A model of facility-based care that is a hybrid between an assisted living community and a nursing home could be the answer for millions of older adults who are not eligible for Medicaid and must pay out-of-pocket for care and services, according to one long-term care expert.
Howard Gleckman, a senior fellow in the Urban-Brookings Tax Policy Center at the Urban Institute, said Monday during a LeadingAge membership call that it will take much creativity — especially with labor accounting for half or more of operations costs — for operators to provide cost-effective congregate living that older adults can afford.
Many older adults have high personal care needs but they don’t need skilled nursing, he said. The answer could be a form of home- and community-based services provided in a hybrid residential setting.
“When you have large numbers of older adults living in close proximity and you’re bringing services into them, that’s a great idea,” he said. “It’s definitely part of the solution.”
Some assisted living communities already provide HCBS through Medicaid waivers.
Gleckman said that although he believes that a chance still exists for some form of the Build Back Better Act — or what he calls Build Back Smaller — to pass, the legislation as written only addresses those who are eligible for Medicaid. Build Back Better was hailed by the aging services industry for its “historic investments in HCBS, affordable senior housing and measures to address the long-term care industry’s severe workforce challenges.”
“The administration and Congress are not doing anything for people trying to pay for this out of pocket,” Gleckman said.
The problem for facilities if federal funding comes, he said, is that additional Medicaid dollars will be tied to additional requirements, including implementing higher staff wages, improving service levels and increasing the numbers of eligible individuals in state programs.
Even if Congress does manage to pass a reconciliation package, Gleckman said, it seems realistic that most of those dollars will go to pay direct care workers.
But he cautioned providers and advocates against relying on the sole message of “give us more money” when lobbying legislators.
“That’s never a winning message in Congress,” Gleckman said, adding that the way for an organization to differentiate itself from other funding requesters is by telling lawmakers what it will do with more money.
“You need to tell that story,” he said. “You need to let people know you’re just not asking for the money to increase your margins. You’re asking for money to take proactive steps to improve the way you are caring for residents and patients.”
