Bipartisan support needed to re-establish House Aging Committee

Published in RINewsToday on May 6, 2024

It was almost like attending a 34^th high school reunion. After over three decades, an on-line meeting on April 25th, would bring five former senior staffers of the House Select Committee on Aging (HSCoA) and House Rules Committee back together to provide firsthand accounts to Maia Leeds, legislative assistant for Josh Gottheimer (D-NJ), as to why the New Jersey Congressman, co-chair of the bipartisan House Problem Solvers Caucus, should call on the caucus to endorse H. Res. 1029, re-establishing the House Select Committee on Aging.

Washington, DC-based groups, including the National Committee to Preserve Social Security and Medicare (NCPSSM), Social Security Works and the Alliance for Retired Americans, including this writer, along with key staff of Congressman Seth Magaziner (D-RI), the primary sponsor of the resolution, participated in the discussion of how the Rhode Island Congressman could attract more cosponsors, especially House Republican lawmakers.

Throughout the half-hour meeting, Leeds and others stressed the importance of recruiting Republican lawmakers, calling for bipartisan support of H. Res. 1029. According to “Votes in Congress” published in the New York Times on Oct. 13, 1974, even with the Democrats controlling the House in 1974, the HSCoA was established by a huge bipartisan vote of 299 to 74. In 1993, House Democratic belt-tightening efforts to save $ 1.5 million funding the operations of HSCoA would force it to close its door.

The House Aging Committee was not charged with drafting legislation. Its mission was to conduct investigations and hold hearings to put the spotlight on aging issues that would ultimately lead standing committees with aging jurisdiction to craft legislation to address these issues.

From the 114^th Congress, until he retired during the 117^th Congress, in each Congressional session, former Congressman David Cicilline had introduced a resolution to bring back the HSCoA. The resolution failed to gain traction and get support from either House Republic Leader Paul Ryan or House Democratic Leader Nancy Pelosi. Magaziner would ultimately pick up the baton and introduce H. Res. 1029, on Feb. 23, 2024. This resolution was referred to the House Committee on Rules for mark-up, and if passed will be considered by the full House. At press time, there are only 26 Democratic cosponsors, with no Republican cosponsors.

Simply Put…

Magaziner’s 213-word resolution simply amends the Rules of the House to establish a HSCoA, without legislative jurisdiction, to conduct a continuing comprehensive study and review an array of aging issues, including income maintenance, poverty, housing, health (including medical research), welfare, employment, education, and long-term care.

H. Res. 1029 also calls for the reestablished HSCoA to study ways that would encourage the development of public and private sector programs and policies that would keep older Americans active in their community.

The resolution would also allow the HSCoA to develop policies that would encourage the coordination of both government and private programs designed to deal with problems of aging -and to review any recommendations made by the President or White House Conference on Aging in relations to programs and policies impacting seniors.

According to EveryCRS Report, the House can easily establish an ad hoc (temporary) select committee just by approving a simple resolution with no Senate or Presidential approval. It contains language establishing the committee, detailing a purpose, defining membership. Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill.

Magaziner, currently out on parental leave, couldn’t make the online meeting, but Chief of Staff Clayton Schroers, and Kyra Whitelaw, Legislative Assistant, came to monitor the gathering to gain insight from former staffers of HSCoA’s impact on the development of aging policy.

According to Magaziner, his staff are working hard to speak to other congressional offices about the benefits of the proposed committee and who will continue to work to raise the profile of this resolution to encourage other members to become cosponsors. “I was grateful for the opportunity to present to the Leadership Council on Aging, a national coalition of national nonprofit organizations that works on policy issues related to the well-being of America’s seniors,” says Magaziner, noting that his resolution has the support of the NCPSSM and Meals on Wheels America.”

As Magaziner works to increase the number of cosponsors for H. Res. 1029, he says: “The support of advocates is important to encouraging Congressional representatives to cosponsor this resolution.”

“I’m ready to work with anyone, from either party, to deliver results for Rhode Island—and that includes finding common ground on important legislation like H. Res. 1029,” says Magaziner. “I believe there’s still room for bipartisanship, and ensuring we address issues for seniors across the country should be an area where we can all agree. I will continue to urge my Republican colleagues to work together with Democrats to move our country forward,” he says.

Former Congressional staffers call for passage of H. Res. 1029

“A House Aging Committee would centralize Congress’s consideration of older American issues and could be of assistance to authorizing committees with legislative jurisdiction over agencies and programs important to seniors,” says Max Richtman, NCPSSM’s President and CEO, explaining why NCPSSM will directly encourage House members to cosponsor H. Res. 1029.

According to Richtman, a 16-year veteran of Capitol Hill, the pros outweigh the cons on supporting Magaziner’s resolution. A House Aging Committee would centralize Congress’s consideration of older American issues and could be of assistance to authorizing committees with legislative jurisdiction over agencies and programs important to seniors. However, it would take staff and clerk hire (money) away from the authorizing committees.

Like Magaziner, Richtman observes that bipartisan support for programs and agencies important to senior has a mixed record. “There is some bipartisan agreement on the Older Americans Act (OAA). But even on OAA, bipartisan action can vary widely, says Richtman, especially when Republicans want to make across the board cuts to non-defense discretionary spending, including OAA, Supplemental Nutrition Assistance Program and Low-Income Home Energy Assistance Program. “And there appears to be no bipartisan agreement on Social Security, Medicare and Medicaid,” he says.

Richtman, a former Staff Director of the Senate Special Committee on Aging, says that the upper chamber sees the value of the Senate Aging Committee, noting that he believes that it has operated in a bipartisan manner.

Bob Blancato, former Executive Director of the 1995 White House Conference on Aging and former Staff Director, Subcommittee on Housing & Consumer Interests, from 1978-93, has joined the efforts to pass H. Res. 1029. “I just wanted to add another voice in favor of this resolution,” says Blancato, President of Matz, Blancato and Associates.

According to Blancato, who served as Staff Director of the Subcommittee on Human Services from 1977 to 1991, important policies were addressed over those years. Several amendments to the Older Americans Act were adopting, including creating a separate program for home delivered meals. He remembers his subcommittee held the first hearing ever on the issue of grandparent visitation rights.

Although some standing committee chairs felt THE aging committee made them work harder because of issues raised in their legislative jurisdictions, there were many examples of both “working together,” says Blancato. He recalls the House Education and Labor Committee working close with his subcommittee on legislation, including the Older Americans Act and the Age Discrimination in Employment Act.

Blancato sees the need to bringing back the HSCoA. Since it was abolished over 30 years ago, there are many issues that need to be addressed with the graying of the nation’s population, he says.

“A good gauge to see if House lawmakers consider aging policy to be a bipartisan issue is if the Older Americans Act gets renewed on a bipartisan vote this year,” notes Blancato, stressing that “this will be a good test.”

Elaina K. Goldstein, JD, MPA remembers the day when the HSCoA ceased to exist. “It was heartbreaking to have to pack up the incredible work done by the HSCoA and I am thrilled to be involved with its resurrection,” says the former Legal Counsel for the Subcommittee on Retirement and Employment. “It would be incredible if H. Res. 1029 passes, to once again see its staff work hand in hand with the Committees of jurisdiction to get important issues into the light so they could be remedied to make life better for seniors,” she says.

As a former HSCoA staffer, Goldstein disagrees with those seeing conflict between the Select Committee and Standing Committees. “Quite the opposite,” she said, noting that Subcommittees did not have and will not have any legislative jurisdiction.,” she noted.

According to Goldstein, many of the Employee Retirement Income Security Act of 1974 (ERISA) health concerns and subsequent hearings held by HSCoA were uncovered by the Senate Finance Committee staff who felt they could not move forward politically in their Committee but felt the House Aging Committee could get the issue out in the open and then they could follow up. “As I said, these issues were ultimately addressed in the passage of the Health Insurance Portability and accountability Act of 1996,” she noted.

As to gaining Republican cosponsors, Goldstein sees aging policy losing some of its bi-partisan appeal with the debates over Social Security and Medicare. “It seems that Republican lawmakers feel the issues of Social Security and Medicare are Democratic issues,” she says, noting that there are so many others. “If the Committee would also take on the issues and concerns of people with disabilities —which they do in the Senate Aging committee —many issues that impact the aging are issues for the disabled as well,” she says, stressing this could well increase bi-partisan appeal.

Robert Weiner, President of Robert Weiner Associates News, saw the negative impact of the HSCoA being abolished. As Staff Director of the Health and Long-Term Care Subcommittee from 1975-76 and the former Claude Pepper’s (D-FL) Chief of Staff (1976-80) when he chaired the full committee, Weiner knew how shortchanged seniors would be when the committee was abolished. “I always have wanted that decision reconsidered.,” he said.

“Reform”, instead of facts on Social Security have unfortunately now become the political value system norm, and age discrimination has crept back more and more, from hiring and firing in everything whether private sector or politics. The Aging Committee and its members were and could again be a wedge of power representing older Americans of both parties,” says Weiner, who was a close confident of Pepper until he died in 1989.

Looking back, “We got legislation passed abolishing age-based mandatory retirement, as well as Medicare expansion of home health care, standards for cancer insurance, a major Social Security protection deal co-authored by Pepper, and many other laws by initial press during our investigations and then working closely with the standing committees on the bills,” says Weiner.

Some say that Cicilline’s efforts to pass the resolution to reestablish the HSCoA stalled because of the standing committee’s fear of loss of power in the legislative process. “This is anything but new. We did, and any new committee must, cooperate with, meet with, and support the standing committees’ efforts. Pepper always made friends and cooperated. We worked closely with chairs and leaders from Gus Hawkins (D-CA) to Gladys Spellman (D-MD) to Dan Rostenkoswski (D-Ill) to House Speaker Tip O’Neill (D-Mass) and Republican leader Bob Michel (R-Ill),” remembered Weiner.

The key to getting Magaziner’s resolution passed is for the Congressman to actively work to expand the co-sponsorships by taking co-sponsorship sign-up sheets and have conversations around the House floor and cloakrooms and thereby get to well over 100,” says Weiner.

A Final Note:

At the on-line meeting, former Senior Staff of HSCoA and Washington, DC-based aging groups, and Rhode Island senior advocates, praised Congressman Josh Gottheimer’s co-sponsorship of H. Res. 1029. Increasing the number of co-sponsors to over 100, especially recruiting GOP lawmakers, might just give the resolution traction this Congress. Hopefully, Congressman Brian K. Fitzpatrick (R-PA) and the moderate Democratic and Republican members of his caucus will see the value of following Gottheimer’s lead. Yes, aging should be considered a bipartisan issue, just like it was in 1974 when both Democrats and Republicans rallied to establish HSCoA.

Without support of the House Republican leadership, Richtman warns that it is unlikely that H. Res. 1029 will be considered during the 118th Congress. However, efforts to drive up the number of cosponsors – especially if it can attract some Republican support – might enable the resolution to be considered if there is a more pro-senior majority in the House of Representatives,” he says.

It’s now time for House Speaker Mike Johnson (R-LA) to step to the plate and support H. Res. 1029, and consider aging to be a bipartisan issue. The switching of legislative control in the Senate over 47 years and the contentious debates over Social Security and Medicare, has had little impact on the operations of the Senate Special Committee on Aging. The bipartisan panel has continued to investigate and put the spotlight on critical aging issues, working with Senate standing committees to draft legislation to enhance the life and well-being of America’s seniors. It’s now time for the House to bring back the HSCoA.

Herb Weiss, LRI’12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 44 years. To purchase his books, Taking Charge: Collected Stories on Aging Boldly, and a sequel, compiling weekly articles published in this commentary, go to herbweiss.com.

Participants of April 25 online meeting:

House Staffers: Chief of Staff Clayton Schroers and Kyra Whitelaw, Legislative Assistant, Office of Congressman Seth Magaziner; Maia Leeds, legislative Assistant, for Josh Gottheimer, Office of Congressman Josh Gottheimer.

Senior House Staffers: Bill Benson, former Assistant Secretary for Aging, US Dept. of Health and Human Services and former Staff Director of the Subcommittee on Housing & Consumer Interests, House Permanent Select Committee on Aging, from 1987-90; Bob Blancato, former Executive Director of the 1995 White House Conference on Aging and former Staff Director, Subcommittee on Housing & Consumer Interests, from 1978-93; Elaina K. Goldstein, JD, MPA, former Legal Counsel for the Subcommittee on Retirement Income and Employment; Robert S. Weiner, former Staff Director, Subcommittee on Health and Long-Term Care from 1975-77, Chief of Staff of the full Aging Committee from 1976-80); Thomas J. Spulak, former Staff Director, House Rules Committee (under Congressman Pepper), 1982-89 and Chair, the Claude Pepper Foundation.

National Aging Organizations: Nancy Altman, President, Social Security Works, Dan Adcock, Government Relations and Policy Director of the NCPSSM; and David Simon, Legislative Representative for the Alliance for Retired Americans.

Rhode Island: Vincent Marzullo, former Director of the Corporation for National Community Service, Board member of the Senior Agenda of RI, and member of Magaziner’s Senior Advisory Council; Robert Robillard, President of RI Senior Center Directors Association; and writer Herb Weiss.

Advocates, providers on new Nursing Home mandates

Published in RINewsToday on April 29, 2024

In the shadow of Rhode Island’s ongoing staffing shortage, the Center for Medicare and Medicaid Services (CMS) issued its 329-page final rule on Nursing Home Minimum Staffing Standards (CMS 3442-F) on April 22 in the Federal Rule.

CMS affirmed its commitment to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare-and Medicaid-certified long-term care facilities.

According to CMS, over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.

Just the Nuts and Bolts

CMS say that central to its final rule are new comprehensive minimum nurse staffing requirements that would significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes. The agency is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities are given the flexibility to use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.

CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care.

This final rule provides a staggered implementation timeframe for facilities to meet the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors. The requirements of this final rule prioritize safety and health care quality while taking into consideration the unique workforce challenges some nursing homes are facing, especially those operating in rural areas.

CMS will closely monitor and evaluate the provisions of this final rule, including but not limited to, the minimum staffing standards, the 24/7 RN requirement, the exemption process, and the definition of rural, as they are implemented over the next several years to determine whether any updates or changes are necessary in the future.

Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities.

Provider, advocate positions on new CMS final rule

At press time, the RI Department of Health (RIDOH) had no comments about CMS’s new final rule released last week, say Joseph Wendelken, RIDOH’s public information officer. The state agency is reviewing the rule and assessing its impact and applicability in Rhode Island,” he says.

With the final rules release, senior advocates and providers are expressing their opinion about its impact.

Former President Donald Trump, who is challenging President Joe Biden for the presidency, has not addressed quality of care in nursing homes with a formal position. Kathleen Heren, Rhode Island’s Ombudsman, speculates that by releasing the CMS mandate before the upcoming presidential election, President Biden is just trying “to establish a record” of enhancing quality of care in nursing homes.

“Nursing homes cannot find Registered nurses (RN), and Nursing Assistances to hire,” notes Heren. The CMS mandate will force nursing homes to downsize, like we have just seen happen at the Scandinavian Home,” she predicts.

According to Heren, the final CMS rules do not include the minimum staffing of LPNs. More important, “it’s an unfunded mandate,” she says.

Gerontologist Deb Burton, MS, executive director of RI Elder Info, is pleased to see a Federal minimum staffing mandate of 3.48 hours of daily nursing care. “It’s important to understand mandates don’t make workers appear and a minimum staffing mandate is only an average amount of time allotted for care across all residents in the facility,” she says, noting that this rule doesn’t mean each resident will receive 3.48 hours of care each day.

According to Burton, the CMS Nursing Home Compare website, as of April 2024, notes there are 6 Rhode Island facilities that would not meet the lower federal minimum staffing mandate if it were enacted today. “The workforce shortage and the dire need to increase Medicaid reimbursements to attract and retain adequate staff with a proper wage are common topics of meetings,” says Burton.

“When workers say ‘It’s only me on the floor – do I help the resident eat their supper or take the other resident to the bathroom? I can’t do both,’ – we need to listen,” says Burton. “The new federal minimum staffing mandate is a good step forward, but we need more. One day it will likely be us waiting for that workers’ help,” she warns.

Like other RI senior advocates, Maureen Maigret, policy director for the Senior Agenda Coalition of RI, sees the importance of CMS releasing its final rules. “It is important that these regulations have been finalized as providing for minimum nurse staffing levels in nursing homes helps ensure residents across the country will receive quality and resident-centered care,” she says.

According to Maigret, Rhode Island has had a provision for 24/7 RN coverage even before the state’s minimum staffing law was passed so that is not a new requirement here. She pointed out the regulations will also promote transparency and accountability by requiring public reporting on how much of the Medicaid payments are spent on direct care staff and that the federal government has committed to invest over $75 Million in an initiative to increase the number of nurses working in nursing homes through such things as financial incentives for tuition reimbursement.

“We are dismayed that the Biden Administration is moving forward with this one-size-fits-all staffing mandate,” says John E. Gage, President and CEO of the Rhode Island Health Care Association. “In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors in Rhode Island and across the country,” he warns, noting that when nursing homes can’t find nurses and/or certified nursing assistants (CNAs), they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need.

New final rule just another unfunded mandate

Like the 2021 RI staffing law, the Federal rule is an unfunded mandate, charges Gage. “Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers, he states.

According to Gage, nationally, the nursing home workforce has declined by 124,200 individuals (-7.8%) since the start of the pandemic. Rhode Island’s numbers are even worse, down 1,495 individuals (-15.3%). Gage calls on Congress to step up and support the bipartisan Protecting America’s Seniors’ Access to Care Act, which would prevent CMS from enforcing this unfunded and flawed mandate.

“Together with our national association, the American Health Care Association (AHCA), we will continue to fight for more common-sense solutions and do everything we can to preserve access to care for Rhode Island seniors,” says Gage.

“The good news about the Biden Administration’s final rule, there are phase-ins over multiple years that will provide an opportunity to challenge the mandates through legislation and/or possible AHCA litigation on the national level,” adds Gage. “The federal mandate highlights how much of an outlier RI’s staffing mandate is. The RI statute has the highest staffing metrics and the highest fines in the country – 10% above the federal standards. Without the Executive Actions of Governor McKee, RI nursing homes would be fined $90 million in the first full year of enforcement – devastating facilities and forcing further closures. RI excludes hours worked by administrative nurses from counting toward the RN metric, yet they are included in the federal standards. RI also excludes med techs’ and nurse aides in training’s hours from the CNA metric, while CMS includes them,” noted Gage.

Gage adds that the CMS final rules consider Rhode Island to be “urban.” As a result, the state has 2 years to phase-in the 24×7 RN requirement.

Rhode Island regulations and law have required 24×7 RN coverage in nursing homes for many decades, says Gage. “While challenging to maintain compliance given the shortage of registered nurses, this should not be a major concern for RI facilities,” he adds, noting that there will be 3 years to comply with the required 0.55 HPRD for RNs and 2.45 HPRD for CNAs.

Additionally, Gage says that there are also waiver opportunities in certain circumstances. “During the implementation phase, facilities and all stakeholders must be laser-focused on building a sufficient pipeline of qualified nurses and CNAs to the nursing home workforce,” he says.

Like Gage, James Nyberg, executive director LeadingAgeRI, sees the CMS mandate as less onerous than the RI staffing mandate that “fortunately” remains suspended. “We remain concerned about the impact of this national mandate on providers in Rhode Island, and its broader impact on consumers and the health care industry,” he says.

According to Nyberg, the state’s current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (six nursing homes have already closed since the COVID pandemic began and two more have embarked on significant downsizing).

“These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes,” says Nyberg, noting that LeadingAgeRI is working with numerous stakeholders on various initiatives to develop a pipeline of workers. “But the simple fact is that it will take time and an infusion of resources,” he adds.

“CMS proposes to spend $75 million on a nursing home staffing campaign. That amount might help a state like Rhode Island, but that money is national, so it is a drop in the bucket in terms of the support the industry needs, states Nyberg. “On the home front, we have been working with the Administration and the General Assembly to provide an infusion of funding to try and rescue the homes from their dire financial straits and try to stabilize the industry. But the federal mandate, and all the related details and requirements embedded in the rule, do nothing to further that cause,” he says.

For the Minimum Nursing Standard final rules, go to https://public-inspection.federalregister.gov/2024-08273.pdf

For the CMS Fact Sheet on Minimum Nursing Standard final rules, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

Shortage of direct care professionals a local and national concern

Published in RINewsTdoay on April 22, 2024

Last week, at the Senate Dirksen Building, Room SD-562, Chairman Bob Casey, of the U.S. Special Committee on Aging, (D-PA), showcased S. 4120, legislation that he introduced with U.S. Senators Tim Kaine (D-VA), and Tammy Baldwin (D-WI). The Long-Term Care Workforce Support Act, introduced during the 118^thCongress, would ensure that direct care professionals have a sustainable, lifelong career by providing substantial new funding to support these workers in every part of the long-term care industry, from nursing homes to home care, to assisted living facilities.

The Senate Aging Committee details a number of statistical findings showing the need for Congress to address the nation’s severe ongoing direct care professional workforce shortage. “A recent survey revealed 92% of nursing facility respondents and nearly 70% of assisted living facilities reported significant or severe workforce shortages.

In 2022, a survey of nursing facilities showed more than 50% of the facilities were limiting the number of new admissions due to staffing vacancies or shortages. Another recent survey of Home and Community Based Service providers showed that all 50 states were experiencing home care worker shortages, and 43 states reported that some HCBS provider groups have closed due to worker shortages,” says the fact sheet.

Addressing the cause

By improving compensation, benefits, and support systems, S.4120 would ensure the United States has a “strong, qualified pipeline of workers to provide desperately needed care for older adults and people with disabilities.” notes a statement announcing the introduction of Casey’s legislative proposal.

Specifically, S. 4120 would increase the number of direct care professionals, especially in rural communities. It also would provide pathways to enter and be supported in the workforce for women, people of color, and people with disabilities.

S. 4120 would also improve wage compensation for direct care professionals to reduce vacancies and turnover. It ensures that direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and provided fair compensation.

The legislative proposal also documents the need for long-term care, identify effective recruitment and training strategies, and promote practices that help retain direct care professionals. It also would strengthen the direct care professional workforce in order to support the 53,000,000 unpaid family caregivers who are providing complex services to their loved ones in the home and across long-term care settings.

At press time, S. 4120 is endorsed by 50 organizations, including Domestic Workers Alliance, SEIU, AFSCME, Caring Across Generations, National Coalition on Aging (NCOA), Justice in Aging, National Partnership for Women & Families, National Council on Independent Living (NCIL), and the National Disability Rights Network (NDRN).

And a companion legislative proposal was introduced in the House by Congresswoman Debbie Dingell (D-MI).

Senate Aging Committee puts spotlight on Direct Care Staffing Shortage

The April 16^th hearing entitled, “The Long-Term Care Workforce: Addressing Shortages and Improving the Profession,” examined the challenges currently facing long-term care workers who are often underpaid and overworked, leading to widespread worker shortages that threaten the availability of care for those who need it.

“It’s a crisis that stems largely from a lack of support for and investment in our caregiving workforce,” warns Casey in his opening statement. “Between 50 to over 90 percent of long-term care settings and providers report significant staffing shortages, affecting their ability to provide services, accept new clients, or even to remain open,” he says.

Casey noted that many direct care professionals have to work multiple jobs or overtime just to be able to support themselves and their families. In 2022, their medium wage was just above $15 dollars an hour, well below what is paid for warehouse and convenience store jobs, per Casey.

“The direct care workforce, the majority of whom are women of color, are more likely to live in poverty compared to the general public,” notes Casey.

“Cumbersome federal regulations, requirements, and protections” and a “one-size fits all approach” won’t fix the direct care staffing shortage, responds Ranking Member Mike Braun (R-IN).

“To grow the long-term care workforce, the federal government should make it easier for people to enter by removing barriers,” says Braun, in his opening statement, calling for “productive approaches to build and grow the care professions.”

Overworked and not enough money

Nicholas Smith, a direct support professional at SPIN, a Pennsylvania-based organization that provides lifespan services for over 3,000 people with intellectual disabilities and autism, came to testify. “I work nearly 65-70 hours a week… due to my work, I have missed family events, nieces’ and nephews’ recitals, and school functions… a lot of people are leaving this field to make more money,” said the Philadelphia resident who has worked in the long-term care industry for over 25 years.

According to Smith, the national average for direct service professional wages is only $15.43 in long-term care. “We spend time training new hires only to lose them because they cannot make a living wage,” he says, noting that other industries are offering more money.

“While people want to stay in this field, they cannot make ends meet. Pennsylvania has a long waitlist for home and community-based services, and this is due to the workforce crisis,” he says.

In her testimony, Brooke Vogleman, a licensed Practical Nurse with Huntington, Indiana based TLC Management, stated: “I’ve seen what happens when long-term care facilities lack workers, resources and government support, like during the pandemic. Many of my colleagues got burned out and left the profession, forcing facilities to rely on costly temporary staffing agencies.”

Vogleman called on federal policy makers, including members of the Senate Aging Committee, to address the challenge through “targeted investments, not blanket mandates.”

For instance, she told the Senators that LPNs are integral to the facility’s interdisciplinary team. “Staffing mandates that do not include our contributions to patient care or recognize us as nurses are very concerning to me and will have unintended consequences on residents,” she says.

Staffing mandates will force facilities to depend more on expensive staffing agencies, warns Vogleman. “Personally, I’m concerned they will actually increase staff burnout, as current caregivers will be stretched thin and working longer hours in order to comply with these impossible standards,” she says.

Matthew Connell, Ed.D., of Ivy Tech Community College of Indiana, came to share the work and achievements of his community college in addressing the shortage of healthcare and long-term care workers in Indiana.

According to Connell, serving more than 190,000 students at 19 campuses and 26 satellite locations as well as on-line, graduates more associate level nurses in Indiana. Nearly half of these students are pursuing college credit while in high school. Ivy Tech is the nation’s single largest provider of dual credit.

Ivy Tech’s programs are especially designed to help graduates enter the workforce quickly and provide critical services for the state’s long-term care population at a tuition rate that is the lowest in the state, he notes. “One in three Registered Nurses [in Indiana] is an alum. More than 90% of its nursing graduates choose to remain in Indiana, working in hospitals and care settings,” he adds.

The last witness, Jasmine L. Travers, assistant professor at New York University’s College of Nursing, concisely summed up how to fix the nursing shortage. She suggested: “To improve access to and quality of long-term are, we must ensure that all direct care workers receive a living wage, a safe, respectful work environment, opportunities for advancement, adequate training, and accessible benefits to maintain their health and well-being. Only when we recognize that these workers are critically important, hardworking processionals, can we begin to improve equity and health outcomes for staff and patients alike.”

Putting the spotlight on Rhode Island’s Direct Care Staffing Shortage

According to John E. Gage, MBA, NHA, President & CEO, of the Rhode Island Health Care Association (RIHCA), the Covid-19 pandemic had a dramatic impact on the healthcare sector across the country and especially in Rhode Island, and a disproportionate impact on nursing facilities. On a national level, in February 2020 nursing facilities workforce totaled 1,587,000. Today, it is 1,462,800, down by 124,200 or 7.8%. In Rhode Island, it is more dramatic. Pre-pandemic RI nursing facility workforce was 9,797 (2/2020). Current BLS data shows the most recent number of workers in RI nursing facilities is 8,300 – down 1,497 workers or 15.3%. This is just about double the rate of loss of workers post-pandemic in RI compared to the national statistics.

“There are some local efforts to attract workers back to RI nursing homes,” says Gage, noting that there is a need to be laser-focused on workforce development efforts.

Gage calls for RI Medicaid to increase reimbursements to nursing facilities to cover today’s actual cost of care, not on facility costs from 2011 (13 years ago!) with minimal average inflationary increases in the 11 years since the price-based reimbursement methodology began in 2013. According to Gage, RI nursing facilities need an adequate, sustainable reimbursement system to foster continued high-quality care and services and provide nursing home with rates that enable them to retain current workers and recruit more caregivers.

RIHCA, a non-profit trade association representing more than 80 percent of the nursing homes in the state, and its parent organization, the American Health Care Association (AHCA) support the legislative efforts of Senator Casey’s Long-Term Care Support Act. “We support all efforts to increase Medicaid rates to enable facilities to regain and grow their workforce – both direct care and ancillary staff, to enhance the quality of care and quality of life for our nation’s and RI’s most frail elder citizens today and for the years ahead,” he says.

“It is heartening to see the Senate Committee on Aging and leading members of Congress addressing the care worker crisis in long term care including supporting our many thousands of unpaid caregivers who provide a significant portion of long term supports and services,” says Maureen Maigret, policy advisory of the Senior Agenda of RI (SACRI). Multifaceted solutions are needed, adds Maigret that include supporting training programs for nurses and paraprofessionals, career ladders and providing adequate Medicaid provider payments as Medicaid is the primary payer for long term care.

According to Maigret, in homecare alone, 75% of persons referred for subsidized home and community care through the state Medicaid or the Office of Healthy Aging Home Cost Share program are waiting two months, and often longer, to get services. “Our nursing homes are challenged to recruit the nursing staff needed to provide resident-centered quality care. Federal funding during the pandemic brought some funding in to support worker wages but that funding has ended,” she says.

“The state Healthcare Workforce Initiative led by the Executive Office of Health and Human Services and the Department of Labor has been looking at needs across the healthcare system and addressing some of the training and education issues,” says Maigret, noting that advocacy groups, such as the SACRI, support the Medicaid reimbursement rate increases as recommended by the Office of the Health Insurance Commissioner. “These rate increases are necessary to reduce service wait lists and provide livable wages for direct care staff many of whom are women and women of color,” she says.

Over 23 years ago, in his weekly commentaries in the Pawtucket Times, this writer reported on the crisis of a direct care staffing shortage and inadequate reimbursement being paid to nursing facilities to care for Rhode Island’s fail seniors. Isn’t it finally time for the Rhode Island General Assembly to come up with the necessary funds and strategy to fix these problem once and for all?

To watch the Senate Aging Committee hearing held on April 16, 2024, go to https://www.aging.senate.gov/hearings/the-long-term-care-workforce-addressing-shortages-and-improving-the-profession