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LEADINGAGE POLICY

 Financing • Home & Community Based Services • Medicare and Medicaid • Senior Housing • Workforce

Click here to view LeadingAge Policy Positions

Click here to view our 2017 Legislative Summary


Financing 

As the population ages, America faces an important challenge in reconciling the difference between the independent and dignified life older adults want and the life that is possible in our current healthcare and aging services system. Too often, lack of choice and inadequate financing put enormous pressure on families and leave older adults depressed and disconnected. In order to bridge this gap, America must create a new way of paying for long-term services and supports financing (LTSS). Learn more about new ways to fund long-term services and supports financing.

LeadingAge Texas believes America needs a fairer and more rational financing system to ensure access to quality long-term services and supports (LTSS) for everyone who needs these services.

An LTSS financing system that promotes consumer choice and flexibility will stimulate and reward innovation, quality improvement, and the development of products and services consumers want and need. This system will promote early health and wellness interventions that can prevent or delay the onset of LTSS need, while helping to reduce and manage lifetime risk. And, most important, it will help us create a society in which all may age with dignity. Read the report on A New Vision for Long-Term Services and Supports.

Nearly 13 million Americans need long-term services and supports (LTSS), and the need is growing rapidly. Yet, we have no planned way to pay for these services. In order to ensure that people get the care they need without impoverishing themselves or breaking the government's bank, we need to find solutions.

On February 17, 2016, LeadingAge released the 2016 Pathways Report, Perspectives on the Challenges of Financing Long-Term Services and Supports. Download the PDF report to read more about our position on long-term care financing.

LeadingAge Texas believes America needs a new financing system that is insurance-based and guided by the principles of rationality, equity, and affordability.


Home and Community Based Services

Consumer preferences for home- and community-based services, as well as federal and state goals to meet these preferences and control costs, have produced significant shifts in policy. Despite this shift in policy, there remain multiple barriers to addressing the growing population of older adults and persons with disabilities that will need these services. Learn more about securing Home and Community Based Services.


Medicare and Medicaid

Medicare and Medicaid are essential sources of coverage for post-acute care and for long-term services and supports. Private long-term care insurance, which in its current form has proven inaccessible and/or unattractive for most Americans, currently covers less than 12% of all long-term care costs nationwide. Few individuals or families are able to cover the cost of long-term care out of their own income and savings. Adequate Medicare and Medicaid reimbursement makes a major difference to providers’ ability to meet the costs of recruiting, training and retaining qualified staff as well as other essential operations that ensure high quality clinical care and quality of life for residents and clients. Learn more about medicaid and medicare solutions proposals.


Senior Housing

LeadingAge and its members are the chief advocates for a strong federal role in affordable senior housing – development, preservation, and management including housing with supportive services. The programs for which we have worked over several decades face a number of challenges. We continue to advocate for creative solutions to ensure safe, decent and affordable housing for our nation’s elders.

Fiscal Year 2019 Priorities for Affordable, Service-Enriched Affordable Housing explains our federal appropriations priorities.


Workforce

LeadingAge Texas believes America needs a fairer and more rational financing system to ensure access to quality long-term services and supports (LTSS) for everyone who needs these services.

The salaries nursing homes and other long-term services and supports providers can pay are inadequate to attract and keep workers. The hours that must be worked include nights, weekends, and holidays. The work itself is physically, psychologically, and emotionally demanding. Direct care workers are at the bottom of the staff pyramid and frequently do not feel respected for the work they do.

70% of the cost of long-term services and supports is paid by public programs, primarily Medicaid. In most states, Medicaid grossly underpays the actual cost of services. States’ moves to managed long-term care under their Medicaid programs and Medicare bundling and other alternative payment models pose further challenges.

The population group from which long-term services and supports providers traditionally have drawn – young and middle-aged women – is falling in proportion to the growing elder population. This trend will become even more pronounced as the baby boomer generation first retires, then ages into needing long-term services and supports. It is also a particular challenge in rural and frontier areas in which the population is disproportionately older.

The population from which we draw workers has its own obstacles to employment. Direct care workers often are single mothers who need affordable child care. They may have difficulty arranging transportation to work. They should not work with elders if they themselves are sick, but without paid sick leave, they cannot afford to stay home.

Long-term services and supports is high-touch. 60-80% of the cost of services relate to our workforce, rather than to technology. Long-term services and supports require different skills, education, and training than acute care. Furthermore, there are insufficient numbers of RN educators and RNs typically are not trained in the supervisory skills they need to manage direct care workers effectively.


POTENTIAL SOLUTIONS

  • Holistic Education/Universal Workers: In the small home, “Green House” model, all staff are trained to perform a variety of tasks, blending roles, and responsibilities. Experience indicates that this staffing model results in better job satisfaction and increased efficiency in the provision of services. Minnesota has an apprenticeship program built on the universal worker model.
  • Better Financing for Long-term Services and Supports: There cannot be any more unfunded mandates. We could consider supporting more requirements on staffing levels in nursing homes if there are provisions for adequate reimbursement and flexibility for rural areas where workers are harder to recruit. Bundling and other alternative payment models must include specific language and provisions related to adequate pay and benefits for direct care workers.
  • Employment Benefits: The health insurance exchanges established under the Affordable Care Act and the expansion of Medicaid may give direct care workers better access to health care coverage.
  • Incentives Necessary: Existing healthcare workforce programs, such as those under the Health Resources and Services Administration (HRSA), should be expanded to apply to direct care workers as well as to physicians and RNs.
  • Ongoing Training and Education: This needs to be provided to direct care workers so that they have the competencies needed to care for a growing population of frail elders. There needs to be special training in dementia care and communication. Problem-solving skills should be developed for all levels of the long-term services and supports workforce. We may need to consider whether regular re-certification would be either beneficial or overly burdensome for direct care workers. Recertification should be accompanied by wage differentials and growth in responsibilities. Federal grants should be available for direct care worker education and training.
  • Recognize Complexity of the Workforce: Policymakers and payors must recognize the importance of all of the staffing positions that are essential to high-quality long-term services and supports, including dietary, social work, and housekeeping.
  • Non-traditional Workers: The long-term services and supports field needs to figure out ways to bring in workers from population groups not previously tapped, including older workers. Immigration preferences should be established for direct care workers.
  • Technology: Applied technology can help to leverage skilled and professional services that may be difficult to find in some geographic areas. Direct care workers should be trained in the use of technology for tasks such as medication management.

 

PROPOSED PRINCIPLES

01: LONG-TERM SERVICES AND SUPPORTS PROVIDERS MUST COMMIT TO BEST PRACTICES IN MANAGING TERMS AND CONDITIONS OF DIRECT CARE WORKERS’ EMPLOYMENT. WAGES AND BENEFITS MUST BE OPTIMIZED, CAREER GROWTH OPPORTUNITIES PROVIDED, AND DIRECT CARE WORKERS RECOGNIZED FOR THEIR UNIQUE SKILLS AND RELATIONSHIPS WITH NURSING HOME RESIDENTS AND CLIENTS.

02: FINANCING FOR THE LONG-TERM SERVICES AND SUPPORTS FIELD MUST IMPROVE. PUBLIC PROGRAMS ON WHICH MANY INDIVIDUALS RELY TO COVER THE COST OF THE LONG-TERM SERVICES AND SUPPORTS THEY NEED MUST REIMBURSE PROVIDERS AT LEVELS THAT ALLOW FOR APPROPRIATE WAGES AND BENEFITS FOR DIRECT CARE WORKERS. A BETTER SYSTEM OF FINANCING LONG-TERM SERVICES AND SUPPORTS WOULD BRING NEW REVENUES INTO THE FIELD THAT COULD GO TOWARD IMPROVED WAGES AND BENEFITS FOR DIRECT CARE WORKERS.


Carry the Conversation: Be the Voice for LTSS

Carry the Conversation: Be the Voice of Long-Term Services and Supports is a campaign to raise awareness about the prevalence of young caregivers ages 20-36 and the lack of affordable long-term services and supports options available to them and their families. Join the Movement.

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