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discover The Issues

Historic Workforce Shortage

Prior to COVID-19, the senior care industry was already in search of workers due to concurrent declines in birth rate, immigration, and the number of adults working outside the home. The pandemic caused the loss of another 400,000 senior care workers, adding strain to those who stayed behind. This significant loss of workforce is the accelerant fueling an exodus of staff to other labor sectors. This crisis will only get worse as the 65 and older population is projected to jump 30 percent – to 73 million – by 2030, while the 65 and under population is barely expected to budge. The advocacy group PHI estimates the country will need to fill nearly 8 million direct care job openings by the end of the decade. The senior care industry has told Congress and the White House repeatedly that the nation’s interconnected healthcare system is facing unprecedented challenges. Negative stories aimed at weaponizing public opinion against nursing homes are a convenient scapegoat for policymakers to avoid addressing the chronic neglect of the healthcare sector. In reality, with the overwhelming majority of financing in the sector coming from state and federal sources, it is clear that policymakers have made deliberate decisions to undermine senior care for decades.

source: One | Two

Historic Underfunding

Nursing homes in underserved communities are overwhelmingly financed by Medicaid, which chronically pays below the cost of care. In addition, Medicaid enrollees tend to have more chronic health conditions at a higher level of acuity than the general population, meaning they need more intensive care. The trouble with Medicaid — the only federal program that pays for long-term care — is a reimbursement rate that the industry has long advocated is too low, about $200 for each day of care, on average. Medicare pays at least twice as much, but it only covers up to 90 days of post-acute care and rehabilitation, typically following a hospital stay.

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Uncover The Solutions

Fighting Minimum Staffing Mandates

The Biden Administration is attempting to find a regulatory solution for a workforce supply problem in the form of a staffing mandate for Skilled Nursing Facilities (SNFs). A CLA report found that 94% of nursing homes would be unable to comply with a potential 4.1 hours per day staffing minimum, and that 450,000 residents could be displaced if facilities are unable to boost their workforces. Moreover, facilities would be forced to reduce their census to meet the proposed minimum, and it would cost upwards of $11.3 B annually to hire the proper staff, if those healthcare workers were available. Currently, providers do not have a robust pipeline from which to hire additional staff or the adequate funding to attract new workers. There is a real risk that these new mandates will lead to an increase in skilled nursing facility closures, especially in rural and low-income areas. Providers are instead asking that Centers for Medicare & Medicaid Services (CMS) grant latitude based on factors like availability of local labor, resident acuity, and buildings’ physical layout along with more Medicare and Medicaid funding to pay for any required expansion. Penalizing and shutting down communities who are working in good faith to solve these issues exacerbates the problem.

source: One

Recapturing Unused Visas

The ongoing healthcare workforce shortage is compounding issues in hospitals and senior care communities across the nation. For more than fifty years, the declining birth rate in developed countries has increased the need and competition for foreign-born workers. Immigrants constitute 22% of the nursing assistant workforce, compared to 16% of the total U.S. labor force. Nearly one in three immigrant healthcare workers — 30.4% — were employed in long-term care settings. A bill introduced in March 2021 would allow thousands of unused, employment-based visas from previous years to go to qualified foreign nurses and doctors who wish to work in the United States.​ Research shows that these highly skilled immigrants allow companies time to promote innovation and growth.

source: One | Two | Three | Four |

Extending Temporary Nurse Aide (TNA) Waivers

States do not have enough instructors or available testing sites to meet the number of applicants ready to take the Certified Nursing Aide certification exam. This risks the loss of thousands of workers that were hired under emergency flexibilities during the pandemic. 17 states and hundreds of facilities have requested an extension of this TNA program to date, meaning tens of thousands of long term care jobs could be at risk when the Public Health Emergency (PHE) ends. The PHE is expected to end on May 11, 2023. Waivers to allow these workers to continue working an additional 24 months following the end of the PHE would solve this issue and count toward their training hours.

source: One

Preventing State-Level Staffing Agency Price Gouging

Staffing agencies are largely unregulated, allowing them to create non-compete clauses at exorbitant rates. Hiring agency staff is a last resort because familiarity is key to meeting seniors’ and their families’ physical, social, and emotional needs. Adding temporary workers to an already existing care team causes strain and is highly inefficient because organizational knowledge has to be retaught again and again. There are financial costs to agency staffing as well. Agency fees cost providers one-and-a-half to two times the hourly rate. This leaves less money to pay higher wages to permanent staff. Most states have price gouging laws activated during a government-declared state of emergency prohibiting suppliers from charging unconscionable prices for necessary goods and services. We encourage each state to add direct care services provided by healthcare staffing agencies to existing law.

source: One | Two | Three | Four | Five |

Financial Assistance for Senior Living Communities

Assisted living is an important part of the continuum of long-term care, which helps delay required nursing services for elderly and disabled individuals. These communities have been significantly impacted by both high agency costs and the shortage of CNAs to hire. We encourage each state to provide state grants through fiscal year 2023-2024 to allow assisted living communities time to stabilize their funding structures to cover the costs spent during the pandemic for additional staffing.

Permanently Eliminating Telehealth Restrictions

The PHE expanded the number of services Medicare would cover via telehealth, increased payment rates for those services, and included additional locations and applicable technology. It is clear from the success of telehealth adoption during the pandemic that seniors need permanent flexibility to decide with their doctors whether or not an in-person visit is medically necessary. Telehealth increases healthcare accessibility to those living in rural areas and makes specialists available across the country. For individuals living in senior care communities, virtual visits benefit residents and their caregivers through fewer trips outside of the community, less exposure to infectious diseases, and an increased chance of being seen sooner. At the end of 2022, Congress extended telehealth flexibilities through the end of 2024. The goal now is to permanently eliminate telehealth restrictions so that providers and seniors alike can access beneficial technologies that increase the timeliness of care.

source: One

Increasing the Use of Technology in Senior Care Communities

The global pandemic accelerated the creation and adoption of technology in senior care communities, enhancing the quality of life for residents and making staff more productive and mobile. Technology helps senior care communities do more with fewer resources by streamlining workflows and eliminating redundancies and mundane tasks. Smart technology and connected devices can save energy and money, which can be used for higher wages to reduce turnover and attract new staff. The adoption of technology into communities requires both internet infrastructure and security. Existing workforce challenges need to be solved to ensure smooth transition and uptake of these groundbreaking solutions in senior care. Federal financial assistance is needed in order for providers to take advantage of new solutions. As a starting point, CMS should set Medicare reimbursement rates that incentivize providers to make investments in technology that have proven positive clinical outcomes and ease the burden of care on the direct care workforce.

Raising Medicaid Reimbursement Rates

We must advocate for raising Medicaid reimbursement rates to cover the true cost of care. Reimbursement for the majority of long term care communities is funded via Medicaid. Currently, the federal government sets rates in conjunction with state add-ons. For every dollar that a nursing center spends on caring for a Medicaid Patient, state Medicaid programs only reimburse the nursing center, on average, approximately 89 cents, according to AHCA. States should be paying an adequate rate, and the issue is defining adequacy. Right now, there’s nothing close to adequacy.

learn Senior Care 101

ADLs

Activities of Daily Living (ADL) include bathing, dressing, grooming, using the toilet, eating, and moving around—for example, getting out of bed and into a chair.

Agency Nurses

Nurses who work for a professional staffing agency and sign temporary contracts with medical organizations to provide services on an as-needed basis.

Assisted Living

Assisted living is for people who need help with activities of daily living, but not as much help as a nursing home provides. It is primarily paid for by individuals’ private or personal funds, such as long-term care insurance or personal assets.

CNA

A Certified Nursing Assistant (CNA) helps patients with a limited scope of basic care duties while under the supervision of a Licensed Practical Nurse (LPN) or registered nurse (RN). CNAs may also be called a nursing assistant or a nurse’s aide.

Home Care

Unlike home health, home care is classified as personal care or companion care and is considered “non-clinical.” Home care provides non-medical care when an individual needs help with Activities of Daily Living (ADLs).

Home Health Care

Includes skilled nursing care, as well as other skilled care services, like physical and occupational therapy, speech language therapy, and medical social services. In short, it is medical care that is prescribed by your doctor and administered in your home.

Long-Term Care

Long-term care is provided in different places by different caregivers, depending on a person’s needs. The most common type of long-term care is personal care — help with Activities of Daily Living (ADLs). Long-term care also includes community services such as meals, adult day care, and transportation services.

Long-Term Care Insurance

Purchased policies from insurance companies that can help pay for nursing or custodial care for a person who’s chronically ill or disabled. Some policies cover only one type of care, while others cover several.

Long-Term Care Provider

These professionals provide care to elderly patients in a variety of settings, including nursing homes, assisted living facilities, adult day care, subacute care facilities, rehabilitation facilities, senior housing, skilled nursing facilities and hospices.

LPN

A Licensed Practical Nurse (LPN) is responsible for the comfort of the patient and able to perform additional tasks to care for patients under the supervision of a registered nurse (RN).

Medicaid

A joint federal and state health insurance program specifically designed for low-income persons. Eligibility and coverage varies from state to state. It is possible to be “dual-eligible” for both Medicaid and Medicare. Medicaid does not limit the number of days they will pay for nursing home care if you meet eligibility requirements.

Medicare

A federal health insurance program for individuals 65 and older. Medicare will not cover long-term care benefits, but Medicaid will. As an example, Medicare will cover nursing home care, but only on a short-term basis, up to 100 days.

Nursing Home/Skilled Nursing Facility

A nursing home is more of a permanent residence for people in need of 24/7 care, while a skilled nursing facility is a temporary residence for patients undergoing medically necessary rehabilitation treatment.

PHE

A Public Health Emergency (PHE) allows the Secretary of the Department of Health and Human Services to take action deemed necessary to address significant infectious disease outbreaks or bioterrorist attacks.

RN

A Registered Nurse (RN) has a more expanded scope of practice than Licensed Practical Nurses (LPNs), in that they can perform diagnostic tests, administer medications, and educate patients on how to manage their health after treatment. An RN is a healthcare professional who has graduated from a nursing program and who holds a nursing license.

Skilled Nursing Care

Care that is provided by registered nurses in a medical setting under a doctor’s supervision. Individuals who require ongoing medical care after an injury, rehabilitation, or other highly effective medical treatment qualify for skilled nursing care.

Telehealth

Also called telemedicine, encompasses a variety of telecommunications technologies and tactics to provide health services from a distance.

Visas

A federal endorsement that would allow foreign-born workers to enter the United States in order to work in a specific occupation. Employment visas are divided into several categories, each of which has its own requirements.

ADLs

Activities of Daily Living (ADL) include bathing, dressing, grooming, using the toilet, eating, and moving around—for example, getting out of bed and into a chair.

Agency Nurses

Nurses who work for a professional staffing agency and sign temporary contracts with medical organizations to provide services on an as-needed basis.

Assisted Living

Assisted living is for people who need help with activities of daily living, but not as much help as a nursing home provides. It is primarily paid for by individuals’ private or personal funds, such as long-term care insurance or personal assets.

CNA

A Certified Nursing Assistant (CNA) helps patients with a limited scope of basic care duties while under the supervision of a Licensed Practical Nurse (LPN) or registered nurse (RN). CNAs may also be called a nursing assistant or a nurse’s aide.

Home Care

Unlike home health, home care is classified as personal care or companion care and is considered “non-clinical.” Home care provides non-medical care when an individual needs help with Activities of Daily Living (ADLs).

Home Health Care

Includes skilled nursing care, as well as other skilled care services, like physical and occupational therapy, speech language therapy, and medical social services. In short, it is medical care that is prescribed by your doctor and administered in your home.

Long-Term Care

Long-term care is provided in different places by different caregivers, depending on a person’s needs. The most common type of long-term care is personal care — help with Activities of Daily Living (ADLs). Long-term care also includes community services such as meals, adult day care, and transportation services.

Long-Term Care Insurance

Purchased policies from insurance companies that can help pay for nursing or custodial care for a person who’s chronically ill or disabled. Some policies cover only one type of care, while others cover several.

Long-Term Care Provider

These professionals provide care to elderly patients in a variety of settings, including nursing homes, assisted living facilities, adult day care, subacute care facilities, rehabilitation facilities, senior housing, skilled nursing facilities and hospices.

LPN

A Licensed Practical Nurse (LPN) is responsible for the comfort of the patient and able to perform additional tasks to care for patients under the supervision of a registered nurse (RN).

Medicaid

A joint federal and state health insurance program specifically designed for low-income persons. Eligibility and coverage varies from state to state. It is possible to be “dual-eligible” for both Medicaid and Medicare. Medicaid does not limit the number of days they will pay for nursing home care if you meet eligibility requirements.

Medicare

A federal health insurance program for individuals 65 and older. Medicare will not cover long-term care benefits, but Medicaid will. As an example, Medicare will cover nursing home care, but only on a short-term basis, up to 100 days.

Nursing Home/Skilled Nursing Facility

A nursing home is more of a permanent residence for people in need of 24/7 care, while a skilled nursing facility is a temporary residence for patients undergoing medically necessary rehabilitation treatment.

PHE

A Public Health Emergency (PHE) allows the Secretary of the Department of Health and Human Services to take action deemed necessary to address significant infectious disease outbreaks or bioterrorist attacks.

RN

A Registered Nurse (RN) has a more expanded scope of practice than Licensed Practical Nurses (LPNs), in that they can perform diagnostic tests, administer medications, and educate patients on how to manage their health after treatment. An RN is a healthcare professional who has graduated from a nursing program and who holds a nursing license.

Skilled Nursing Care

Care that is provided by registered nurses in a medical setting under a doctor’s supervision. Individuals who require ongoing medical care after an injury, rehabilitation, or other highly effective medical treatment qualify for skilled nursing care.

Telehealth

Also called telemedicine, encompasses a variety of telecommunications technologies and tactics to provide health services from a distance.

Visas

A federal endorsement that would allow foreign-born workers to enter the United States in order to work in a specific occupation. Employment visas are divided into several categories, each of which has its own requirements.

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