A post-pandemic analysis of New Jersey’s long-term care industry, including assisted living, created an “aspirational vision” of what the industry could be, but the state’s failure to provide resources make most of its recommendations “unattainable,” according to experts.
The New Jersey Task Force on Long-Term Care Quality and Safety released a report recently suggesting sweeping changes to policies, regulations and financial incentives in the sector. The body was formed in 2020 to develop potential solutions to improve outcomes.
The group called for expanding home- and community-based services, including assisted living; making assisted living more affordable for middle- and low-income residents; and increasing Medicaid payment rates for assisted living.
“While the pandemic brought about innovation and creativity, it exposed some new and long-standing concerns and reinforced the need for improvement in certain areas,” the task force wrote. “In addition, it reinforced the need for consumers to have a wider array of choices in the place they call home.”
The group said there is a “historic opportunity to improve the allocation of and increase resources for the long-term care delivery system.”
Industry advocates, however, said that the body “set forth an aspirational vision of what long-term care could be if we were not limited by workforce and funding constraints.”
“But indeed, we are limited by real shortages in workforce and funding, and we need to focus on how to best care for vulnerable seniors in the context of those real world constraints,” Andy Aronson, president and CEO of the Health Care Association of New Jersey, told McKnight’s Senior Living. “The report’s failure to focus on the current underfunding of our existing system undermines all of its recommendations.”
Aronson added that the “most obvious” way to make assisted living more accessible would be to raise Medicaid payments that cover the cost of care — an approach, he said, that would be far less expensive than the report’s “unrealistic” recommendations due to limited workforce and funding. He said that HCANJ supports several of the group’s recommendations aimed at increasing the supply of nurses and frontline staff members in long-term care.
LeadingAge New Jersey & Delaware similarly told McKnight’s Senior Living that it supports the task force’s recommendations, with an emphasis on all of the funding and resources needed to achieve the goals set forth in the report.
“Without substantial investment in long-term care, the recommendations are otherwise unattainable,” LeadingAge NJ & DE Vice President Meagan Glaser said. “Our association broadly supports the recommendations surrounding acuity rate adjustments, updating Medicaid reimbursement rates based on recent cost reports — something that hasn’t been done in New Jersey for more than a decade — investing in the direct care workforce and expand[ing] access to home- and community-based services.”
Aronson said the state cannot delay making a significant investment in caring for older adults.
“It’s not a choice; it’s an obligation,” he said.
Glaser added that the suggestion that increasing punitive measures will help poor-performing facilities improve is erroneous. Such measures, she said, would further marginalize those providers and potentially create access issues for older adults.
“While bad actors in the field should most definitely be held accountable, a more collaborative approach to improvement would better strengthen the long-term care sector and help the residents they serve,” Glaser said.
The recommendations
The report noted that the state is “historically over reliant” on nursing homes and has not sufficiently invested in HCBS. It also pointed out that the state’s long-term services and supports workforce is shrinking, worsening the imbalance of supply relative to the growing older adult population.
The task force recommended that the state adopt a three to five-year strategic plan and front-load funding to rapidly expand HCBS. According to the authors, more than 80% of consumers prefer to receive LTSS in HCBS settings, including assisted living and in-home care. But they noted that assisted living is “virtually out of reach for middle- and low-income New Jersey residents.”
One way to expand HCBS, according to the task force report, is to promote New Jersey’s Assisted Living Program, a flexible model that allows lower-income older adults to age in place in public housing. There are only 17 ALPs in the state, and they face challenges in scaling their programs.
The task force said the state should review regulatory and payment changes to expand the number of ALP providers, update state licensing requirements and educate housing providers about the benefits of ALPs. The task force also called for an increase in Medicaid payments rates for assisted living services.
Under workforce recommendations, the report called for wage and benefit parity, the creation of a single curriculum and training for the direct care workforce to allow workers to flow between settings, simplified entry to the LTSS workforce, and more resources for recruitment and exposure to LTSS opportunities.
Task force members included assisted living administrators, family members and advocates, representatives from senior living and assisted living providers, nursing home residents and representatives from the AARP.
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