A collection of worker advocates and long-term care provider associations Tuesday called on the Senate to adopt a House version of President Joe Biden’s Build Back Better plan — and add more funding to address the needs of seniors and their caregivers.

Build Back Better, as passed by the House on Nov. 19, is a nearly $2 trillion social safety net plan that includes roughly $150 billion to boost home- and community-based services under Medicaid and $329 million in grant funding for recruiting, retaining and training long-term care workers. It also addresses affordable housing and seeks to add new layers of regulation for skilled nursing facilities, including mandated staffing levels and an expansion of the Special Focus Facilities program, which makes for somewhat of a mixed-bag for aging services providers.

The package is “the most important legislation in a generation for older Americans,” despite little national attention on provisions geared toward seniors and those with disabilities, said Katie Smith Sloan, president and CEO of LeadingAge.

“Build Back Better has the potential to significantly impact the lives of today’s older adults and all of us who hope to grow old with health and dignity,” Sloan said during a teleconference arranged by her organization. “The Senate’s job is clear: to adopt these investments without shaving off one dollar, and to indeed increase them.”

Sloan called for a doubling of Build Back Better’s spending on affordable housing for low-income older adults and for additional funds to support staffing provisions affecting skilled nursing providers. The latter include a proposal to enact federal minimum staffing requirements and adopt 24/7 registered nurse coverage in all nursing homes. Sloan called these requirements unrealistic without dedicated funding to make them happen. Currently, only six states require round-the-clock RN staffing.

Charlotte Haberaecker is president & CEO of Lutheran Services in America, which operates 1,400 healthcare and senior living communities in 45 states. She referenced an earlier estimate from the American Health Care Association that found increasing nursing hours to the proposed level would precipitate the hiring of 21,000 additional nurses and carry a price tag of $2.5 billion annually.

“These are unfunded mandates to add additional staff during a period of historic workforce shortages,” Haberaecker said. “So without funding to support increased staff and without meaningful policies to improve workforce supply, they’re only going to accelerate the workforce crisis and reduce older adults’ access to services.”

Others call for transparency

Their concerns about recruiting came on the same day that The National Consumer Voice for Quality Long-Term Care published a new study that finds 29 states have minimum nurse care requirements that are significantly lower than a 4.1-hour-per-resident research-based staffing standard proposed in a study for CMS in 2001 but never adopted.

Consumer Voice Executive Director Lori Smetanka called on the Senate to maintain the existing provisions in hopes of improving care quality.

“Long-term care providers receive billions of dollars in public funds to provide care from Medicare, Medicaid and supplemental government payouts,” she said in a statement. “Yet there is a lack of transparency and accountability for how they spend that money, or whether adequate amounts go toward the provision of care — the only thing that really matters to residents. 

“We are asking the Senate to include these provisions that would improve the quality of care and enhance the transparency needed to account for the use of public funds, including more than $4 billion in additional funding to assist with recruitment, training and retention of staff.”

While AHCA and LeadingAge have expressed support for quality improvements to the long-term care workforce, each has cautioned that new requirements without funding could force providers to close their doors.

“Oftentimes, nursing homes are struggling to find and retain qualified nursing assistants, especially during COVID-19, when the pandemic has reinforced how dangerous working and living in nursing homes can be if they’re not properly resourced and funded,” Robert Espinoza, vice president of policy at PHI, said during the Tuesday LeadingAge event. “It’s important that we think about, ‘How can we improve financing for nursing homes and how can we strengthen the overarching LTC system?’ ”