Assisted Living

Part of LeadingAge's 2021 Policy Priorities

(NOTE: Assisted living services are not federally funded or regulated. However, they are affected by some federal policies. Further, they have received federal support to fight COVID-19 in the form of testing and plans for vaccines. It is critical to note that these communities respond to local needs, are regulated by states, and are not federally funded or regulated. We work closely with LeadingAge state partners to support relevant state-specific advocacy. In this section of LeadingAge’s 2021 Policy Priorities, we simply pull together the elements of the Priorities that relate to Assisted Living providers.)


  • Advocate for assisted living communities to have all the resources needed to fight the COVID-19 pandemic, including staff, testing, PPE, and vaccines.
  • Understand and advise members on the current framework of varying state regulations and standards governing assisted living and memory care.
  • Work with members and stakeholders to explore ideas to bring more affordable assisted living options to the “middle market” that is currently underserved.
  • Analyze existing programs and experiment with new ways to determine the most effective avenues to reduce abuse/incidents and increase quality in assisted living.
  • Establish and implement a vision and action plan to drive a national consensus process to improve care.

LeadingAge members are saying:

  • “We, as assisted living providers, are facing the same shortage of PPE, supplies, and testing as nursing homes and our costs are rising exponentially - all while we are getting little guidance and direction on the changing standards of care dealing with this pandemic.”
  • “The evolution of assisted living has gone from a more collaborative approach to a more punitive approach like the nursing home survey and certification process. There are other ways to address the real issue at play – quality.”
  • “How do we address the “Middle Market” – as more regulations arise that increase costs and there is already an issue with serving the middle market in AL.“


With close to one million assisted living residents nationwide, assisted living and memory care providers are faced many of the issues that all aging services providers faced this year – COVID-19, workforce shortages, behavioral and mental health program gaps, inadequate Medicare/ Medicaid reimbursement and more.

Assisted living providers have struggled with the financial sustainability of their operations because of the dramatic increase of unbudgeted expenses for COVID mitigation – PPE, testing, staffing - combined with precipitous drops in occupancy. In addition, there is a looming and unwarranted burden of liability claims and the associated rising cost of insurance as a result of COVID-19.

In addition to the COVID-19 issues faced by assisted living providers, we are quickly reaching a tipping point in concerns about quality and safety. LeadingAge is looking to ensure a constructive, future-focused action plan to promote smart approaches to quality in assisted living and memory care without federal regulations.


117th Congress

  • COVID-19 relief. We support the House and Senate introduction of legislation that will provide funds and other relief for aging services.
  • Support liability protection. We will continue to work with a coalition of national associations and state association partners to enact state civil liability protections for assisted living providers relating to COVID-19 claims. Nearly half the states have enacted some sort of protections (but many not including assisted living providers) and we are still advocating for broad protections on the federal level.
  • Vaccine distribution. We support and advocate for an adequate budget to enable seamless implementation of the Pharmacy Partnership and rapid, efficient distribution of vaccines to all aging services workers including all employees of Life Plan Communities. We encourage HHS to implement consumer education programs to encourage immunization.
  • Medical Expenses. We support the reintroduction of the Medical Expense Savings Act to make permanent the reduction in the adjusted gross income threshold that must be exceeded before a taxpayer can claim an itemized tax deduction for medical expenses.
  • Professionalize the Workforce. We will work with the incoming administration to fill in details of the workforce provisions of the platform’s caregiving proposal to treat LTSS workers with respect and dignity. LTSS settings must feature greater standardization of competency-based training requirements and education needed to prepare the frontline workforce to deliver quality care.
  • Behavioral Health. Geriatric Social Worker Education, Recruitment and Retention Program. We support the inclusion of expanded programs to recruit, educate and retain geriatric social workers that encourage more social workers to join and specialize in the aging services field.

Executive Branch

  • Various COVID-19 Mitigation Efforts. As in all other areas of aging services, we support and advocate for: distribution of testing materials; vaccine distribution; extension of the Public Health Emergency; prioritization and delivery of personal protective equipment; streamlined Provider Relief Fund reporting; among many others.
  • Regulatory waivers. We advocate that CMS continue 1135 regulatory waivers to allow providers the flexibility to focus their resources on preparing for and responding to COVID-19 outbreaks in their communities and those additional flexibilities be considered.
  • Alternative Payment Models. We engage in activities geared toward the development of alternative payment models, such as the Unified Post-Acute Care Prospective Payment System Technical Expert Panel.


  • Visit the Advocacy Action Center to let your representative and senators know you support legislation that enhances access to assisted living.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact assisted living.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to create and sustain assisted living.