President Joe Biden said Tuesday his administration plans to finalize its nursing home staffing rule in “coming weeks,” just one element of a platform meant to transform caregiving for patients and workers.

Biden spoke to a union-heavy crowd at Washington, DC’s Union Station hours after releasing an updated fact sheet on investments his administration has made to support caregivers, boost pay, improve job quality and expand care options for patients and families.

“We’ve made progress, but there’s so much more we have to do,” Biden said. “If we want the best economy in the world, we need the best care economy in the world.”

Much of Biden’s speech Tuesday centered on bolstering child care and home care services, But the president’s caregiving agenda continues to shape regulatory oversight of nursing homes, including the proposed staffing rule that was still being reviewed by the White House Office of Management and Budget Tuesday afternoon.

The rule is intended to have a twofold effect of driving up quality and creating additional caregiving jobs that would most likely have to pay far above minimum wage to attract the needed number of candidates. But the nursing home sector has repeatedly raised concerns that the rule — requiring round-the-clock registered nurse coverage as well as setting hourly minimum standards for aides and RNs — would be nearly impossible to meet during the current nursing shortage.

Biden Tuesday cited a 40% increase in the cost of long-term care over the last decade — an apparent dig at for-profit healthcare owners and operators that have often been the target of his reform messaging, including two of his last three State of the Union addresses.

“In the coming weeks, we plan to release new rules that strengthen staffing standards in nursing homes [and] get home care workers a bigger share of Medicaid payments,” citing a controversial proposed rule that would require HCBS providers to spend at least 80% of Medicaid payments received for personal care, homemaker and home health aide services on direct care staffing.

“It’s not enough just to praise them for all they’re doing, we have to pay them!” Biden exhorted the crowd.

LeadingAge President and CEO Katie Smith Sloan said Tuesday afternoon that her organization shares the goal of ensuring quality care in nursing homes but that the mandate is not the right approach. 

“Two major issues — the ongoing workforce crisis and the proposal’s astronomical implementation costs — make this proposal impractical and simply bound to fail,” Sloan said. “Instead of impractical and ineffective new rules, the administration and Congress should invest in serious solutions to tackle the aging services workforce crisis in America.”

She urged the administration to develop and invest in a robust workforce development strategy that includes immigration reform, increasing funding and work with states to increase Medicaid reimbursement rates; and growing training programs for RNs, LPNs and CNAs. 

Push for more HCBS funding

Biden noted that 700,000 seniors or people with disabilities are waiting to access home- or community-based services, and he plans to expand access to such programs in a second Biden term.

He also pledged to adopt policies that would better support the ability of workers to spend time as caregivers without giving up their jobs, including a push to legislate 12 weeks of paid leave covering illness, child care, or care for a sick relative.

“We’re the only advanced economy in the world not to include paid leave. We’re going to change that,” he said. “In the United States of America, no one should choose between caring for a parent who raised them, a child that depends on them or a paycheck that they need.”

Also Tuesday, Biden continued his call for taxing the nation’s highest earners, calling for a 25% minimum tax for all US billionaires.