President Biden speaking in front of American flag

President Joe Biden signed a massive executive order Tuesday morning that includes several measures intended to improve access to long-term care and bolster job protections for those who work in skilled nursing. Among them are calls to expand on an as-yet undisclosed staffing mandate and tie Medicare payments to retention.

The White House called it the “most comprehensive set of executive actions any President has ever taken to improve care for hard-working families while supporting care workers and family caregivers.”

An early morning announcement noted that many workers providing long-term care “find themselves in low-paying jobs with few benefits,” leading to high turnover. It directs the Department of Health and Human Services to consider issuing “several” regulations and guidance documents to “build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.”

Biden first proposed a minimum staffing standard for nursing homes in February 2022. The Centers for Medicare & Medicaid Services earlier this month delayed its unveiling but said it still expected to publish a new rule “later this spring.”

Meanwhile, the new move by the White House includes more than 50 directives ordering most cabinet-level agencies to help expand access to long-term care and child care, as well as provide financial and other support for direct care workers and family caregivers.

“Too many families and individuals struggle to access the affordable, high-quality care they need,” the White House said. “For the elderly or people with disabilities long-term care costs are up 40% in the past decade. The result is many Americans – particularly women – stay out of the workforce to care for their families, making it hard for businesses to attract and retain a skilled workforce and for the economy to grow.”

The order also aims to advance domestic workers’ rights. Biden will order the Department of Labor to publish a sample employment agreement so long-term care workers and their employers understand their rights and responsibilities.

“Care workers should be supported, valued, and fairly compensated, and care workers should have the free and fair choice to join a union,” the White House said. 

Biden also said he would direct HHS to consider how it can leverage Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid.

The order also directs Veterans Affairs to consider expanding its Veteran Directed Care program to all 172 VA Medical Centers by the end of fiscal year 2024 to increase beneficiaries’ ability to pay for personal care assistance. VA will also consider adding 75 new interdisciplinary teams to its Home-Based Primary Care program to serve an additional 5,600 veterans in their homes.

McKnight’s Home Care offers additional context on how the Biden executive order aims to advance home-based services.

This is a developing story. Check back for more details.