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A proposed federal bill includes substantial new funding for long-term care workforce development, but it potentially threatens the assisted living model by including the setting with more clinical ones, according to industry leaders.

The Long-Term Care Workforce Support Act, S 4120, would provide federal grants, tax credits, apprenticeships, childcare and student loan payment assistance, along with provisions related to mandatory leave, worker classifications, workers compensation and overtime pay.

But senior living industry advocates said they have “serious concerns” with a portion of the bill relating to labor and employment matters, including duplication of existing federal, state and local programs that may cause confusion for employers and employees. The proposal also does not recognize the nuances of assisted living, lumping it in with other clinical care settings covered by the proposed legislation, advocates said.

“We will oppose any efforts that would threaten the state regulatory model of assisted living and will continue to engage with the bill sponsors and cosponsors to educate them on the nuances of assisted living,” Argentum said in submitted comments.

The act recently was introduced by US Sens. Bob Casey (D-PA), the chairman of the US Senate Special Committee on Aging, Tim Kaine (D-VA) and Tammy Baldwin (D-WI), saying the legislation, if passed, would professionalize and support caregivers. Companion legislation was introduced in the House of Representatives by Rep. Debbie Dingell (D-MI).

The act, according to the sponsors, would ensure that caregiving can be a sustainable career by providing substantial new funding to support long-term care workers, including those who work in assisted living communities, nursing homes and in home care and home health. 

“We have a crisis of caregiving in this country, and it’s a crisis that stems largely from a lack of support for and investment in our caregiving workforce,” Casey said in a statement. “We need to invest in these workers not just to ensure that caregiving can be a sustainable, lifelong career, but to improve the quality and availability of care for all who need it.”

Support mixed with concern

In comments sent last week to Casey, Argentum President and CEO James Balda said that the association supported provisions in the act that would improve Medicaid reimbursement for direct care professionals and add support for long-term care services. Argentum also supports the bill’s focus on improving training, recruitment and support for direct care professionals and their employers, he said.

But Balda raised concerns about provisions in the act that he said are “unnecessary” and would duplicate existing federal, state and local laws and potentially worsen challenges in communities to the detriment of senior living providers and residents. 

“Our communities have historically had high turnover in staff, often with little notice, that may necessitate other providers covering schedules, if only temporarily, on an emergency basis,” Balda wrote. “Put most simply, while a predictable and fixed schedule with as much notice as possible as to change is preferable, given the nature of our communities and the needs of our residents, it sometimes may simply not be possible.”

Specifically, Balda said that Argentum does not support fixed schedule requirements, noting that senior living operators need flexible scheduling options to address resident needs. Argentum also objected to the bill’s limits on arbitration agreements with personal care workers, saying that those agreements are a more cost-effective and quicker way to resolve disputes in a “fair and equitable” way for both the company and the employee.

In her submitted comments, LeadingAge President and CEO Katie Smith Sloan raised similar concerns about fixed schedules, saying that they impose “significant administrative burdens” for employers and limit the ability for employers to change employment policies. LeadingAge suggested exploring alternatives, including an evaluation of employer notification requirements rather than written agreements. 

Balda said that Argentum also does not support the bill’s expansion of the Department of Labor’s authority under the Fair Labor Standards Act wage and hour laws related to worker classification. Federal wage and hour laws, as well as state and local laws, he said, already provide processes for addressing complaints.

“We do not believe an expansion of these laws is warranted generally, and particularly not in an industry operating on the margins that the personal care industry does under current Medicaid reimbursement policies,” Balda wrote. 

Sloan said that LeadingAge was “invigorated by the bold vision” outlined in the act, but she also outlined concerns and recommendations on several sections of the proposal, including questioning what happens when federal financial assistance runs out, recommending the dedication of specific funds to clear long-term services and supports waitlists, suggesting the simplifying the legislation’s complex grant structure, recommending providing flexibilities for the delivery of mental health services for aging services caregivers, and suggesting including providers’ voices in any workforce initiatives.

The American Seniors Housing Association, in submitted comments, opined that the committee must take a broad view on policy needs to ensure an adequate pipeline of workers by creating and granting access to training tools, grant programs and other resources. Immigration policies to allow foreign workers to care for older adults are another necessary component to workforce solutions, ASHA President and CEO David Schless added..

Schless said that the legislation makes a “significant investment” in workforce development and training programs offered at the state level, including a wide range of worker supports, skills training, demonstration projects, technical assistance and worker protections.

But he added that grant programs that result in efficient and effective approaches to increasing the workforce sooner rather than later should be prioritized. Among those programs, he said, are the Bipartisan Workforce Pell Act and the Improve and Enhance the Work Opportunity Tax Credit Act

“We support workforce development grant programs as critical resources to building a supply of caregivers and other essential workers in the long-term care field, but efforts to understand how existing programs have succeeded in growing the workforce, as well as the impact on wages and career path development, will inform future programs,” Schless said. “It is important that effective programs tailored to meet the needs of the long-term care worker are extended and enhanced, while new programs are created to meet the growing need.”

Clif Porter, senior vice president of government relations for the American Health Care Association / National Center for Assisted Living, said the legislation “ignores a wide swatch of the profession” and fails to address the fact that Medicaid doesn’t cover the cost of care. That failure, he said, makes it difficult for providers to offer higher-paying, competitive jobs.