USA, Kentucky, Frankfort, State House of Representatives
Credit: Walter Bibikow/Getty Images
USA, Kentucky, Frankfort, State House of Representatives
Credit: Walter Bibikow/Getty Images

Calls for greater support for direct care workers have reached lawmakers’ ears, but a hearing revealed a partisan split on how to best grow, retain and professionalize this critical workforce.

“If we claim that their work as caregivers is essential, we should accord them the status of a professional,” Sen. Bob Casey (D-PA) noted in his opening statement during a Senate Special Committee on Aging hearing on Tuesday. “Numerous studies indicate that insufficient staffing is directly correlated with lower quality of care, worse health outcomes for people receiving long-term care, and increased burden on family caregivers … It’s time to make the smart choice for families and communities and strengthen our long-term care workforce.”

This workforce, which includes individuals who work in patients’ homes or residential facilities, is in need of better wages, more pathways to employment and safer working conditions, Casey, chair of the committee, said. Earlier this week he introduced the Long-Term Care Workforce Support Act, which would use federal funds to invest in care worker wages and training opportunities, according to an analysis by PHI.

Casey is also in favor of two soon-to-be released regulations: the nursing home minimum staffing mandate and Medicaid Access Rule, which contains the controversial 80/20 provision. The provision would require that 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers.  The Office of Management and Budget concluded its review of both rules, which are expected to be finalized by the middle of May, according to news outlet Axios.

State-by-state approach

Many Republican senators, however, are not in favor of such federal initiatives. They expressed that workforce development initiatives should be left up to the states.

“Giving more power to the federal government usually means spending more money, almost all of which we borrow, we don’t actually have,” Sen. Mike Braun (R-IN), ranking member of the committee, said during the Tuesday hearing. “These [proposed] solutions are sometimes very partisan in nature as well.”

As many as 80% of facilities do not currently have the staff to meet the proposed nursing home staffing requirements, and implementing such a rule could lead to closures, he said. Home care providers also have criticized the rule. In an October letter to Congress, some suggested that imposing strict staffing minimums for nursing homes would draw potential workers away from home health agencies that are also in need.

“We need innovation at the state and local levels,” Braun said in his prepared remarks. “We don’t need the federal government forcing a one-size-fits-all approach.”

Providers’ reaction

Many providers themselves hold doubts about the approaching minimum staffing mandate and Medicaid Access Rule.

“Looming regulatory changes — the nursing home staffing mandate and the workforce provisions of the Enhancing Access to Medicaid Services rule — if implemented as proposed, will negatively impact older adults’ and families’ ability to access needed care and services,” Katie Smith Sloan, president and chief executive officer of LeadingAge, said in a statement Tuesday. “We urge policymakers to pay attention to necessary refinements on particular issues such as funding for the education and training initiatives needed to build and sustain the workforce and investment in coordinated state and federal infrastructures to ensure programs achieve their desired goals.” 

But Sloan added that the Long-Term Care Workforce Support Act introduced Monday represents “a big step in the right direction.”