Rural Issues in Aging Services

Part of LeadingAge's 2020 Policy Priorities

LeadingAge Advocacy Goals

  • Federal and state regulatory and payment policies must accommodate challenges facing rural providers.
  • Ensure that rural aging services organizations have the financial resources to be able to hire and retain enough high-performing staff at all levels.
  • Promote policies that reimburse transportation in rural areas for staffing and to support older persons’ mobility and independence.
  • Promote policies that address financing inequities, such as equalizing funding with federal critical access hospitals.
  • Support improving broadband reception in rural and frontier communities so that aging services providers can better reach the people they serve and provide additional services to older persons.
  • Support increased Medicaid funding and Medicare rural add-ons for aging services.
  • Replicate programs and models that hold promise.

The Issue

Rural aging services providers face the same financing and policy challenges that all other providers face, but these challenges are magnified by distance and loss of population. Transportation, housing, workforce shortages, care coordination, telehealth, technology, and internet challenges, along with inadequate public financing, raise significant public policy challenges. As populations shift to urban areas, these problems are exacerbated. And yet our nonprofit nursing homes and low-income housing and life plan communities form the backbone of many rural areas, providing care, services, and employment. If they close, communities - and the older adults remaining in them - lose.

Advocacy Action 2020

116th Congress

  • Telehealth: We support the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 (HR 4932/S 2741) to expand the use of telehealth.
  • Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) – We promote this legislation that counts all nights in the hospital toward Medicare Part A SNF eligibility.
  • Rural Hospice Access: We support the Rural Access to Hospice Act (HR 2594) that would allow rural health care providers and FQHCs to receive payment for physicians’ services, while acting as attendings for their patients in hospice care.
  • Rural Internet Access: We support the Internet Exchange Act (IX – S. 1166; H.R. 3869) to help improve high-speed internet access in rural areas.
  • Aging Services Guest Worker Program: We support the introduction and enactment of a temporary guest worker program for CNA and home care aides.
  • J-1 Cultural Exchange Visa Changes: We support the introduction and enactment of Cultural Exchange Visa changes to include aging services workers, in addition to child care workers.
  • Modify EB-3 Visas for Nurses: We support expanding and modifying visas to support improvements to increase the quotas for foreign-born LTSS nurses.
  • Expand “Religious Occupation” to Include Aging Services: We support modifying the R-1 program to cover temporary workers so it includes include aging services settings.
  • Increase Geriatric Academic Professionals and Clinician Educators: We support enactment of the EMPOWER for Health Act of 2019 (H.R. 2781) that reauthorizes the Geriatrics Workforce Enhancement Program (GWEP) and Geriatrics Academic Career Awards (GACA) program to provide training to students, faculty, providers, direct service workers, patients, and families to address gaps in health care for older adults.
  • Older Americans Act Reauthorization: We support the reauthorization of the Older Americans Act to include provisions focused on the direct care workforce and allows the SCSEP program to train older workers in LTSS. The Dignity in Aging Act (H.R. 4334) has passed the House.
  • Award Grants to Recruit and Retain Direct Care Workers: We support the Direct CARE Opportunity Act (S. 2521; H.R. 4397) that directs the Department of Labor to award grants to recruit and provide advancement opportunities to direct care workers.
  • Reinstate CNA Training Programs Within SNFs: We support enactment of the Nursing Home Workforce Quality Act (H.R. 4468) that repeals the CNA training “lock-out” and reinstates training programs when SNFs are in compliance.

Executive Branch

  • We support finalizing Department of Labor proposed regulation allowing individuals under the age of 18 to operate lifts.

Actions You Can Take Now

  • Visit the Advocacy Action Center to let your representative and senators know that you support preserving and enhancing services for older adults in rural areas.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact services in rural areas.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to preserve and enhance services for older adults in rural areas.

Additional Resources