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Senior Living Workforce Crisis Needs Immediate and Long-Term Policy Solutions


By Kenya McCullum

Maggie Elehwany

Worker shortages are nothing new in the senior living industry—but COVID-19 has only made the challenge more pronounced. To get to where we need to be will require a multipronged approach. One of those prongs is developing and supporting the policies that can bring an influx of talent into the field.

To get a look at possible policy changes that can make a difference, we spoke to Maggie Elehwany, Argentum’s senior vice president of public affairs.

Q. Where does the assisted living industry currently stand in terms of policy resources?

A. My number one job is to ensure that our members, these caregivers of two million seniors across the country, have the resources they need to keep their seniors safe. During COVID, as we continue to battle new variants, we have been fighting for the resources and relief that assisted living caregivers need just to continue to stay in business, to keep their doors open, and to continue providing the great services they do.

A host of reasons has made this challenging. We aren’t necessarily on the federal government’s radar screen. It sometimes assumes we are taken care of, but unfortunately, we’re not. Through the pandemic, there have been literally trillions of dollars in COVID relief, much of it specifically targeted for long-term care providers. Yet because we don’t meet a typical definition of long-term care providers, we have been excluded from a lot of the relief and legislation. Argentum’s public affairs team and CEO are working to make sure we no longer are being left behind.

Worried about workforce? Make your voice heard with Argentum’s Public Policy Institute, March 7-9, Washington D.C.

Q. Why was senior living left behind in these policy discussions?

A. In large part, the senior living community is licensed on a state level. It has kept out of the federal arena purposely because providers have finite resources and really wanted to focus those on what was going on at a state level. COVID changed everything for senior living. Our communities were subject to CDC and OSHA requirements to protect the population, and variants led to this national state of emergency for seniors.

The senior living community invested in safety: They invested in PPE and workforce training and education. They complied with the ever-changing CDC guidelines, and they spent a lot of their resources doing it. Of course, some also had to shut down communities and lost a lot of revenue from lack of new folks coming in.

These are losses that will endure even if the pandemic ends tomorrow. The federal government and Congress made a natural assumption that when dollars went out to long-term care, we were receiving relief. Unfortunately, we weren’t.

What we are looking for is any moving vehicle in Congress to attach the relief that our members need in the human infrastructure.

Q. What is “human infrastructure”? How does it relate to senior living?

A. President Biden proposed two large pieces of legislation, one focusing on hard infrastructure and one focusing on less tangible infrastructure and human infrastructure.

This means an investment in soft assets, human assets—senior care, childcare, education, climate change benefits, energy policies.

It’s an important bill, but as the president indicated, there are dollars there for helping seniors in their aging process. An expansion of a Medicaid benefit is designed to allow individuals to either be paid for caring for an aging or disabled person in their home, or to pay for a caregiver.

Our position is that assisted living, unlike other types of long-term care facilities, really are homes for two million seniors across the country and provide these caregivers. It’s the most cost-effective way of providing care. That’s the point we’re trying to make for Congress.

The other part of the human infrastructure bill is a significant investment in workforce development. This covers many different industries, but there’s also a special focus on the needs of the aging population and the workforce shortages there.

Again, we are fighting to ensure that we are in the bill. The problem that we run into is that many leaders—both in the House and Senate—believe that assisted living is included in the bill—yet we’re excluded, because they’re not using a specific definition of long-term care. So that’s our education battle with Congress right now.

Q. What is Argentum working for with regard to human infrastructure?

A. Our advocacy efforts are trying to include a definition of long-term care that includes assisted living so we will be able to access the resources in this bill if it does pass and become law. Overall, what we’re looking for is additional relief for our members—financial relief and help with the workforce shortage crisis.

There are other avenues where we’re fighting for additional relief. One of those is The Safeguarding Elderly Needs for Infrastructure and Occupational Resources (SENIOR) Act. This legislation would provide a fund that creates financial relief for assisted living caregivers who suffered COVID-related losses and haven’t been justly compensated. It also is a tremendous investment in the workforce shortages and the long-term care spectrum as a whole, but specifically targeting some of the workforce shortage needs for assisted living.

Q. What are the basics of the need for caregivers and senior living workforce ahead—and what is the gap between what’s needed and what we may have?

A. The challenges are tremendous. They were tremendous before COVID, and that certainly has exacerbated the problem. Other industries across the nation are experiencing a workforce shortage crisis—from service industries to manufacturing entities. But of course, it becomes critically important when you’re talking about making sure older adults have the care they need.

That’s why it’s been incredibly challenging for so many of our members. Workforce costs as a result of the labor shortages has added to their financial burden to the point of crisis.

As we look at the demographics of our nation, where we have such a rapidly aging population, we can see that for the first time in our country’s history, in the year 2034, we’re actually going to have more seniors than we will children. We don’t have the workforce we need to care for those individuals in the future. And we need to address it now.

Q. What policies might help the United States fill this gap?

A. A lot of folks talk about ways to work with community colleges and even at a younger age in junior high and high school, and there are special programs funded by the federal government to really target certain populations to help them become caregivers. All of these are fantastic and wonderful ideas, but they take a while. It takes years to fully develop those concepts, and we need short-term solutions as well.

What we really want to focus on is as Argentum moves into 2022—and as we host our Public Policy Institute in March—is establishing those strategies of long-term and short-term solutions in the workforce crisis and in long-term care financing.

In the Affordable Care Act, a commission was created to focus on workforce shortages in the healthcare arena. They prioritize underserved areas and rural areas, and for good reason, because there have certainly been healthcare shortages there.

But looking at the numbers, there is no greater healthcare workforce crisis than that affecting the aging population. That’s where we can engage with the federal government, with this administration—working on actionable items needed at this moment.

There are a lot of wonderful federal job training programs that collaborate on a state-by-state basis to help meet shortage needs: Job Corps, Area Health Education Centers, National Health Service Corps. These all involve training or loan forgiveness programs, and target young people, and can directly meet the healthcare shortage.

However, senior living and senior caregiving—the whole long-term care continuum—is a blank in all of these discussions. We have to be prioritized. That’s where we can have immediate impact. We must get leaders to rethink program design based on the nation’s greatest needs

Argentum’s Healthcare Apprenticeship Expansion Program (HAEP) is a good example of the type of program that can work. It is funded by the Department of Labor to address skills gaps. It creates career pathways through education, for instance from CNA to LPN to RN, and for certifications and education for rehabilitation technicians, pathways for positions including CNAs, LPNs, RNs, and rehab technicians. In addition, it is creating new apprenticeship programs for healthcare leadership positions, such as nursing directors and executive directors. Currently, it has an 85 percent retention rate, which is a good measure of its effectiveness. We need apprenticeship programs to show more people, as Argentum’s HAEP program does, that you may start at an entry level, but you can turn this work into a career.