We can reverse the caregiver crisis, but fast action is needed

The COVID-19 pandemic has laid bare how decades of state and federal underinvestment in our aging service infrastructure has created a crisis for families trying to access long-term care services — and historic challenges for aging service providers serving millions of older adults.

The good news is that with quick and meaningful action, we can still turn the tide.

The main challenge is that Medicaid, the primary payer for long-term care services, does not fully cover the cost of nursing home care in most states. For example, a recent study found that rates in Pennsylvania are $86.23 per day lower than the cost of providing care. That’s more than $31,000 a year in unpaid care, per Medicaid resident.

This cruel deficit, combined with a pandemic that only happens once in a century, means that we do not have the direct care professionals we need: 400,0000 people have left the field since the start of the pandemic! And while caring for the elderly is a true calling for many, the fact is that professional caregivers can make more money (with less emotional and physical stress) working shifts at a fast food restaurant or a retail warehouse.

And, because nursing homes’ primary source of income comes from state and federally funded Medicaid reimbursements that don’t cover the cost of care, our providers simply don’t have the ability to raise wages to compete with Starbucks or Amazon.

Due to these labor shortages, many providers are suspending new admissions and struggling to hire. Many report being in financial peril due to pandemic-related costs, including exorbitant fees charged by temp agencies. In a Cleveland nursing home, the cost of care is $100 more per day per resident than their reimbursement, which can quickly add up to millions in shortfalls. Filling these gaps with philanthropy is no longer enough, which is why this retirement home is closing its doors in June. Others may follow.

Older Americans and their families are paying for the long-term failure of our policymakers to prioritize our aging workforce in services.

The federal government and its state partners share responsibility for insufficient funding, low staff salaries, and failure to measure and improve quality using the strongest evidence. Quality of care and staffing go hand in hand, and neither can be achieved without adequate funding.

A bold, whole-of-government approach is needed to get us out of this crisis and ensure continued access to the quality care seniors and their families deserve. Here’s how to start:

  • Pay front-line staff fairly. This can be accomplished by Congress acting to provide increased federal “FMAP” funding for nursing home care and requirements that states reimburse the cost of care.
  • Develop the pool of candidates seeking meaningful careers in aging services, with training and apprenticeship programs modeled on initiatives that already exist in the Departments of Education and Labour. We need to provide career ladders to help people stay in the business and continue doing the work they love.
  • Make immediate changes to immigration policy allow foreign nurses hired by long-term care communities to travel to the United States as quickly as possible.
  • Fight against the price gouging of temporary help agencies. Ban the ability of agencies to charge exorbitant rates to nursing homes whose income comes primarily from Medicaid and Medicare.

Aging service providers want more than anything to hire and train more people willing to care for the millions of growing Americans who need help. But we need the help of Congress and the administration to get there.

Katie Smith Sloan is President and CEO of LeadingAge, the association of nonprofit providers of aging services, including nursing homes.

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