans to use the feedback to identify bipartisan solutions to include in future legislation.
In a letter to Sanders and Cassidy, Argentum President and CEO James Balda said the association was encouraged by the hearing and the solicitation for comment because “policymakers have primarily focused on nurse and physician shortages but haven’t focused enough on the shortates in long-term care,” which he said will “eclipse those in all other healthcare sectors.”
“Within the long-term care sector, shortages in the senior living workforce — assisted living, memory care and independent living — are objectively the most acute,” Balda’s comments read, adding that the industry lost more than 100,000 positions between February 2020 and November 2021. “While the hospital and home healthcare sectors are closer to returning to pre-pandemic employment, the senior living workforce is presently at its lowest levels since 2015.”
Argentum also said that 96% of senior living communities are facing staffing shortages, and 61% are concerned that those shortages might force them to close their doors.
“We are deeply concerned that if we do not act now, there will not be enough caregivers to meet the needs of the tens of millions of seniors who will need help in the coming decades,” Balda wrote.
LeadingAge similarly called the workforce shortage “the most pressing issue aging services providers face.” President and CEO Katie Smith Sloan wrote in her comments that although the COVID-19 pandemic brought several aid programs to increase wages, provider reimbursement rates remain low, as do hourly wages for direct care workers, which vary across settings and regions.
Equally concerning, Sloan said, is that long-term care providers are paying up to four times the hourly cost for agency staff to fill open positions. And filling those positions has led to cross-industry competition.
“Healthcare, particularly aging services, needs the resources to offer the same pay and benefits as non-aging services jobs in their communities,” Sloan said.
She attributed the root causes of the workforce shortage to the pandemic, inadequate pay, burnout and trauma, contract labor and agency costs, and “burdensome” regulatory compliance.
Seventy percent of assisted living providers in a recent LeadingAge workforce poll said they still are experiencing a significant or severe workforce shortage.
Argentum also recently released a report stating that by 2040, long-term care settings will have 20 million job openings, 3 million of those alone in senior living. That same report found that the senior living industry lost 107,000 positions during the pandemic. Although employment levels began trending higher, the total number of jobs in the combined long-term care sector as of September 2022 remained below its pre-pandemic peak, according to Argentum.
American Seniors Housing Association President and CEO David Schless said in his comments to the senators that the pandemic “wreaked havoc” on the senior living and long-term care industry, and members are working hard to recover.
“Senior living plays a significant role in the greater healthcare system, and these workers are key to maintaining the health and wellbeing of the residents they serve, thereby reducing the need for more critical services or hospitalization,” Schless wrote. “When residents are safe, the overall healthcare system benefits.”
Among the solutions provider organizations are throwing their support behind are workforce development programs, immigration reform and private-sector partnerships.
In his letter to Sanders and Cassidy, Balda suggested that Congress take up the Safeguarding Elderly Needs for Infrastructure and Occupational Resources (SENIOR) Act, introduced last year to bolster existing workforce development programs within the US Department of Health and Human Services’ Health Resources & Services Administration.
Argentum also supports legislative solutions narrowly targeted to the direct care workforce to expand US immigration levels, as well as establish workforce training programs in the long-term care sector for refugee and asylee populations already in the country.
In his comments to the senators, Schless said policymakers have a responsibility to respond to the lack of workers and a broken immigration system that perpetuates the problem.
Among ASHA’s suggestions are creating visa categories for frontline direct care workers, expediting work applications and updating the Department of Labor’s Shortage Occupation List to include senior living front line workers.
“Immigration fuels the economy,” Schless wrote. “There are many talented immigrants who are willing to enter the senior living or other long-term care sector, but are faced with insurmountable roadblocks. These workers should be given the opportunity to make a career, a good living, and a difference in their own lives and the lives of others.”
ASHA also supports proposals and initiatives aimed at building retaining and training the direct care workforce
Drawing from its 2023 workforce policy platform, LeadingAge called for a “whole of government” approach to solving the workforce crisis, requiring a range of solutions to solve the various problems and challenges.
Among the solutions Sloan offered were a living wage for aging services professionals, incentives for training and advancement opportunities, meaningful immigration reform and prohibitions on price gouging.
To achieve those solutions, Sloan said LeadingAge supports the Better Care, Better Jobs Act; additional pandemic relief for aging services providers; Medicare Advantage reforms; allocations to the Administration for Community Living to address recruitment, retention and training; permanent authorization of the Department of Labor Registered Apprenticeship Program; and visa programs designating long-term care workers as high priority, among other solutions.