LeadingAge panel

As Congress finalizes the $3.5 trillion budget reconciliation package, long-term care leaders and providers are pushing the need for “game changing” investments for older adults and their caregivers.

LeadingAge President and CEO Katie Smith Sloan led a virtual panel discussion Tuesday about what she described as Congress making “one of the biggest decisions of our lifetimes.”

Earlier this month in a letter to Senate Majority Leader Chuck Schumer (D-NY), LeadingAge detailed what it considers to be the nation’s most pressing aging services needs, including $400 billion for home- and community-based services, $7.5 billion to address a shortage of affordable housing for low-income older adults, and a $1 billion investment in the aging services workforce to strengthen training and recruitment.

“What happens in the next few weeks will determine whether millions of Americans can access the care they need as they grow older,” Sloan said, adding that an “unacceptable number of older adults and families are struggling each day because they can’t access the care they need.”

Long-term care providers of all kinds are running short of care professionals. 

“This is the most important moment in decades for older Americans and their families,” Sloan said. “Unless Congress acts now to begin making meaningful changes to begin strengthening the infrastructure of care and services, the needs of older adults could overwhelm our country’s capacity to provide quality care.”


LeadingAge Texas President and CEO George Linial said that a recent survey of his membership revealed some “astounding” results: 60% were unable to hire enough nurses, two-thirds were unable to hire enough dining staff, and 70% were unable to hire enough certified nursing assistants. In addition, 60% of assisted living and skilled nursing members reported using agency staffing in the past six months.

One in five members said they had to restrict admissions due to a lack of staffing, Linial said. 

“That has a profound impact on quality,” he added. “The consistent staffing model is disrupted.”

The pandemic, Linial said, uncovered the need for a livable wage, support and respect for the caregiver profession. 

“An investment in the long-term care workforce is going to pay huge dividends,” he said.

Carol Silver Elliott, LeadingAge board chair as well as president and CEO of Rockleigh, NJ-based Jewish Home Family, said that compassion for and a commitment to older adults is the reason people get into the aging services business. 

“Caregivers do difficult work — physically demanding, intimate and emotional as we become attached to the elders we serve,” Elliott said. “How can we pay someone the same for this vital work as we pay someone who says ‘Do you want fries with that?’ ”

Affordable housing

Tom Egan, president and CEO of the Foundation for Senior Living in Phoenix, said that he is seeing a dramatic increase in first-time homeless adults aged 55 or more years. The end to the Centers for Disease Control and Prevention’s COVID-related eviction moratorium, he said, will lead to a dramatic spike in the number of people needing affordable housing.

Egan said that the waiting lists for the foundation’s 25 apartment complexes around Arizona are at 300 or more people each today, with a wait time of three to five years. Nationally, he said, a need exists for 7 million to 10 million more affordable housing units.

“We’ve seen estimates that the reconciliation bill money would allow Arizona to nearly quadruple the number of units built each year,” he said. “Keep that up for several years, and it will make a big difference.”

Jasmine Borrego, president of TELACU Residential Management in Los Angeles, said she has similar waiting lists for her affordable housing units. The Section 202 Supportive Housing for the Elderly program, the Department of Housing and Urban Development’s flagship senior housing initiative, provides a “critical lifeline” to low-income seniors, she said.

“Additional money from the reconciliation bill will bolster aging services infrastructure by increasing the affordable housing supply,” Borrego said. “More money means more units. The wait lists are long, and they don’t get shorter.”

Borrego also made the case for additional affordable housing service coordinators, who work on site to help residents access services.

“Without them, quality of life declines, and aging in place and living independently becomes more difficult,” Borego said.


David Totaro, chief government affairs officer for Moorestown, NJ-based Bayada Home Health Care, said the $400 billion for HCBS could be a game-changer for older adults. 

His company, he said, has seen an “unprecedented” shortage in caregivers. In 2020, the company had to deny service to 50% of all new case referrals in New Jersey, its largest service state, due to a lack of available workers. This year, referral denials grew to a record 64% in the Pennsylvania, Delaware and New Jersey coverage area, Totaro said.

It’s important to pay workers a living wage and provide child care support, training and advancement opportunities, he said.

“We’ve kicked the can down the road for decades,” Totaro said. “It’s time to act.”