Closeup of the documents of both the Cares Act (Coronavirus Aid, Relief, and Economic Security Act) and the American Rescue Plan Act (ARPA) of 2021. A comparison between two acts.
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Assisted living providers can glean best practices from a report outlining state efforts to support home- and community-based service workers using federal COVID-19 relief dollars, according to one of the lead authors.

ADvancing States, a collaboration of state aging and disability agencies, and its partner ARPA HCBS Technical Assistance Collective, created a report tracking state efforts and activities under the American Rescue Plan Act HCBS spending plans. Specifically, the report focused on HCBS workforce shortages and state efforts to increase worker compensation and improve training and education activities. 

Damon Terzaghi, senior director of long-term services and supports policy at ADvancing States, told McKnight’s Senior Living that the report revealed several initiatives around the country related to assisted living. Some of those initiatives looked at reviewing rates for complex cases, adding waiver slots to waiting lists focused on assisted living, and helping assisted living communities tie in with the Centers for Medicaid & Medicaid Services HCBS settings rule.

“We wanted to get a sense of where some of the challenges or innovations are, what states have experienced with their activities,” Terzaghi said. “We really let the states talk to each other for this to work. The report is a summary of those ongoing discussions so other states could get a sense of where some of the opportunities and challenges lie.”

Among the initiatives highlighted in the report was a Washington, DC, study on determining access to assisted living and the scope of need in its Medicaid program. California proposed adding a number of slots to its assisted living waiver to expand access. And Delaware looked at trying to deal with some of its workforce issues and funnel more certified nursing assistants into assisted living.

“I think that, especially in this field, there is so much value that can come from learning about what other states and initiatives do,” Terzaghi said, adding that a lot of focus was on payment and access issues. “I do think that the ability to directly focus on these types of things is a real valuable effort around the country and can really support the expansion of assisted living in Medicaid.”

The ARPA HCBS Funding Initiative, enacted through the American Rescue Plan Act in March 2021, was the largest infusion of new federal resources into the nation’s HCBS system over the past 30 years, according to the report. An estimated $35 billion will be spent by March 2025.

CMS recently extended the deadline for states to spend all of their ARPA HCBS funding to March 31, 2025. 

The labor-intensive nature of the work performed by the direct care workforce, historically low wages and increased competition from outside industries is creating an environment where recruitment strategies and career advancement opportunities will be “crucial” to ensure the needs of older adults and people with disabilities are met, according to the report. 

The authors concluded that a comprehensive, objective and rigorous evaluation is critical to determine the return on that investment.

“As the demand for HCBS services among the nation’s aging population inevitably increases over the next 30 years, the level of commitment which the nation makes in a Medicaid-funded HCBS system will be a major policy concern,” the authors concluded. 

The report was funded by the SCAN Foundation, the John A. Hartford Foundation, the Milbank Memorial Fund and Arnold Ventures.