August 31, 2021, Washington, DC—As Congress finalizes a $3.5 trillion reconciliation package, a top aging services organization and providers from across the country explained why investments in home and community-based care, along with a range of critical supports, are needed to protect the health and well-being of millions of older Americans and people with disabilities.

The proposals include the President’s $400 billion pledge to provide home and community-based care for older adults who need extra help to live at home, including bathing, taking medicines and preparing and eating meals. A recent LeadingAge survey showed 89% of Americans support public investment in affordable home care services to help older adults.

“This is a once in a generation opportunity for Congress to make the long-overdue investments in care for our seniors” said Katie Smith Sloan, President & CEO of LeadingAge. “Unless Congress acts now to begin making meaningful changes to strengthen the infrastructure of care and services, the needs of older adults could overwhelm our country’s capacity to provide quality care.

The call participants reported on a series of alarming developments facing aging services providers around the country.

• New Jersey home care providers are declining nearly 2 out of every 3 new home care cases due to a shortage of available caregivers.
• Maricopa County is seeing a dramatic increase in the first-time homeless population of people over the age of 55.
• Older adults who live in California affordable housing are living on Social Security as little as $700 a month, choosing between millions of older adults must choose between rent, food, and medicine.
• 20% of Texas nonprofit aging services providers are restricting admissions because of staffing shortages. 60% are unable to hire nurses, and 70% Certified Nursing Assistants.

“This is the most important moment in decades for older Americans and their families,” Sloan added.

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. (Biographical information on the speakers can be found here.) Key points included:

• Home care challenges in 22 states (including NJ): David Totaro, Chief Government Affairs Officer, BAYADA Home Health Care, Moorestown, NJ
  • “Today we are declining nearly 2 out of every 3 new home care cases due to a shortage of available caregivers. If these trends continue, by the end of this decade, the US will be short an estimated 4.5 million aides.”
  • “Our home health aides are the foundation of our healthcare system. They keep our elderly out of more expensive care settings, saving the government billions of dollars.”
  • “Congress needs to allocate every dollar it can so that home and community-based providers can compete with the likes of Amazon, Walmart, McDonalds and others.”
  • “$400 billion in federal relief for HCBS would be a game-changer for millions of older adults who need personal help to remain at home.”

     

• Growing affordable housing needs:

Tom Egan, President and CEO, FSL (Foundation for Senior Living), Phoenix, AZ

o “Maricopa County is seeing a dramatic increase in the first-time homeless population of people over the age of 55. After the Supreme Court’s decision on eviction moratoriums, we’re going to see a dramatic spike in the number of people who need affordable housing.”

o “Every one of our 25 apartment complexes has 300 or 400 people on the waiting lists, and the wait time is 3 to 5 years.”

o “When an older adult has to decide each month between paying large electric bills, or medication or food, eventually they can’t continue living independently.”

o “We’ve seen estimates that the reconciliation bill money would allow Arizona to nearly quadruple the number of units built each year. Keep that up for several years, and it will make a big difference.”

Jasmine Borrego, President, TELACU Residential Management, Inc., Los Angeles, CA

o “The older adults who live in our affordable housing are living on Social Security as little as $700 a month, with no other assets or private health insurance.

o “Wait lists for each community are generally 300 to 500 applicants. We simply do not have enough affordable housing to meet demand. More money means more units.”

o “Millions of older adults must choose between rent, food, and medicine. And if they cannot afford their rent, they may become homeless because they have nowhere else to go.”

o “Right now, we can’t afford service coordinators for many of our units. They are critical to helping residents get food stamps, Meals on Wheels, free bus passes, and ADA transportation. They also monitor residents’ health, assist with the Medicaid process, help them schedule and keep their appointments, and also help them manage their medications. They are especially important for families who need extra help.”

• Texas’s growing provider workforce shortages: George Linial, President & CEO, LeadingAge Texas
  • “When we asked our members what keeps them up at night, more than four in five say it’s staff shortages. 60% of our providers are unable to hire nurses, and 70% Certified Nursing Assistants.”
  • “20% of our members are restricting admissions because of staffing shortages.”
  • “We are seeing more staff retire and change jobs, which puts that much more pressure on remaining staff. And when residents lose a regular staff member, they lose someone who knows their history and how to spot health threats.”
  • “75% of our members are operating at a loss right now–and 1 in 10 wonder how they will survive without help.”

     

• Need for National Medicaid funding change: Carol Silver Elliott, Jewish Home Family, Rockleigh, NJ
  • “45% of our organizations pay $200 less per day per Medicaid residents than what it takes to provide these services.”
  • “Nearly all CNAs have to work two jobs to make ends meet. Recruiting staff is difficult because we can’t raise prices like Amazon and McDonalds in order to raise wages.”
  • “Caregivers do difficult work, physically demanding, intimate and emotional as we become attached to the elders we serve. How can we pay someone the same for this vital work as we pay someone who says ‘Do you want fries with that?’”
  • “We do this because of our passion for and care for older adults. It is so important that our legislatures provide the support to give older adults the care they are entitled to, and providers need in order to provide this care.”

LeadingAge’s Specific Requests

Half of all Americans will need long-term services and supports after turning 65–and by 2040, a quarter of the U.S. population will be 65 or older. LeadingAge calls on lawmakers to ensure those growing needs are addressed in the upcoming reconciliation package by providing $400 billion for home and community-based services; $7.5 billion to expand affordable housing for older adults; $55 billion to increase Medicaid reimbursement for nursing homes; and $1 billion investment in the aging services workforce.

In a letter sent to Congress, LeadingAge called on lawmakers to ensure the upcoming reconciliation package specifically provides for investments to address the nation’s most pressing aging services needs:

• $400 billion for Home and Community-Based Services to allow more older adults to get the help they need in their homes or in their communities so they can grow older wherever they call home—including increasing pay for the staff who provide the help.
• $7.5 billion to address the nation’s shortage of affordable housing for older adults with very low incomes through HUD’s Section 202 Supportive Housing for the Elderly program.
• $55 billion to increase Medicaid reimbursement for nursing homes so they can pay wages that enable them to recruit and retain staff, especially frontline workers.
• $1 billion investment in the aging services workforce to implement strategies to strengthen recruitment, career and training opportunities that our nation’s direct care workers need to care for millions of older Americans and people with disabilities.

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 encompasses the entire continuum of aging services. 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.