As a kickoff to Caregivers Month, President Biden spoke Tuesday about the “care economy” at Washington, DC’s Union Station, celebrating the contributions of care workers across the country. Senior living industry advocates, however, said they need help recruiting and retaining those workers in an industry that lost more than 400,000 jobs during the pandemic — 110,000 in the assisted living industry alone, according to Argentum.
“Dedicated caregivers are the backbone of assisted living, providing the person-centered care that improves the health and well-being of 1.4 million seniors today,” Argentum Senior Vice President of Public Policy Maggie Elehwany told McKnight’s Senior Living. “We encourage the president to work with Congress to pursue policies to ease the healthcare workforce shortage.”
Last spring, Biden’s executive order on strengthening the care economy was deemed by industry advocates to be well-intentioned but inadequate in offering solutions for senior living and other long-term care providers.
LeadingAge said it shares the Biden administration’s goal of ensuring quality care for the nation’s older adults but said the administration’s approach “misses the mark.”
The American Seniors Housing Association applauded the administration’s efforts to raise awareness of the critical role of caregivers.
“Policies to make child care more affordable, addressing the waitlist for Medicaid [home- and community-based services], increasing rates to HCBS providers and recognizing the increased cost of long-term care over the last decade are important as we look to address the needs of an aging population,” ASHA Vice President of Government Affairs Jeanne McGlynn Delgado told McKnight’s Senior Living.
But Delgado added that ASHA is disappointed that Biden didn’t mention the significant worker shortage in the long-term care sector during Tuesday’s speech.
Workforce a bipartisan issue
Argentum’s Elehwany said that workforce issues have been one of the few areas of bipartisan agreement in the 118th Congress, with multiple House and Senate committee hearings and calls from both sides of the aisle to “stem the exodus of healthcare workers.”
Although the employment picture has improved in many sectors, worker participation in the nursing and residential senior care sectors continues to shrink, she said. Citing statistics from the Agency for Healthcare Research and Quality, Elehwany said that the overall healthcare workforce grew 15.5% over the past decade, but the residential care and nursing home workforce is down 8.4% from January 2020.
Delgado said that although wages and benefits for senior living staff members have increased significantly since the COVID-19 pandemic, the workforce pipeline has not grown.
“There are not enough US workers to fill these jobs, a deficit that will only get worse unless sensible immigration reform is enacted to create a worker visa for caregivers,” she said. “Workforce training grant programs can go a long way to build a pipeline of workers, but without adequate numbers of people interested and available to enter such programs, we will not be ready to care for those most in need.”
Touting its public policy efforts in the area of workforce, Argentum noted it has worked with lawmakers to secure funding for the Department of Labor’s Employment & Training Administration, Job Corps and the Health Resources and Services Administration health workforce programs. The association also has promoted the Safeguarding Elderly Needs for Infrastructure and Occupational Resources (SENIOR) Act, HR 7605, as “the most consequential investment in workforce development for assisted living communities to date and will make a real difference in the lives of America’s seniors.” Argentum also supports the Care Across Generations Act, HR 6835, which would provide resources to create and maintain childcare programs within assisted living communities.
“Time is of the essence — our country will need to create more than 20 million new jobs by 2040 to care for our rapidly aging population,” Elehwany said. Three million of those workers will be needed in senior living, according to the association.
“Creating the workforce to meet the needs of our seniors is not a partisan issue,” she said.
Increase Medicaid reimbursement rates
LeadingAge President and CEO Katie Smith Sloan said the proposed Medicaid Access Rule, which would require at least 80% of all HCBS Medicaid payments to be spent on direct care worker compensation, likely will reduce, rather than increase, older adults’ access to care and services. State rate structures, she added, show that states would need to increase rates by more than 45% on average. Without rate increases, providers would need to cut their non-caregiver wage expenses by more than two-thirds, Sloan said.
“We expect that the rule, if implemented as proposed, will lead to provider closures and exits from the sector,” Sloan said, adding that the infrastructure and data don’t exist to enable tracking and support for this wage passthrough. “A proposal of this magnitude cannot be implemented without federal and state investment, both to fund the workforce and to ensure that the administrative infrastructure needed to ensure that such a threshold can be implemented as intended.”
Quite simply, Sloan said, “the math does not work.”
Rather than “impractical and ineffective” new rules,” Sloan called on the administration and Congress to invest in “serious solutions” to tackle the aging services workforce crisis. She said the focus should be on developing and investing in a robust workforce development strategy that includes immigration reform, increased Medicaid reimbursement rates, and replicating existing successful training programs.
Think beyond nursing homes, home care
In response to Biden’s remarks, American Health Care Association / National Center for Assisted Living Senior Vice President of Government Relations Clif Porter said that caregivers across the entire continuum of long-term care — not just those providing home care — deserve the support of the administration.
“We support HCBS funding, but not at the expense of other essential settings in the continuum of care,” Porter told McKnight’s Senior Living. “Fully funding Medicaid is the best way to ensure we can invest in our caregivers and strengthen every aspect of care.”
Sloan urged Biden to “think more broadly when considering older adults’ needs.”
“A focus on care in the home is important, as is care in nursing homes,” she added. “But older adults and their families rely on a range of care settings to ensure their well-being and quality of life, which is why we urge action to support providers serving older adults in assisted living, adult day settings and affordable housing communities for low-income older adults.”
