Addressing Our HCBS Infrastructure Crisis

Conversations with Katie | June 08, 2021

President & CEO Katie Smith Sloan calls on Congress to support the aging services infrastructure.

We’ve lost a lot during the COVID-19 pandemic. But the health crisis we’ve lived with for more than a year hasn’t just been about loss.

It’s also been a time to discover and appreciate those who kept our society going when everything seemed to be falling apart.

Grocery store workers who kept the shelves stocked. Transit workers who bussed us where we needed to go. Emergency room personnel who responded tirelessly to the growing number of health emergencies.

And, most important to me: the women and men who show up for work every day at LeadingAge member communities and home and community-based services (HCBS) programs, standing by older adults during one of the darkest periods in their lives.

We call all these individuals “essential workers” for a very good reason. When we were ready to lose hope, when it looked like things could not get any worse, they were there for us, supporting us, and keeping our society intact. They made it possible for us to keep going. We could not have made it through without them.

If these workers, and the organizations who employ them, don’t qualify as integral parts of our nation’s infrastructure, I don’t know who does.

But here’s the thing about infrastructure: it needs care. If it doesn’t get that care, it won’t be there for us when we need it most.

Our aging services infrastructure needs that care right now. Three HCBS providers made that need abundantly clear recently during a meeting with members of the press. The providers used their own experiences to underscore the urgent need for legislation to bolster the underlying framework of our nation’s system of long-term services and supports (LTSS). Clearly, that framework is badly broken and in need of repair.

David Totaro, chief government affairs officer at BAYADA Home Health Care, estimated that his organization saves New Jersey more than $30,000 a year for each client it serves at home. But many older adults don’t receive that care either because they can’t afford to pay for it out of their own pockets or, in many cases, because there are just not enough professional caregivers to go around.

Kara Allread, senior vice president and chief administrative officer at Brethren Retirement Community in Greenville OH, blamed low reimbursement rates for her organization’s inability to recruit new caregivers to provide home-based services. No high school students participating in a recent jobs fair signed up to speak with Brethren recruiters because they knew the organization’s wages would not be competitive.

Dr. Brandi Derr, director of programs at Rogerson Communities Adult Day Health Programs in Boston, painted a stark picture of what happens when older adults can’t access community-based services like adult day health programs. When clients returned to the Rogerson program after the COVID lockdown, many showed disturbing changes in blood pressure and blood sugar, losses of muscle strength and flexibility, and dangerous weight changes—all health issues that the program had helped them manage successfully before the pandemic.

David, Kara, and Brandi also told stories about the growing challenges family members face as they try to fill the care gap—often putting their own health and financial well-being at risk.

LeadingAge members know better than anyone that America’s aging services infrastructure has been ignored and underfunded for decades. Those members are feeling the strain of that neglect. And they worry about the challenges they will face when they have to fill future care needs—needs that will grow as the population ages.

That’s why LeadingAge is calling on Congress to recognize that the LTSS infrastructure needs its support. We want Congress to invest in that infrastructure by addressing workforce needs, increasing access to services, and supporting family members.

This will require action on several fronts. But it all comes down to one important imperative: supporting the older Americans who built our communities, fought our wars, and raised our nation’s children.

I urge you to read our Blueprint for a Better Aging Infrastructure and to help us advocate for acceptance of its recommendations. As David, Kara, and Brandi showed clearly, members are in the best position to describe why taking action now to support our nation’s older population is the compassionate and the moral thing to do.