Senate Hearing Focuses on Long-Term Care Worker Woes, But Provider Groups Say Related Bill ‘Misses the Mark’

Federal lawmakers have introduced the Long-Term Care Workforce Support Act, in conjunction with a hearing that took place Tuesday, hosted by the U.S. Senate Special Committee on Aging. The bill, if passed, would increase the number of direct care professionals, including in rural communities.

Some associations representing the nursing home industry said the legislation managed to be too broad while also leaving key roles out, and completely sidesteps inadequate Medicaid reimbursement.

The bill would improve pay and promote a safe and respectful work environment however, and document the need for long-term care, effective recruitment and training strategies. Direct care professionals, according to the bill, are employed by and provide services to people living in nursing homes, as well as in home health settings, group homes, assisted living facilities, intermediate care facilities and other long-term care settings.

The Senate committee hosted a discussion on the long-term care workforce to address shortages and improve the profession alongside the introduction of the legislation. Committee members discussed the federal minimum staffing proposal, legislation to boost the workforce and the ever-present workforce shortage.

Nursing home association LeadingAge, which represents nonprofit organizations, said the legislation recognizes the industry’s workforce crisis, but refinements are needed. Clif Porter, senior vice president of government relations for the American Health Care Association and National Centers for Assisted Living (AHCA/NCAL), said the legislation “misses the mark” and won’t have the desired impact.

“It is especially disappointing that there continues to be a lack of support for nursing homes when they have been the hardest hit by this labor crisis and face a federal staffing mandate,” Porter said in a statement. “The entire long term care continuum, no matter the type, faces a growing caregiver shortage that impacts access to care for our nation’s seniors and individuals with disabilities.”

The legislation ignores a wide swath of the profession and fails to address the elephant in the room, he said – that Medicaid often doesn’t cover the cost of care, making it difficult for providers to offer high paying, competitive jobs.

“As experienced advocates with a rich history in helping to craft laws and regulations regarding the financing and delivery of long-term services and supports, we can say with confidence that the devil is truly in the details,” said Katie Smith Sloan, president and CEO of LeadingAge.

Smith Sloan urged policymakers to pay attention to necessary refinements on funding for education and training initiatives, along with investment in state and federal infrastructures to ensure programs achieve their desired goals.

A committee hearing focused on pay, training

Dr. Jasmine Travers, a gerontological nurse practitioner and assistant professor of nursing at New York University Rory Meyers College of Nursing, called on the committee to address workforce challenges using a multi-pronged approach including federal and state governments, aging organizations, payers, provider advocates and care recipients, along with direct care workers themselves.

Financial investment in minimum wage floors, wage pass throughs or incentive payment programs must be considered, she said, as well as benefit packages that include child care and transportation, paid sick leave and rural pay differentials.

Next, providers, states and federal officials need to invest in comprehensive and accessible training for direct care workers, and foster a positive – and safe – work environment through culture change.

“Direct care workers report that a pervasive lack of respect is more detrimental than low pay. Leaders must be held accountable for creating positive work environments that are free of abuse and disrespect,” said Travers. “As one direct care worker shared, if a cashier was punched, the customer would without a doubt be arrested. But you can punch, spit on, kick or bite a health care worker with no punishment.”

Other prongs in the workforce approach include incentivizing providers to integrate direct care workers into care teams and center their voices, she said.

In terms of the federal minimum staffing requirements, officials must ensure that the most “thoughtful” version of the proposal is finalized and enacted immediately, she said.

In other words, the federal staffing mandate needs to be coupled with support from government officials in the form of the latest legislation, she said.

Fellow witness Brooke Vogleman, licensed practical nurse (LPN) for TLC Management in Indiana, said she’s hopeful that federal policymakers will help address the workforce shortage through targeted investments and not blanket mandates, while keeping in mind that quality over quantity should be a driving force behind staffing initiatives.

“For instance, LPNs [licensed practical nurses] are integral to the interdisciplinary team and long term care. Staffing mandates that do not include our contributions to patient care or recognize us as nurses is very concerning to me and will have unintended negative consequences on our residents,” Vogleman said of the federal staffing proposal.

The proposal will also force facilities to depend more on costly staffing agencies and end up increasing burnout among nursing home workers.

“Current caregivers will be stretched and working even longer hours in order to comply with these impossible standards,” Vogleman told the committee. “If facilities still cannot find the workers needed, which is very likely since we are facing a caregiver shortage, more facilities will be forced to limit the access to care or even close their doors completely.”

Matthew Connell, senior vice president for healthcare at Ivy Tech Community College, was another witness during the hearing, along with Nicholas Smith, direct support professional and behavioral specialist lead for provider SPIN in Pennsylvania.

Digging into new workforce legislation

The Long-Term Care Workforce Support Act was put forward in the House of Representatives by Democratic Rep. Debbie Dingell of Michigan, and in the Senate by Democratic Sens. Bob Casey of Pennsylvania, Tim Kaine of Virginia and Tammy Baldwin of Wisconsin. The bill has 20 co-sponsors in the Senate.

The legislation addresses a number of Travers’ concerns, if broadly. The bill seeks to improve compensation for direct care professionals to reduce vacancies and turnover, and provide pathways for women, people of color and people with disabilities to enter and be supported in the workforce.

Forty-four organizations endorsed the bill, including the Long Term Care Community Coalition (LTCCC); AHCA and LeadingAge were not among endorsing organizations.

Currently, caregivers in nursing homes earn a median wage of $15.43 an hour, according to bill text. Such staff are often living in poverty.

Nicholas Smith said it’s common for direct care professionals to work 60 to 70 hours per week with little time for family and leisure activities. Better pay will mean weekly hours will be reduced, and staff will be able to provide better care with less stress and improve work-life balance.

“The long- term care system relies on a workforce that is often unseen and unheard, known as direct care workers,” said Travers, of the 4.8 million personal care aides, home health aides and certified nursing assistants (CNAs) on long-term care. “Despite the critical role of the direct care workforce, it faces significant challenges in recruitment, retention and morale that threaten its sustainability. In the next decade, the long-term care sector will need to fill 9.3 million jobs.”

The supply of direct care workers is shrinking relative to the demand, especially in nursing homes serving a high proportion of Black residents in deprived neighborhoods, Travers said. Meanwhile, turnover among direct care workers is 46% across long-term care settings.

Another aspect of the legislation would document the need for long-term care and identify effective recruitment and training strategies, while promoting practices that help retain staff. The bill would work to make sure staff are treated with respect and provided a safe work environment, protection from exploitation and fair compensation.

“Workforce continually reports that their job is physically taxing, emotionally draining and stressful. The issues affecting this workforce are multi-dimensional and are compounded by an external environment that devalues their worth,” said Travers. “Put simply, it is a job behind a job with underlying realities that make direct care work unsustainable.”

For residents and their families, the legislation aims to improve access and quality of long-term care.

Overall, the bill’s sponsors say it would strengthen the nursing home workforce to support the 53 million unpaid family caregivers who are providing complex services across the care continuum.