April 1, 2021, Washington, DC—A top aging services organization released a plan to build the national aging services infrastructure needed to keep up with America’s growing older population.

The comprehensive Blueprint for a Better Aging Infrastructure would help address the needs of millions of middle and lower income people and their families who require aging services and supports, including affordable housing, in-home care and services, and 24-7 nursing care. The package also addresses the fundamental need to build a new aging services workforce and overhauling the long-broken long-term care financing system. The plan would help older adults age with purpose and dignity, wherever they call home.

“This is the most important moment in a generation for aging services,” said Katie Smith Sloan, President & CEO of LeadingAge. “Our country doesn’t have the infrastructure for aging services that we need to care for our rapidly aging population — and the systems we do have are crumbling. This plan lays out a path for Congress and the Administration as they focus on infrastructure.”

Sloan added that half of all Americans will need long-term services and supports after turning 65–and that by 2040, a quarter of the U.S. population will be 65 or older.

“Even as these needs grow, an infrastructure crisis threatens to leave millions of older Americans out in the cold during their most vulnerable years,” said Ruth Katz, Senior Vice President of Public Policy/Advocacy, LeadingAge. “America’s aging supports have been ignored and underfunded for decades, as Medicare and Medicaid reimbursements are too low to support quality care and a living wage for professional care workers. Any infrastructure plan must solve the dire workforce shortages and affordable housing shortages. It is unconscionable that two out of three older adults who need affordable senior housing can’t get it.”

“We need to recognize the vital role that home care plays in the lives of so many American families,” Sloan added. “When we can support families with professional care it pays off in human ways for individual families and economic ways for all Americans.”

The Blueprint for a Better Aging Infrastructure was released as the Biden Administration begins to release infrastructure packages, including Caregiving Economy proposals focusing on home care for older adults and human infrastructure.

Remarks by State Aging Services Leaders

Nonprofit aging services leaders joined the press conference to discuss the challenges in their states, and call on Congress to take the steps needed to build out desperately needed infrastructure for older adults. Key points included:

• Home health care: Dorothy Davis, President & Chief Executive Officer, Visiting Nurse Health System, Inc.
  • “There are just not enough really qualified workers. We have turned away more than 500 patients in the last four months due to workforce shortages. We’re hopeful that an investment in infrastructure will enable us to hire qualified workers — nurses, LPNs, CNAs, occupational therapists — to really support what we are being asked to by our health partners, our payers, and our consumers.
  • “If we’re unable to take care of folks at home, they’ll end up in hospitals and it will drive up costs.”
• Nursing homes: Deke Cateau, President & CEO, A.G. Rhodes
  • “We have to offer older adults dignity and respect in life just like every American.”
  • “The current design and infrastructure of the vast majority of nursing homes is inadequate. We have an opportunity, and I think now is time for change, to rebuild our buildings and turn them into true homes for aging seniors.”
  • “We have two choices: continue as usual with an outdated and undignified infrastructure, or view this as the key and critical community issue it is–and use the opportunity to rebuild our buildings and turn them into the homes they should be. I want to bring the home back into nursing homes, and give seniors the dignity they deserve.”
• Affordable housing for older adults: Jasmine Borrego, President, TELACU Residential Management, Inc. and TELACU Property Management, Inc.
  • “For a 75-unit building, I have a waiting list of 300-500 people. And with turnover of 5 to 8 units a year, the applicant has to wait years before receiving a unit.”
  • “We do not have sufficient housing for people who live from social security check to social security check. People are living on only $700 a month from social security, and a one bedroom apartment costs $1,800 here. People who don’t have affordable housing are paying 50%-80% of their income to pay rent.”
  • “For older adults living on social security–$700 a month–paying rent, buying food and medications–$50 or $60 a month for internet expenses is out of reach. Whether for telemedicine visits or to keep in touch with family, friends and community members, dependable internet access is a must have, a necessity.
  • “WiFi is a necessity, just like water and heat. Without it, you may not be able to have a medical appointment, you lose social connections, and your quality of life and health decline.”

Blueprint for a Better Aging Infrastructure

The Blueprint spells out the infrastructure support needed to help the aging services sector recruit the workers needed to care for a growing older population, increase the stock of affordable senior housing, support the fast-growing home and community-based care field, strengthen nursing homes and the care they provide, and rebound from the pandemic. It also calls for an affordable, meaningful set of policies to finance long-term care for those who need it.

Build a Larger, Stronger Aging Services Workforce: The plan addresses acute shortages in the current aging services workforce, and ensures that enough high-quality care workers can be recruited to fill the jobs needed to serve a growing older population.

• Permanently increase the federal match (FMAP) by 10% for both home and community based and nursing home services.
• Strengthen federal investments in competency-based training programs, offer career pathways to advancement opportunities, and provide support for loan forgiveness programs, especially in rural or underserved communities.
• Provide adequate funding and programs to train additional geriatric nurses and physicians and establish programs and initiatives that train COVID-19 frontline staff to address fatigue and mental health challenges.
• Enact the Palliative Care and Hospice Education and Training Act (PCHETA) which would allow more training of specialized workforce to support those with serious illness.
• Make meaningful changes to immigration policies to support hiring foreign-born workers at all levels and positions in aging services. Ensure that workers hired under these programs are protected from exploitation and have a path to citizenship if they so choose.

LeadingAge also supports a living wage, determined by locality, for all aging services workers across the continuum of care, with providers fully reimbursed to cover wages and benefits.

Support Care in the Home and Community: Funding and program support for service and care at home and in the community must be expanded, allowing more older Americans to get the help they need to grow older wherever they call home.

• Ensure full access to Medicaid home and community based services (HCBS) by reclassifying these benefits as mandatory, and doing so in a geographically equitable way.
• Provide incentives to states to eliminate waiting lists, with generous matching and pay for performance metrics.
• Help states develop and improve capacity to provide HCBS, consistent with Senator Casey’s framework outlined in 2020.
• Expand access to integrated models of care like PACE (Programs of All-Inclusive Care for the Elderly) by making it easier for PACE organizations to expand service areas, increase enrollment, and serve additional populations.
• Make permanent Money Follows the Person and HCBS spousal impoverishment protections.
• Provide expanded support for programs under the Older Americans Act.
• Invest in programs to design, revamp, and build accessible physical spaces, such as day centers used for adult day services, PACE organizations and senior centers.
• Add an in-home respite level of care in hospice; this would also provide more jobs.
• Establish pilots that allow for community-based advanced illness services, to provide an extra layer for support to patients with serious illness prior to hospice eligibility.
• Modify the home health benefit to include more personal care, technology, and other necessary services to provide a higher level of care in the home for those who want it.
• Maintain COVID-19 telehealth flexibilities into the future, and expand them to include appropriate reimbursement for Medicare home health and PACE providers.
• Make sure that providers of care in the home and community are eligible to receive technological infrastructure investments such as those offered by the Federal Communications Commission (FCC) and other sources.

Expand and Improve Affordable Senior Housing: The plan increases the stock of affordable senior housing, along with age-friendly retrofits to existing housing, and support for broadband internet access critical to providing telehealth and fighting social isolation.

• Expand the supply of affordable senior housing by investing $2.5 billion in U.S. Department of Housing and Urban Development (HUD)’s Section 202 program to build approximately 54,000 homes.
• Provide a $1 billion pool of capital funds under an Age Friendly Retrofit program for HUD-assisted senior housing and the homes within them, to guarantee physical accessibility, make room for health and wellness activities, and improve air ventilation systems.
• Ensure equity in internet access by defining broadband as a subsidized utility. Invest $5 billion to enable equal access to the health/telehealth, economic, and social connectedness benefits of the internet.

Strengthen Nursing Homes and other Congregate Living Communities: Congregate living communities and nursing homes would be modernized with physical improvements to provide more private rooms and person centered care, stepped-up staffing and improved quality standards and mechanisms to improve care.

• Maintain and improve outdated physical structures, ensuring private rooms and person centered care.
• Improve clinical care by requiring 24 hour RN coverage, mandating a 30 day minimum supply of PPE required, and improving the role of infection preventionists; all tied to increased reimbursement to cover the costs.
• Improve staffing ratios in nursing homes with enhanced FMAP funding, and a requirement that increases in funding be passed through to workers’ wages and benefits.
• Direct the Centers for Medicare & Medicaid Services (CMS) to modify the nursing home regulatory framework consistent with recommendations from the National Academies of Sciences, Engineering and Medicine’s forthcoming report.
• Mandate improvements in the survey process that enable the best resident care and rapidly turn around chronic poor performing nursing homes.
• Establish a publicly reported customer satisfaction measure.
• Enhance FMAP across the board for nursing home and HCBS settings.
• Establish federal guidelines for state allowable cost definitions.

Reform Long-Term Care System and Financing: It’s time for Congress to establish an affordable, meaningful set of policies to finance long-term care for those who need it.

Ensure a Comeback from COVID: The plan hard-hit providers rebound from the massive financial costs of the pandemic, while protecting residents and staff from continued outbreaks of the virus.

• Establish a $6 billion “Hardest Hit” Provider Relief Fund for aging and long-term care providers to ensure that aging and long-term care providers continue to be available to deliver services to our aging population.
• Ensure that the cost of required testing and personal protective equipment to keep staff and residents, patients, and clients safe are fully covered.
• Expand the number of Service Coordinators and the availability of internet in affordable senior housing communities.
• Invest in a nationwide broadband infrastructure to sustain COVID-19 related telehealth flexibilities and other technological additions that help provide more accessibility to high quality care. 

We represent more than 5,000 nonprofit aging services providers and other mission-minded organizations that touch millions of lives every day. Alongside our members and 38 state partners, we use applied research, advocacy, education, and community-building to make America a better place to grow old. Our membership, which now includes the providers of the Visiting Nurse Associations of America, encompasses the continuum of services for people as they age, including those with disabilities. We bring together the most inventive minds in the field to lead and innovate solutions that support older adults wherever they call home. For more information visit leadingage.org.