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LeadingAge Responds to State of the Union Address

Reax: "With the Nation at an Inflection Point, Aging Services Are at a Crossroads."


Comment from Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services, on President Biden’s State of the Union remarks:


“Tonight, President Biden spoke about a country that is at an inflection point where, if we make the right choices, a better future lies ahead. In many ways, aging services are at a similar crossroads, where the critical policy decisions we make today will decide if we’re moving toward a more equitable future for all as we grow older.


We are past the first awful years of the COVID pandemic, but for millions of older adults and families, the threat remains very real. We know that for too many years leading up to COVID, older adults and long-term care were forgotten—and we know that we can’t go back. As the COVID Public Health Emergency comes to an end, our government must prioritize action to ensure that older adults, their families, and millions of professional caregivers have the support they need.


Significant questions impacting care and services for older adults must be answered—now, as America's older adults and families are facing a crisis in access to housing, care, and services. The president was right to call for help for older adults who want care in their homes, and for millions of family caregivers. Nonprofit and mission-driven aging services providers need policies, waivers, and flexibilities that address the chronic shortcomings of our patchwork system and enable older adults to access the help and support they need wherever they call home. And it’s time to address the long waiting lists that keep millions of extremely low income older adults from ever finding an affordable home.


And there’s no doubt that a growing aging services sector is an indispensable part of a successful 21st century economy: creating jobs, providing relief for struggling families, and helping sustain communities across the country.


We look forward to continuing to partner with the Biden Administration and Congress as we work to build a stronger, more equitable, and more sustainable aging services system that meets the needs and challenges of the post-COVID world.”


Three key issues, Sloan said, are:


Workforce: The staffing crisis across aging services, particularly, but not exclusively, in America’s nursing homes, is priority #1. Decades of inadequate government support have left the backbone of quality care deeply underfunded.

  • Inadequate reimbursement that does not cover the cost of care, in nursing homes and in home health settings, translates into limited access to care for millions of older adults and families nationwide.

  • Too few people to hire. Like much of healthcare and other sectors of the economy, nursing homes and other aging services settings simply do not have enough applicants to fill open positions—and demand is growing.

An all-of-government approach, which includes policy changes and additional funding to build and support training and recruitment programs will help to build the long-term care workforce.


White House Office on Aging: Leadership and vision is needed to focus on the critical issues relevant to older adults, their families, and the hardworking people who serve and care for them. It is time for the Biden Administration to follow up its demonstrated commitment to older Americans with the creation of a robust, visible Office on Aging Policy. Centralized leadership and cross-government coordination will help ensure much-needed resources are delivered to older adults and families.


Nursing Home Reform: For the first time in decades, our federal government is committed to meaningful action to ensure America’s older adults and families can receive quality nursing home care—a goal that LeadingAge and its nonprofit, mission-driven nursing homes have long shared. To get this done right, CMS and the Administration have got to get real on staffing ratios. We proposed six common-sense conditions that must be met before mandatory nursing home staffing ratios could be implemented:

  • The Medicaid fee for service nursing home rate covers at least 95% of the cost of care.

  • States with Medicaid Managed Long-Term Services and Supports have a set benchmark rate equal to at least 95% of the cost of care.

  • The secretaries of Labor and Health and Human Services have certified there is not a shortage of potential employees qualified to work in long-term care settings.

  • Standards are flexible enough to meet the current needs of the residents being served.

  • A national public health emergency is not in place.

  • Staffing ratio mandates include waivers for local emergency conditions in place.

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