Policy Asks

Older adults and their families are facing immediate challenges accessing essential care and services to remain independent, safe, and healthy. Longstanding workforce shortages in the aging services sector, exacerbated by the COVID pandemic, mean families’ requests for care go unfilled and countless nursing homes in communities across the country are closing their doors permanently. Aging services providers rely on funding and programs supported by federal policies. Without more attention and resources, the crisis will only deepen as America ages.

It is time for Congress and the Administration to take immediate action to:
  • Pay aging services professionals a living wage
  • Offer incentives to retain and attract qualified staff
  • Expand training and advancement opportunities
  • Build dependable international pipelines of trained caregivers
  • Enact meaningful, equitable long-term care financing
Include in the FY 2023 Appropriations package:
  • Build up our workforce through funding for the National Health Care Workforce Commission authorized by the Affordable Care Act.
  • Bolster wages for dedicated aging services professional caregivers through $1.6 billion to the Department of Health and Human Services (HHS) to support staffing wage subsidies that deliver tuition assistance, childcare and transportation assistance.
  • Invest in the Administration for Community Living Direct Care Workforce Competitive Grants with $1 billion and the creation of the Direct Care Workforce Technical Assistance Center with $20 million.
  • Support a Centers for Medicare and Medicaid Services study of on-site nursing staff coverage with $50 million, as specified in the Nursing Home Workforce Training Grants.
  • Increase our pipeline of prospective workers by funding the Department of HHS and Education to jointly develop and implement an aging services training program for high school students.
  • Reauthorize and expand grants that train low-income workers for high demand jobs by supporting the Health Profession Opportunity Grants program with $40 million.
  • Implement nontraditional apprenticeship programs, including serving individuals with disabilities or nontraditional apprenticeship populations, with $350 million in funding support. 
  • A directive to the Biden Administration to establish an Interagency Aging Services Workforce Taskforce and report on activities to Congress.
Take the following legislative action:
  • Pass the Better Care Better Jobs Act (S. 2210) or enact the Home and Community Based Services (HCBS) provisions of H.R. 5376. Any HCBS extension should include a permanent HCBS Federal Medical Assistance Percentage (FMAP) bump, and provisions to provide direct pass throughs for workers and to update Medicaid rates regularly. 
  • Enact the Building America’s Health Care Workforce Act (H.R. 7744) to get more nursing home aides on the floor as quickly as possible.
  • Cosponsor and help pass the Ensuring Seniors' Access to Care Act (S. 4381) to speed up the training of more certified nursing assistants in nursing homes.
  • Enact the Palliative Care and Hospice Education and Training Act (PCHETA) (S. 4260) to allow more training of specialized workers to support people with serious illness.
  • Pass the Citizenship for Essential Workers Act (S. 747 / H.R. 1909) so that long-term care workers who were deemed “essential” during the pandemic have a pathway to citizenship and permanent residency status.
  • Pass the Health Care Workforce Resilience Act (S. 1024, H.R. 2255) to speed up the ability of foreign nurses and doctors to come to the United States and start working.
  • Enact the Future Advancement of Nursing Act (H.R. 851/S. 246) to get more nurses trained and working.
  • Make permanent the important gains made in telehealth over the course of the pandemic that were extended as part of the Consolidated Appropriations Act 2022 that allow aging services providers to expand the reach of their existing staff.   
The Biden Administration can immediately make an impact with these administrative changes:
  • Establish and convene a cross-agency working group in the Domestic Policy Council to bring all federal resources and solutions together to solve the aging services workforce crisis.
  • In HHS:
    • Design and implement a methodology for calculating a living wage and incorporate it into Medicare and Medicaid reimbursement formulas.
    • Do not impose staffing mandates on nursing homes without increasing reimbursement to providers to cover the cost of additional staff and without ensuring that there is a ready supply of applicants.
    • Advocate that HHS continue to think more futuristically about technology and how to pay for telehealth and technology needs to successfully deliver care and services across all of our provider types.
  • In the State Department, permit virtual interviews in embassies to decrease wait times–currently a year or more–for in-person interviews for caregivers who have been hired by providers.
  • In the Department of Labor (DOL), require a separate queue for processing prevailing wage determinations to aging services providers who are hiring registered nurses and physical therapists. 
  • Take immediate steps to expedite United States Citizenship and Immigration Services  processing of backlogs and delays with immigration applications for aging services professionals.
  • In the Department of Housing and Urban Development, improve salary expectations for staff in HUD-assisted senior housing communities, including service coordinators.

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