home nurse sitting with patient

Medicaid home- and community-based services expansion, workforce development, immigration reform and long-term care financing are top of mind for senior living industry leaders as they prod U.S. House and Senate leadership to keep older adults top of mind on infrastructure discussions.

The Biden administration has proposed spending $400 billion through the American Jos Plan to provide HCBS for older adults and individuals with disabilities. In a letter sent Wednesday to leaders in Congress, American Seniors Housing Association President David Schless lobbied for assisted living to continue to be defined as an HCBS setting. Often confused with skilled nursing facilities, he said, assisted living offers significant benefits to residents that not always are available to older adults living in a traditional single-family home.

“Policy goals that are singularly focused on keeping seniors at their traditional home to the exclusion of other residential care settings may overlook these benefits,” Schless wrote. “The community living environment available in assisted living combats prolonged social isolation, lack of engagement and loneliness that can contribute to functional and cognitive decline, as well as depression and anxiety in older adults. These benefits should factor heavily as efforts to prove options and choice are considered.”

During a Wednesday media event held by her organization, LeadingAge President and CEO Katie Smith Sloan said that an “unacceptable number of older Americans can’t access the care they need to deal with the changes and challenges of aging.” 

Medicaid eligibility for and access to assisted living, as well as reimbursement rates, vary by state, resulting in limited access to the full range of settings that meet the unique needs of older adults. The consequence, Schless wrote, is unmet needs in traditional private housing or unnecessary institutionalization in a skilled nursing facility. 

LeadingAge released a new needs report documenting what it says is a growing care affordability and access crisis facing older Americans, as well as the need for more government reimbursement to enable care providers to meet the demand. By 2029, 54% of middle-income older adults won’t be able to afford the housing and long-term care they need, LeadingAge said, pointing to the findings of a 2019 study funded by the National Investment Center for Seniors Housing and Care.

Schless and LeadingAge also called on the federal Centers for Medicare & Medicaid Services, as well as state Medicaid agencies, to ensure that assisted living communities are included in the temporary 10-point federal matching assistance percentage increase provided to Medicaid HCBS through the American Rescue Plan Act of 2021. 

Workforce development

The pandemic exacerbated senior living workforce shortages, with even more job openings than people to fill them. ASHA said it supports programs to train, retain and promote these essential workers, as well as immigration policies to meet the U.S. labor needs.

Kara Allread, senior vice president and chief administrative officer for Brethren Retirement Community in Greenville, OH, said during the LeadingAge event that Medicaid reimbursement rates “simply do not allow us to pay enough to attract and retain staff in a sustainable way.”

“Workforce development is essential to providing efficient, qualified staffing and, ultimately, the quality of care and services required,” Schless wrote in his letter. “Responsible immigration reforms can attract skilled, as well as unskilled, workers to industries most in need of labor, including senior living, and can grow the tax base of the U.S. economy.”

Financing reform

Schless emphasized that senior living has been hit hard financially by the pandemic yet has not received a “meaningful” level of financial relief from the Provider Relief Fund. He called on Congress to support a Phase 4 allocation of dollars to senior living providers. 

Schless said “there is a better way forward,” and proposals to strengthen the long-term care system for older adults should call attention to the need for a comprehensive strategy to address the needs of middle-income older adults. This group does not have the resources to pay for long-term care costs but has too much income to qualify for Medicaid.

“The country is experiencing a demographic transformation, and to meet the demands this will place on society and the economy, policymakers must consider a strategy that will address the long-term care needs and workforce demands of the future,” Schless wrote. “The senior living industry should be recognized as part of this strategy and solution.”