America’s long-term care workforce and older adults’ and families’ access to care took center stage on October 25 at the House Energy and Commerce subcommittee hearing, “Supporting Access to Long-Term Services and Supports: An Examination of the Impacts of Proposed Regulations on Workforce and Access to Care.”

The conveners, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Subcommittee on Health Chair Brett Guthrie (R-KY), focused on two critical workforce proposals put forth by the Centers for Medicare and Medicaid Services (CMS): nursing home staffing mandates and the Medicaid Access “80/20 pass through” in an effort to better understand “the challenges ahead and ways to preserve access to care,” per the hearing memo.

Expert witnesses shared stories of their work on the front line of long-term care and home and community-based services.

Sarah Schumann, vice president of operations at Colorado-based Brookside Inn and Brookside Rehabilitation, outlined her family-owned community’s efforts to improve staff retention and recruitment. She believes that the combined impact of the staffing mandate and a caregiving crisis will be “terrifying and heartbreaking,” and fears that the potential impact may force her family to close its majority Medicaid facility.

Schumann went on to say that despite increasing salaries by 40%, with CNAs now being paid a starting salary of $23 an hour and greatly improved benefits, including covering health care for employees and their families and offering 3.5 weeks of paid vacation, she still struggles to recruit and retain caregivers, “simply because the number of qualified caregivers that we need are not there.”

Schumann challenged the assertions that skilled nursing facilities have been taken over by greedy corporate tycoons, noting that, “Like most of the profession, Wall Street does not own my company. We serve residents on Medicaid, and we do not have the resources to fund this unfunded mandate. … We cannot be expected to just magically grow new caregivers.”

Patti Killingsworth, former chief of LTSS for TennCare and chief strategy officer for CareBridge Health, is concerned about the combined impact of the two proposed rules, raising concerns that limiting home and community-based services spending and a rule driving more required skilled nursing facility spending would overlap, hitting state budgets especially hard as demand for services increase.

Several committee members, including Rodgers and Guthrie, expressed eagerness to address the gaps in care in our nation’s senior services, but expressed concern with the Biden administration proposals. Rep. Diana Harshbarger (R-TN) raised alarms about the potential unintended and combined impact of the two proposed policies that may push older and disabled adults into institutionalized care that may not meet their needs.

Notable Quotes

Rodgers: “The future of care for seniors and people with disabilities depends on us finding ways to support long-term care workers.”

Rep. Joseph Pallone (D-NJ), the Ranking Member of Energy and Commerce: “ I’m glad the Administration is serious about taking steps to improve patient safety and staffing conditions, while also recognizing the unique challenges some nursing homes may face in complying with the new rules. I look forward to hearing our witnesses’ perspectives on the rule and to working with all of you and with the administration to ensure that it’s successfully implemented.”

Rep. Anna Eshoo (D-CA): “The Biden administration has proposed what they view as a solution to the lack of staff providing care in nursing homes. Red light and siren: Hire more people. It’s as simple as that.”

Schumann: “I am concerned that the Administration does not realize the unintended consequences of this policy, and how it will disproportionately impact underprivileged seniors and underserved communities. As a small, independent operator who serves residents on Medicaid, we do not have the resources to meet this unfunded mandate.”

In addition to Schumann and Killingsworth, the committee heard from Mary Killough, vice president of operations and government relations for AccentCare; Shelly Hughes, a CNA; and Lori Smetanka, executive director of The National Consumer Voice for Quality Long-Term Care.

To learn more about the hearing and watch the recording, visit the Energy and Commerce website here.