March 11, 2022 Washington, DC — Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services, including nursing homes, today laid out in a letter to President Biden and top cabinet leaders a package of proposals and critical next steps needed to address our country’s growing crisis in access to aging services care, with a focus on nursing homes. 

The proposals, which also include a request for an in-person meeting, are a response in support of initiatives introduced in President Biden’s March 1 State of the Union address. Sloan urged the President to take a bold, all-of-government approach to ensure access to consistently high-quality nursing home care for older Americans and families across the country.

“For millions of older Americans and their families,” said Sloan, “it’s time to make the staffing crisis priority #1—because after decades of inadequate government support, we know that the foundation of quality care is proper funding.

The pandemic has added dramatic increases to costs as providing care has grown far more complex. Workforce challenges across aging services, which were chronic even prior to COVID-19, have reached new heights. And inadequate and unsupportive federal policies now lag further behind, and do not reflect the best evidence for quality care.  

• The most basic problem is that reimbursement rates don’t cover the true cost of caring for individuals 24/7.  
• Government policies don’t do enough to help care providers recruit and retain professional caregivers, offer stronger career support, and deliver more person-centered care. 
• Too many nursing homes must reassign nurses and other caregiving professionals away from residents’ care to paperwork and reporting duties, in order to comply with federal regulation.” 

“We urge the Administration to focus first and foremost on funding an array of staffing solutions,  including fair compensation for frontline staff, expanding the pipeline of applicants with training and apprenticeship programs, allowing foreign nursing staff to help long-term care communities, and addressing price gouging by temporary staffing agencies.

We also urge the administration to strengthen accountability within the sector by applying evidence-based quality improvement and measurement to nursing home oversight, offering expert consultation and help to nursing homes, and reserving extra-burdensome compliance requirements and reserving punishment for poor performers—rather than relying on one-size-fits-all solutions that can drive up costs and siphon staff time caring for older adults. 

LeadingAge’s nonprofit and mission driven nursing home members operate with financial transparency and open communication. The President should build on that foundation of trust. Meaningful funding will yield better jobs, and better jobs will yield greater access to quality care.”

In her letter, Sloan outlined a three-pronged approach to best support the millions of residents, family members and staff in nursing homes nationwide: 

ADDRESS THE URGENT STAFFING CRISIS using a strategy that draws on expertise and resources of our country’s Executive branch agencies, including not only Health and Human Services and the Centers for Medicare and Medicaid Services, but the Federal Trade Commission, State and Homeland Security, Education and Labor and other key contributors.  

Working collaboratively and independently, their focus should include creating solutions that:

• Compensate frontline staff fairly. This can be accomplished with FMAP increases for nursing home care and requirements that states reimburse for the cost of care. LeadingAge members are ready to pass increases directly through to staff.
• Expand the pipeline of applicants seeking meaningful careers in aging services with training and apprenticeship programs modeled on initiatives that already exist in the Departments of Education and Labor. Offer career ladders and lattices to help people stay in the field and continue doing the work they love.
• Make immediate changes in immigration policy to allow foreign nursing staff hired by long-term care communities to get to the United States as quickly as possible.
• Address price gouging by temporary staffing agencies. Prohibit agencies’ ability to charge exorbitant rates to nursing homes whose revenues are principally drawn from Medicaid and Medicare.

PAY FOR QUALITY CARE Meaningful, fair funding for services provided by nursing homes is critical to ensuring providers’ ability to recruit and retain employees—a must because evidence shows staffing is directly linked to quality care.  

• Increase current reimbursement rates delivered to providers to ensure actual cost of care is compensated by increasing Medicaid’s Federal Medical Assistance Percentage (FMAP) for nursing home care and requiring that states reimburse for the cost of care.
• Require regular review of reimbursement rates to ensure they keep up with changing costs and ensure prompt delivery of funds to providers. Stagnant Medicaid rates that don’t change with inflation force providers to cover ever-widening gaps between actual operating costs and reimbursements. 

APPLY EVIDENCE-BASED QUALITY IMPROVEMENT AND MEASUREMENT to nursing home oversight. Quality improvement organizations’ research shows that motivated, committed, high-performing nursing homes improve with expert consultation and help. Punishment should be reserved for poor performers.  

• Distinguish high-performing, high-quality, dedicated providers from poor performers and reserve the most frequent survey schedules for the latter. Do not punish good homes by forcing them to devote limited resources to unnecessary compliance steps, at added cost of time and money. 

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.