Part of LeadingAge’s 2021 Policy Priorities


  • Ensure that aging services providers can hire and retain a sufficient number of high performing staff at all levels.
  • Ensure aging services organizations have urgently needed COVID-19 protections for care workers across the continuum.
  • Provide additional pandemic “premium pay” for essential workers, which includes direct care workers who play a critical role in aging services.
  • Increase pay for direct care workers to at least a living wage. Professionalize the workforce with competency-based training requirements, increased training requirements, and offer career pathways to advancement opportunities.
  • Establish programs and initiatives that address COVID-19 frontline staff fatigue and mental health challenges
  • Develop partnerships to support learning, tutoring, and aftercare pods for children of LTSS services workers.
  • Establish a national Long-term Care Service Corp to recruit, retain, and hire LTSS clinicians to work in communities with escalating COVID-19 case counts.
  • Enable older adult services organizations to hire foreign-born workers through a range of programs, including some focused on older adults and LTSS workers.
  • Increase grant funding for training and hiring aging services workers at all levels.
  • Expand funding to train geriatric nurses and physicians.
  • Support the retraining of older workers.
  • Replicate programs and models that hold promise.
  • Support federal and state efforts to increase Medicaid reimbursement for older adults services, leading to increases in wages and benefits. Increase the Federal Medical Assistance Percentage (FMAP) by a total of 14 points and for home and community-based services providers, an additional 10 points.
  • Support the creation and/or strengthening of mental health and wellness tools, resources, and funding to enable employers to support aging services staff members on a state and federal level.
  • Collaborate with lawmakers and regulators to develop and support comprehensive behavioral and mental health intervention training programs for all professions and disciplines that serve older adults.
  • Support the creation and/or strengthening of mental health and wellness tools, resources and, funding to enable employers to support aging services staff members on a state and federal level.

 LeadingAge members are saying :

  • “The top 3 challenges in aging services are workforce, workforce, and workforce.”
  • “We just don’t have enough people to even apply for all these jobs. The only answer is to look overseas for workers.”
  • “Recruiting, training, and maintaining a quality workforce is exceptionally hard during the coronavirus crisis. Workers – especially frontline caregivers – are working long hours and maintaining stringent health safety processes. They are also struggling with personal issues – childcare, family demands, and concerns about their own health – that the crisis creates.”
  • “We need everything from aides to physicians but especially nurses. There are just not enough nurses – people are sitting in our parking lot to recruit them away with huge incentives. It’s not even that I can’t pay them what they ask for (though that is an ongoing challenge that will continue), but all they want and need is a vacation which is the one thing I can’t give them.”
  • “Not having enough staff impinges on our ability to serve the patients we have and to do what all levels of government are asking us to do – take pressure off the hospitals by admitting more patients. We are squeezing the balloon – if we increase staffing for one service, we can’t serve patients in another setting.”


Recruitment and retention of older adult services workers have long been THE perennial, critical issue for nearly every provider member of LeadingAge. As the coronavirus pandemic raged on throughout 2020, it exacerbated and exposed these widespread staffing challenges to a broader audience.

Demographic trends – a rapidly aging population and fewer people of working age – portend fewer informal caregivers and insufficient numbers of American-born workers. Half of all people turning 65 today will need to be paid LTSS before they die. LeadingAge members feel the staffing pinch in front line jobs – certified nurse aides, home care and home health aides, with dietary, housekeeping, and maintenance a close second. There are huge gaps in the supply of geriatric nurses and physicians.

COVID-19 not only took the lives of over 342,000 older people but also the lives of thousands of healthcare workers, including aging services workers. Many workers at all levels of aging services organizations left their jobs in 2020, out of fear, family responsibilities, or burnout, and inability to cope with the intensity of fighting COVID. With increased media focus on the impact of COVID in nursing homes and other provider organizations, much of it blaming aging services workers, individuals who might have considered this work in the past are reluctant to seek out aging services positions.

Entering 2021, aging services providers across the continuum must find new sources of workers, be able to pay frontline workers a living wage and guarantee that they will have the PPE and testing they need to stay safe and healthy, have access to ongoing programs and funding to support the mental well being of staff. In addition, resources must be available to ensure providers have access to qualified backup and emergency workers, such as members of the National Guard. Any work on the aging services workforce must be done with the recognition that people of color are disproportionally represented in this workforce.

U.S. Bureau of Labor Statistics (BLS), Employment Projections Program (EPP). 2017. Employment Projections: 2016–26

External Challenges by Care Setting

Work-Related Challenges by Setting


117th Congress

  • COVID-19 relief. We support the House and Senate introduction of legislation that will provide funds and other relief for aging services.
  • Medicaid reimbursement. Increase the Federal Medical Assistance Percentage (FMAP) by a total of 14 points and for home and community-based services providers, an additional 10 points. We would like to see these increases, at least in part, reimburse aging services providers at a level that allows them to pay workers a living wage, and ensure that the appropriate percentage of provider reimbursement goes directly to pay direct care workers.
  • Vaccine distribution. We support the seamless implementation of the Pharmacy Partnership and rapid, efficient distribution of vaccines to all aging services workers. We encourage HHS to implement consumer education programs to encourage immunization.
  • 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.
  • Increase Geriatric Academic Professionals and Clinician Educators: We support the reauthorization of faculty education and training grants relating to the Geriatrics Academic Career Awards (GACA) and the Geriatrics Workforce Enhancement Program (GWEP) which provides a five-year $41 million authorization, as part of the CARES Act.
  • Older Americans Act Reauthorization: We support the reintroduction of the Supporting Older Americans Act of 2020 which would reauthorize the OAA for five years, at increased levels to allow more older adults to benefit from the program. It also that calls for direct care workforce demonstration projects to test concepts and improve the direct care workforce.
  • Award Grants to Recruit and Retain Direct Care Workers: We support the introduction of the Direct CARE Opportunity Act that directs the Department of Labor to award grants to recruit and provide advancement opportunities to direct care workers.
  • Health Professions Opportunities Grants (HPOG): We support the reauthorization of the HPOG grants that provide training to Temporary Assistance for Needy Families (TANF) program recipients for various allied health occupations, which includes home health aides and CNAs. The program was amended to allow SNFs and nonprofits to be included as eligible entities for the program.
  • Reinstate CNA Training Programs within SNFs: We support the reintroduction and enactment of legislation the Nursing Home Workforce Quality Act that repeals the CNA training “lock-out” and reinstate training programs when SNFs are in compliance.
  • Healthcare Workforce Resilience Act: We support the opportunity to allow as many as 40,000 unused immigrant visas to be awarded to nurses and physicians to come to the U.S. during the Covid-19 national emergency.
  • Fairness for High-Skilled Immigrants: We support legislation that would eliminate the per-country caps on job-based green cards.
  • Older Adult Services Guest Worker Program: We support the introduction and enactment of a temporary guest worker program for CNA and home care aides.
  • J-1 Cultural Exchange Visa Changes: We support the introduction and enactment of Cultural Exchange Visa changes to include older adult services workers in addition to child care workers.
  • Modify EB-3 Visas for Nurses: We support expanding and modifying visas to support improvements to increase the quotas for foreign-born LTSS nurses.
  • Expand “Religious Occupation” to Include Aging Services: We support modifying the R-1 program to cover temporary workers so it includes older adult services settings.
  • Covering Social Workers Under Medicare: We support the reintroduction of the Improving Access to Mental Health Act, a proposal to increase access to services provided by licensed clinical social workers in Medicare. 

Executive Branch

  • Extend administrative flexibility. Support the Public Health Emergency 1135 Blanket Waivers that CMS put in place during the pandemic that has helped shore up the workforce and not caused negative consequences, including potentially: establishing a basic care aide position; reducing training requirements for paid feeding assistants, and reducing CNA in-service training requirements and clinical hours needed for certification.
  • Protect staff from COVID infection. Ensure that staff of all aging services providers, regardless of where the people they serve live, have access to a fully-funded national testing program, sufficient PPE, and Coronavirus vaccines when they become available so they can safely provide needed care and services.
  • Project ECHO nursing home initiative. We ask HHS to monitor the ECHO nursing home initiative, which offers staff to staff co-learning in a collaborative setting, and continue it beyond March 30, 2021, if it appears to be producing positive results. We urge considering funding ECHO for other aging services settings.
  • Workforce Commission. Identify commissioners and quickly establish and convene the Long-Term Care Workforce Commission recommended by the Coronavirus Commission on Safety and Quality in Nursing Homes in its report released in September 2020.
  • Establish a core set of competencies across all aide occupations and settings and work with providers to create meaningful career pathways for the direct care workforce.
  • The U.S. Department of Labor and its state counterparts should work with providers to develop comprehensive apprenticeship programs that provide training and career advancement opportunities.
  • Support finalizing the Department of Labor proposed regulation allowing individuals under age 18 to operate lifts.
  • Trauma-informed Care: We will continue to support the effective implementation of trauma-informed care training for staff across LTSS settings


  • Visit the Advocacy Action Center to let your representative and senators hear your voice on the workforce issues facing aging services providers.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact aging services workforce issues.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know that you support addressing workforce issues in aging services.