Although a bipartisan infrastructure deal reached Thursday did not include much-sought-after funding for home- and community-based services and affordable housing, the senior living industry is hailing another piece of legislation that invests in older adults.
The Better Care Better Jobs Act, introduced Thursday, is being celebrated for taking steps toward closing the gap in HCBS for older adults and implementing President Biden’s American Jobs Plan, which provides “historic investment” in HCBS.
The infrastructure deal announced by the White House late last week focuses on physical infrastructure, leaving out the “human infrastructure” piece of Biden’s initial $2.2 trillion American Jobs Plan.
Those involved in negotiating the deal said it involved compromise. The framework includes $579 billion in new spending for a total of $973 billion over five years, as well as just over $1.2 trillion over eight years, according to The Hill. The bill includes $312 billion for transportation programs, with the remaining $266 billion going toward water infrastructure, broadband, environmental remediation, power infrastructure and other areas.
American Seniors Housing Association President David Schless said the initiatives included in the bipartisan plan are necessary for improving the nation’s declining physical infrastructure, which is critical to the success of all business sectors — including senior living.
“We applaud increased investments in key areas, such as technology to ensure broadband access to support telehealth, family and community communications,” Schless told McKnight’s Senior Living. “It is noteworthy that the deal doesn’t include previously identified tax increases that would impact real estate investment, such as carried interest, capital gains tax and like-kind exchanges.”
Argentum President and CEO James Balda said that caring for the nation’s older adults is an “essential part of our infrastructure and it should receive the proper investment in future packages.”
The Better Care Better Jobs Act provides states with enhanced Medicaid funding for HCBS if they perform certain activities that support expanding access to HCBS and strengthening the workforce. It also would provide funding from the Centers for Medicare & Medicaid Services to carry out the bill’s programs and conduct oversight.
Balda called the act an important step in building on the home care needs for the country, but, he said, “There is an even greater need for investment and focus on all senior care settings, including senior living.” He said the legislation should be more expansive to include all long-term care options for aging Americans.
“Providing access to home- and community-based services could be a game-changer that helps older adults get high-quality care and lead independent lives at home,” said LeadingAge President and CEO Katie Smith Sloan, adding that the bill would mean better pay and benefits for direct care professionals.
LeadingAge recently released a needs report documenting the growing care affordability and access crisis facing older Americans. The association also called for additional government reimbursement for care providers to meet the demand.
The National Center for Assisted Living said that with one in six assisted living residents relying on Medicaid for their daily care, it appreciates Congress recognizing the importance of expanding access to HCBS.
“We need to strengthen the entire long-term care continuum so individuals receive the best possible care at every step of the journey,” Clif Porter, senior vice president of government relations for NCAL and sister organization the American Health Care Association, told McKnight’s Senior Living. “Seniors and individuals with disabilities should be able to receive long-term care in the most appropriate setting for their specific needs.”
Each long-term care setting, Porter said, has an important role to play, and “investing in the care economy should be a comprehensive, integrated approach.”
“The Better Care Better Jobs Act would not only enable more older adults and people with disabilities to remain in their homes, stay active in their communities and lead independent lives; it would also create jobs and lead to higher wages for care workers, who are predominantly women and people of color,” said U.S. Sen. Bob Casey (D-PA), chairman of the U.S. Senate Special Committee on Aging and one of the bill’s sponsors. “This legislation is critical to advancing equity, spurring economic recovery and improving quality of life for older adults and people with disabilities.”
Schless said that ASHA supports efforts to enhance the Medicaid HCBS program to meet the needs of lower-income older adults with care needs, as well as increasing wages for direct care workers.
“We have and continue to advise policymakers to recognize that assisted living is also a home- and community-based setting, and that for older Amercians, living at home is not always an option or the best option,” Schless said. “We also continue to believe that this proposal should include immigration policies to help meet the U.S. caregiving needs.”
More than 3.5 million older adults and people with disabilities receive Medicaid HCBS. Eligibility and benefit standards vary among states, and almost 820,000 Americans are on wait lists. Eligibility and coverage variations can limit access to the full range of settings that meet the unique needs of frail, older adults, Schless said.
In the Senate, efforts behind the Better Care Better Jobs Act were led by Casey, Senate Finance Committee Chairman Ron Wyden (D-OR) and Democratic Leader Chuck Schumer (D-NY), along with chair of the Health, Education, Labor and Pensions Committee Patty Murray (D-WA) and Sens. Tammy Duckworth (D-IL), Maggie Hassan (D-NH) and Sherrod Brown (D-OH).
U.S. Reps. Debbie Dingell (D-MI); Frank Pallone (D-NJ), chairman of the House Energy and Commerce Committee; Jan Schakowsky (D-IL); and Doris Matsui (D-CA) introduced the House companion bill.