Calling residential care communities such as assisted living a “vital member” of their communities, LeadingAge said it was “mystified” by its lack of inclusion in the strategic framework for a National Plan on Aging. The association made the remark in comments to the committee charged with creating the plan.
Although Americans’ desire to age in place is strong, LeadingAge said, a robust long-term care system also needs to include, support and encourage residential-based options as well. Assisted living, LeadingAge President and CEO Katie Smith Sloan said in submitted comments to the Interagency Coordinating Committee on Healthy Aging and Age-Friendly Communities, or ICC, provides a bridge between independent living and nursing home care. Continuing care retirement communities provide a blend of services and socialization, she added, and nursing homes may be the best place to support some care needs.
Experts from 16 federal agencies and departments worked through the ICC to create the report, which was released in May by the US Department of Health and Human Services, through its Administration for Community Living.
Sloan’s comments to the ICC provided feedback on the framework’s four domains: age-friendly communities, coordinated housing and supportive service, increased access to long-term services and supports, and aligned healthcare and supportive services.
Underfunding aging services
In her comments, Sloan called out the lack of resources and specifics on how much the country should be spending on the various components of the plan.
“Considerations around financing, such as expanded Medicaid funding, ensuring adequate Medicare funds, and ensuring long-term care affordability through new financing systems, all need to include reliable and sufficient guiding nursing homes and assisted living,” she wrote. “Underfunding aging services, its workforce and its administration work against healthy aging and health-related social needs, thus making healthcare costs more costly in the long run,” the comments read.
Flexible employment options
LeadingAge also encouraged the plan to take a broad view of employment amid workforce challenges that are expected to worsen in the coming decade.
Pointing to its Aging Services Workforce Now campaign, LeadingAge called on the strategic framework to incorporate several of its goals, including paying aging services professionals a living wage, offering incentives to retain and attract qualified staff members, expanding training and advancement opportunities, building dependable international pipelines of trained caregivers, and enacting meaningful long-term care financing.
“While we will not reach the peak of demand for care for several more years, contracts have already begun with many nonprofit service providers — the backbone of the aging services sector — closing or reducing the number of individuals they serve because of the shortage of long-term care workers,” Smith wrote. “Put simply, in order to grow and support direct care workers, wages must be increased as part of comprehensive reimbursement reform.”
The association also recently released a report supporting a variety of immigration reforms to expand the long-term care workforce. That report called for increasing immigration caps, expanding access to employment-based visas, enhancing training and testing, and improving worker protections.
Supporting housing and supportive services
A key component of an “age-ready” America is identifying funding sources for the housing and services that older adults will need as they age, Sloan wrote. She said the nation is not equipped with enough service-enriched housing options for older adults at various levels of care, citing the urgent need for both supportive services and mental health support in affordable senior housing.
Similarly, older adults ready to transition out of independent living, but not needing nursing home-level care, need increased access to assisted living communities. LeadingAge said that this is especially true for low-income older adults but that affordable assisted living options are “exceedingly rare.” Sloan called for clarity, investment and leadership from government leaders to identify funding sources for needed affordable housing and services.
The strategic framework does not clearly state the nation’s approach to affordable housing falls “woefully short” of meeting the housing needs of older adults, she said, adding that the “small handful” of housing programs that exist are not sufficiently supported. The Treasury Department’s Low Income Housing Tax Credit, for instance, needs additional subsidies or housing vouchers to be more accessible, the Department of Housing and Urban Development’s Section 202 Supportive Housing for the Elderly Program lacks support and has experienced “decades of gross underinvestment,” and HUD’s Project-Based Section 8 program has not seen investment in new contracts in decades, Sloan said.
The CEO’s letter also addressed economic and financial security of older adults, accessible and climate-resilient housing, long-term care financing reforms, Medicare and Medicaid, elder justice, health information technology, mental and behavioral health, and more.
