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A special report published last week by CNHI News and the Associated Press that focused on several “issues and complications” in assisted living and other forms of long-term care is a “wake-up call for America,” according to one industry advocate. 

As part of its “High Cost of Long-Term Care” special report focusing on affordability, staffing and equity in the long-term care industry, the media outlets analyzed data from the 2020 National Post-acute and Long-term Care Study, finding that Black people are underrepresented in residential care communities nationally by nearly 50%. Blacks account for 9% of older adults in the nation, but only 4.9% of the residential care community population — they make up 16% or nursing homes residents.

In contrast, the data showed that whites make up 75% of the older adult population, and 88% of residents in residential care communities. 

Linda Couch, LeadingAge senior vice president of policy and advocacy, was quoted in the series as saying the process of paying for long-term care is “as opaque as it can be.”

“Because we don’t have a comprehensive and cohesive long-term care financing system in this country, we are left with this patchwork,” Couch was quoted as saying. 

The media outlets also quoted NCAL Executive Director LaShuan Bethea about the need for research to fully understand whether fewer Black people accessing assisted living are truly missing out on care or are finding that care in other ways.

“It’s really important to do the work … trying to understand: What does this mean when Black and brown people can’t access assisted living, knowing what it brings in terms of quality and outcomes?” Bethea was quoted as saying.

Workforce crisis

The package also focused on workforce challenges in senior living and other long-term care settings. 

Citing data from the federal Health Resources and Services Administration, the media outlets stated that overall demand for workers in longer-term services and support settings is projected to increase by 42% between 2021 and 2036, and demand for direct care workers is expected to grow 41%.

Argentum has stated that the assisted living industry will need more than 3 million workers by 2040, with more than 20 million workers needed across long-term care settings in that time. 

Argentum Senior Vice President of Public Policy Maggie Elehwany told McKnight’s Senior Living that the workforce focus of the report is “important and overdue.”

“Argentum has long stated that our nation is not prepared to meet the needs of our aging population, and we have advanced policies to help both with affordability and improve the workforce shortage crisis in long-term care,” Elehwany said, adding that Argentum agrees that older adults deserve quality, dignity, choice in care and a sense of community. “That, in essence, is the assisted living model. This social model of care has exceedingly high resident satisfaction rates and is half the cost of nursing home care, and more cost-effective than home care.”

The American Seniors Housing Association told McKnight’s Senior Living that the pandemic was and continues to be a significant contributor to the workforce shortages, and that assisted living providers are making great strides to attract and retain a solid workforce through higher wages and benefits, flexible scheduling, enhanced training and career paths.

“The work is hard and demands a person who has compassion for older adults,” ASHA Vice President of Government Affairs Jeanne McGlynn Delgado said, adding that not all workers are suited for the mission-driven work. “There are simply not enough native-born workers to meet the current and future demand for long-term care.”

Delgado said that thousands of people in the country await work authorization. ASHA has urged action to expedite work authorization documents for those currently eligible to help meet the demand.

One story in the CNHI News / Associated Press package focused on the work of direct care workers, saying it comes with low wages and a high risk of injury. Pointing to a January US Department of Health and Human Services report, the media outlets highlighted that approximately half of direct care workers rely on public assistance.

Medicaid is the primary payer for long-term services and supports, but the industry long has argued that Medicaid reimbursement rates are insufficient to cover the true cost of care. 

Sixty-one percent of assisted living communities are Medicaid certified, and 18% of assisted living residents rely on Medicaid to pay for daily services. 

Another story in the CNHI News / Associated Press package pointed out the strict asset limits for Medicaid beneficiaries and Medicaid estate recovery programs that require states to seek reimbursement for long-term care costs from Medicaid beneficiaries after they die.

Few prepared to cover costs

Meanwhile, other stories in the CNHI News / Associated Press package focused on the cost of long-term care and how unprepared most Americans are to deal with those costs. 

A LeadingAge spokesperson called the package a “wake-up call for America” and said the association is calling for a comprehensive and equitable long-term care financing system, as outlined in a 2022 policy vision paper.

“Our patchwork approach to funding and delivering critically needed services is simply not up to the task — and as our population ages, demand will grow,” the spokesperson told McKnight’s Senior Living. “We can do better.”

As Americans live longer lives, LeadingAge said, it’s time to ensure that their potential isn’t “squelched by an oppressive and unfair long-term care financing system.”

“The solutions are complicated — but smart approaches abound,” the spokesperson said. “It’s time to act.” 

Delgado said that the nation’s rapidly aging population sheds light on a “significant and unavoidable” issue: many Americans do not have sufficient savings or home equity to pay for long-term care. And many underestimate the consequences of longer life spans.

“Our society does not have an adequate answer in place to help those whose savings are insufficient or who do not qualify for medicaid funds toward assisted living — which are limited and not an option in all states,” she said, adding that Congress, states and federal agencies need to create more options for older adults. “Policymakers need to think broadly for ways to incentivize saving for retirement, reactivate the market for long-term care insurance, expand Medicare benefits and much more.”

She added that the senior living industry has devoted considerable resources to exploring solutions, and the cost of senior living “is something we grapple with, but there are no easy solutions.

“However, it is still the lowest cost setting available to older adults relative to nursing home and home healthcare,” Delgado said. “A small percentage of providers engage in the Medicaid waiver program in states that allow assisted living as an eligible home- and community-based provider. It is a good option for Medicaid-eligible seniors who can benefit from the program, but the dollars are limited, and it is not available for assisted living in all states.”

It is anticipated that 70% of older adults will need long-term care at some point, but only 3% to 4% of Americans aged 50 or more years are paying for long-term care policies, according to the insurance industry. High premium costs are blamed for placing those policies out of reach for most Americans. And those who have insurance often find that it doesn’t provide enough coverage for assisted living, home health aides or nursing home stays. 

Washington state created long-term care insurance pools funded by payroll taxes to pay a portion of residents’ long-term care expenses. The WA Cares program created a long-term care benefit program, which provides residents with up to $36,500 to pay for LTSS costs. That fund is covered by a payroll tax. But that fund faces a repeal effort that hopes to make the program voluntary. 

Thirteen other states — Alaska, California, Colorado, Hawaii, Illinois, Michigan, Minnesota, Missouri, New York, North Carolina, Oregon, Pennsylvania and Utah — are considering their own programs.