Senate Democrats are seeking to improve access to affordable long-term care by using incentives to address workforce shortages, increasing nursing home quality and expanding home care services.
The initiative was outlined in a letter signed by Senate Finance Committee Ranking Member Ron Wyden and 16 other Senate Democrats. The budget reconciliation signed by President Donald Trump last July and repeal of the federal minimum staffing rule could damage long-term care, worsening access to home care and exacerbating nursing home resident safety, according to a flash report from Wyden’s office.
The senators wrote these setbacks are deepening the long-term care crisis. Nursing home thought leaders and associations are waiting to get more details, but said that any reforms must include the reimbursement and support structures operators would need to build a more sustainable workforce.
The long-term care system is unaffordable and fragmented, with the cost of a private nursing home room far exceeding the average Medicare beneficiary’s income at $120,000 per year, the senators noted in the letter.
David Grabowski, professor of health care policy at Harvard Medical School and contributor to the National Academies of Sciences, Engineering and Medicine (NASEM) landmark report in 2022 which called for many of the same reforms, said he was “hopeful that we would see different policies to address some of the challenges that we currently face.”
“But there really hasn’t been anything,” Grabowski told Skilled Nursing News. “We have even taken some steps back, I would say, and as the letter suggests, with Medicaid funding and the kind of pullback of the minimum staffing standard … I don’t know necessarily that we’re making good progress right now on a lot of these issues.”
‘This is a five-alarm fire’
In the letter, the senators wrote about factors that can force older adults and their loved ones into “a confusing, fragmented long-term care system filled with gaps, complexity and staggering price tags.”
The senators cited data from the most recent Genworth Cost of Care Survey showing that around-the-clock home health care can cost more than $288,000 annually. Full-time personal care services such as help eating or performing activities of daily living cost about $62,400 per year, and a private nursing home room averages more than $120,000 per year, the senators wrote.
“All of these costs far exceed what the typical person with Medicare lives on, $36,000 per year,” the letter reads. “A lifetime of savings can disappear in a matter of months. Families who worked and saved their entire lives often discover there are no affordable options when care is needed most – this is a five-alarm fire.”
The Finance Committee is working on “policies to invest in Medicaid home- and community-based services and establish a home care guarantee for people with Medicare,” the letter reads.
They also are taking aim at nursing home quality and the strength of the long-term care workforce.
To improve nursing home quality, the senators are working on policies that make sure taxpayer dollars are spent on director care, strengthen staffing standards and improve transparency of reporting and oversight.
The Finance Committee also is working on multiple policies to improve wages, benefits, training, and career pathways for nursing home workers; set in stone new training incentives involving government, employers, and labor unions; improve immigration and attract and protect immigrant workers; maintain the jobs, savings and retirement security of family caregivers; and recognize caregivers as “essential.”
Nursing homes a ‘forgotten issue’ on the Hill
Nursing homes are a “forgotten issue” on Capitol Hill right now, but Grabowski said the letter was encouraging. It’s unclear how reforms mentioned in the letter will play out in actionable ways, with midterm elections looming, he said. Either way, senators said in the letter that they plan to have more details on these reforms in the coming months.
“I don’t know how much enthusiasm there is right now on the Hill … these are steps to really fix some of the problems we have. I don’t know if they’re going to happen in the short-term, but I like having a road map here,” said Grabowski. “Maybe it starts later, after the midterms, maybe it starts in two or three years, but at least carving out a path here. I think that this is encouraging.”
Grabowski added that growing home care, making nursing homes higher quality and bolstering the frontline caregiver workforce are “exactly the right areas to reform our system.”
“I think everybody, regardless of political party, wants care and community,” said Grabowski. “We want good nursing homes, we want more workers, and so how do we go about doing that? I hope that’s a discussion that we have after the midterms.”
Nursing home associations are taking the letter in stride and are willing to work with Senators on reforms that will ultimately reflect the realities of the sector’s current challenges and a rapidly aging nation, and provide adequate resources for operators.
“LeadingAge plans on engaging in all three topics addressed in the letter and is approaching this bold effort optimistically,” said Molly Gurian, VP of police and government affairs for LeadingAge. Gurian placed emphasis on “a public policy and reimbursement structure built to support, trust, and incentivize high quality nursing home care with staff that are well trained and paid fairly.”
Clif Porter, president and CEO for the American Health Care Association (AHCA), said that while the association supports these goals of improving quality, transparency and building a sustainable workforce, reform must also recognize and address chronic underfunding and labor shortages that permeate the sector.
“We are already striving to advance rational and achievable solutions through our Caregivers for Tomorrow initiative and Better Way policy priorities,” said Porter. “AHCA/NCAL remains committed to working with lawmakers and other stakeholders to develop bipartisan and balanced solutions.”
Companies featured in this article:
