by Kimberly Bonvissuto
Proposed federal legislation would make a “generational investment”
in the senior living and care workforce at a time when the aging
population is growing exponentially and an increasing number of older
adults are living with chronic conditions and disabilities, according to
its sponsors.
The Long-Term Care Workforce Support Act, introduced by Democrats, was met with mixed reviews from senior living industry advocates on Tuesday, however.
US Sen. Bob Casey (D-PA), chairman of the Senate Special Committee on
Aging, called direct care workers the “backbone” for long-term services
and supports and said they are “irreplaceable” and “essential” during a
Tuesday committee hearing focused on long-term care workforce shortages.
“Here is the bottom line — if we claim that their work as caregivers
is essential, we should accord them the status of a professional,” Casey
said in introducing the bill, S 4120,
co-sponsored by Sens. Tim Kaine (D-VA) and Tammy Baldwin (D-WI). “By
professionalizing and supporting the long-term care workforce, we can
better recruit and retain professionals in this vital field.”
Casey said the bill would ensure that caregiving can be a
sustainable, lifelong career by providing “substantial” new funding to
support workers in every part of the long-term care industry, from
assisted living communities to nursing homes to home care. Specifically,
he said, the bill would provide pathways to enter the care workforce,
improve wages and benefits, ensure a respectful and safe working
environment, and introduce best practices on recruitment as well as
training strategies to promote retention.
Pointing to a PHI report,
Casey noted that caregivers earn a median wage of $15.43 per hour,
resulting in almost 70% of assisted living communities and 92% of
nursing homes reporting significant or severe workforce shortages.
US Rep. Debbie Dingell (D-MI) introduced companion legislation in the House of Representatives, HR 7994, calling caregiving the “foundation of our economy” that allows for all other work to be possible.
“No care workers should have to live below the poverty line to do
this work that millions of Americans depend on,” Dingell said in a
statement. “This legislation will make much-needed investments in our
care infrastructure and workforce, including family caregivers, to
ensure they have the support they need, are paid a living wage, and are
able to continue doing their critical jobs.”
‘Time is of the essence’
Provider advocates had varying responses to the bill.
Argentum said it appreciated recognition of the workforce shortages
and potential resources to address it but added that “time is of the
essence,” with the need to create more than 3 million new jobs in senior living by 2040 to care for a rapidly aging population.
Argentum Senior Vice President of Public Policy Maggie Elehwany said
that workforce issues have been one of the few areas of bipartisan
agreement in the 118th Congress, with multiple congressional hearings
and calls from both sides of the aisle to “stem the exodus of healthcare
workers.”
The association, she added, continues to champion public policy
efforts to bolster the senior living workforce, including support for
the Safeguarding Elderly Needs for Infrastructure and Occupational
Resources (SENIOR) Act, which targets assisted living workforce development, and the Care Across Generations Act, which addresses twin senior and childcare workforce shortages.
The American Seniors Housing Association told McKnight’s Senior LIving
that the act prioritizes the need for workforce development programs as
the industry and nation face the “real risk of not having enough
available and willing workers to keep pace with the growing demand for
their services.”
“This important legislation makes a significant investment in
workforce development and training grant programs to be offered at the
state level, offering a wide range of worker supports, skills training,
demonstration projects, technical assistance, as well as worker
protections,” ASHA Vice President of Government Affairs Jeanne McGlynn
Delgado said. “These are all worthy goals, and if enacted and successful
in creating a pipeline of trained long-term care workers, the industry
will be well served.”
But Delgado said the legislation is only a partial solution, adding
that immigration reform is a necessary component to addressing the
sector’s workforce shortage challenges. ASHA said that Congress must
take action to advance “one of the many reforms” already proposed,
including creating a new visa category for caregivers, accelerating the
timeframe an asylee can seek work authorization, and granting green card
status to essential workers who worked during the COVID-19 pandemic.
“Congress will have to address the broken immigration system, and the
sooner it does, the better for our seniors,” Delgado said.
The Center for Excellence in Assisted Living, CEAL@UNC,
which formally endorsed the legislation, said the act calls out
“discriminatory” immigration actions, but “unsurprisingly” doesn’t go so
far as to address the “third rail” of immigration.
“CEAL@UNC encourages supportive immigration policies to build the
pipeline of new workers into assisted living and other long-term care
settings,” Sheryl Zimmerman, MSW, PhD, executive director of CEAL@UNC, told McKnight’s Senior Living.
Zimmerman also said that although the federal government calls for
recognizing the importance of the long-term care workforce, CEAL@UNC
suggests going one step further and formally recognizing all of those
providing direct care.
“The Center for Excellence in Assisted Living appreciates the federal
government’s recognition of the essential nature of the direct care
workforce, the fact that’s it’s important to virtually every family at
some point in their lives, the evidence tying its sufficiency and
competency to the well-being of older adults, and that the Long-Term
Care Workforce Support Act expressly references the importance of the
workforce in assisted living,” Zimmerman said.
Workforce bill ‘misses the mark’
Some senior living and long-term care industry advocacy
organizations, however, said the proposed bill “misses the mark” and
wouldn’t produce its intended effects.
“The entire long-term care continuum, no matter the type, faces a
growing caregiver shortage that impacts access to care for our nation’s
seniors and individuals with disabilities,” Clif Porter, senior vice
president of government relations for the American Health Care
Association / National Center for Assisted Living, told McKnight’s Senior Living.
“This legislation ignores a wide swath of the profession and fails to
address the elephant in the room — Medicaid frequently doesn’t cover the
cost of care, making it difficult for providers to offer higher paying,
competitive jobs.”
Porter added in a statement that it’s important for policymakers to
recognize that assisted living communities and nursing homes “do
everything possible to hire more caregivers.”
“We must focus on meaningful and comprehensive policies that will
actually help long-term care facilities recruit and retain workers, as
well as build a strong pipeline of caregivers,” Porter said in a
statement. “We hope to continue working with Congress and the
administration to find more supportive ways to ensure our nation’s
seniors have continued access to care.”
AHCA / NCAL said it supports several bipartisan bills to address workforce challenges facing providers, including the Healthcare Workforce Resilience Act and the Train More Nurses Act as well as three pieces of legislation that apply specifically to nursing homes: the Protecting Rural Seniors’ Access to Care Act, the Building America’s Health Care Workforce Act and the Ensuring Seniors’ Access to Quality Care Act.
LeadingAge, which also pledged its support to the above-mentioned
bills, similarly said that the “devil is truly in the details.”
President and CEO Katie Smith Sloan, in written comments submitted to
the committee, urged policymakers to pay attention to “necessary
refinements” on funding for the education and training initiatives
needed to build and sustain the workforce and investment in coordinated
state and federal infrastructures to ensure programs achieve desired
goals.
Among LeadingAge’s recommendations was passage of the Expanding Veterans’ Options for Long Term Care Act, the Home and Community-Based Services Relief Act, the Better Care Better Jobs Act and the Expanding Service Coordinators Act to address “inadequate” reimbursement mechanisms.
In addition, LeadingAge called on Congress to pass legislative
proposals addressing gaps in the US immigration system and to develop
and streamline federal training requirements for direct care
professionals, including exploring how licensed vocational / practical
nurses and experienced direct care professionals can assume increased
training responsibilities for professional caregivers.
“This should be done with a focus on developing stackable
certifications and opening pathways for aging services staff to engage
in a lifetime of career development and learning,” Sloan wrote in her
comments.
Addressing the newly introduced Long-Term Care Workforce Support Act,
Sloan suggested dedicating a specific fund to clear HCBS waiting lists,
including long-term care providers in both the rate-setting process and
the formation of any passthrough threshold for which they would be held
accountable by their states, combining grant funds under one roof, and
including home health and hospice in the definition of long-term care.
Senate Aging Committee Ranking Member Sen. Mike Braun (R-IN)
cautioned against a federal “one-size-fits-all” approach, suggesting
that innovation at the state and local levels is needed to meet the
increased demand for direct care professionals.
“Giving more power to the federal government
usually means printing more money and forcing top-down solutions. These
solutions are partisan and will not get us anywhere,” Braun said. “To
grow the long-term care workforce, the federal government should make it
easier for people to enter by removing barriers.”
Elehwany said that Argentum agrees with Braun’s stance on partisan
solutions and the need to “work together to pass bipartisan solutions
that offer flexibility.”
‘Historic’ legislation addresses job quality
PHI called the bill “historic” and said that it “enthusiastically
endorses” the legislation designed to systematically improve direct care
job quality and address the sector’s workforce crisis. The organization
said the bill enshrines many of PHI’s long-standing policy priorities
related to compensation, training, employment conditions and evaluation.
Specifically, the organization noted that the bill authorizes the
Department of Health and Human Services to award grants to support
workforce recruitment, training, compensation and retention. This
authorization includes a $10 million investment in pilot projects on
education, training and career advancement across settings, as well as
$10 million to support a national technical assistance center to support
states’ workforce efforts.
PHI also supports the bill’s proposal to create a National Direct
Care Professional Training Standards Commission to develop national
training standards for the direct care workforce, as well as an advisory
council to develop a national direct care compensation strategy.
Issues are ‘multi-dimensional’
Jasmine Travers, PhD, RN, an assistant professor at New York
University Rory Meyers College of Nursing, testified during the hearing
that the issues affecting the recruitment, retention and morale of the
direct care workforce are “multi-dimensional and compounded by an
external environment that devalues this work.”
She said the realities that make direct care work unsustainable
include low wages and limited benefits, inequities, chronic under
evaluation and a demanding work environment, insufficient training and
limited growth opportunities.
Travers called for a multi-pronged approach involving federal and
state governments, managed care organizations, aging organizations,
payers, providers, advocates, care recipients and direct care workers to
create solutions for a stronger direct care workforce.
Financially, she called for competitive wages and benefits, and
spending minimums for staffing for Medicaid-funded facilities. She also
called for enhanced training programs and opportunities for career
advancement, fostering a positive work environment through culture
change, focusing on recruitment and retention and sharing best
practices.
“To improve access to and quality of long-term care, we must ensure
that all direct care workers receive a living wage, a safe, respectful
work environment; opportunities for advancement; adequate training; and
accessible benefits to maintain their health and well-being,” Travers
testified. “Only when we recognize that these workers are critically
important, hardworking professionals, can we begin to improve equity and
health outcomes for staff and patients alike.”
Brooke Vogleman, a licensed practice nurse with senior living and
care operator TLC Management of Marion, IN, said that staffing should be
about training, education and retention.
“We need workforce development programs that help us grow the care
force, incentivize caregivers to choose a career in long-term care, and
invest in their career development,” Vogleman said.
Some hearing witnesses testified in favor of access to worker supports and protections. You can read witness testimony on the hearing website.
The Long-Term Care Workforce Support Act is endorsed by 44
organizations, including the Center for Excellence in Assisted Living,
or CEAL@UNC; the Gerontological Society of America; the Coalition to End
Social Isolation and Loneliness; the American Geriatrics Society; the
National Coalition on Aging; and Justice in Aging.
Full Article & Source:
Bill promises ‘generational investment’ in senior living and care workforce
