The Longevity Agenda

What Should Congress Do?

By longevity project staff

Rarely in history have so many issues affecting older Americans hit Congress and the federal government all at once. The coronavirus pandemic exposed a wide variety of challenges in how the country supports and cares for its older population, creating a formidable to-do list for President Biden and Congressional leaders.

Chief among these challenges has been the tragedy of American nursing homes and assisted living facilities. While 5% of the country’s coronavirus cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for about 34% of the country’s pandemic fatalities. The heightened attention on long-term care facilities during the pandemic has exposed the heartbreaking consequences of neglect, not only for residents but for care staff as well, who are routinely placed in high-stakes situations with poor training, limited resources and inadequate support and compensation.

Although the flawed nature of our long-term care infrastructure is perhaps the most tangible lesson of the pandemic, it is by no means the only one. Another national shortcoming revealed by the pandemic is our inability to meet the needs of older Americans hoping to avoid long-term care facilities in favor of aging in place. Despite many Americans’ overwhelming preference for this option, in no small part because it is far more cost efficient than custodial care, there is an 800,000 person-long waiting list for Medicaid home services.

The pandemic has also exacerbated the caregiving crisis, with millions of Americans forced to take on additional caregiving responsibilities. Consequently, many people, particularly women, have been driven from the workforce. The economic fallout of the pandemic has also hit older workers (those over 55) extraordinarily hard, with this group suffering higher rates of job loss and lower rates of reemployment since the beginning of the pandemic, according to recent studies from the New School for Social Research.

These issues are just a subset of the broader economic, social and health challenges of the last year, and Congress and the Biden Administration will have to triage these issues in connection with the broader goals of recovering from the pandemic. The $1.9 trillion American Rescue Plan, passed by the House of Representatives last week, represents a significant and unprecedented first step in addressing the issues of older Americans after the pandemic. The plan includes additional funding for aging and disability services, and many older adults are eligible to receive significant benefits, like the $1,400 stimulus checks and expanded earned income tax credits. The Plan also includes $1.4 billion in funding for programs authorized under the Older Americans Act, including support for nutrition programs, community-based support programs and the National Family Caregiver Support Program.

Potentially the most important piece of the American Rescue Plan for older Americans is the dedicated funding for Medicaid home and community-based services (HCBS). Specifically, the Plan provides a one-year increase of 7.35 percentage points in the federal share of spending for Medicaid HCBS waiver services (such as adult day services), state plan services including home health and personal care, and the Medicaid share of Programs of All-Inclusive Care for the Elderly (PACE) reimbursement.

Most of the provisions in the American Rescue Plan are short-term funding provisions, rather than long-term programmatic shifts, though many advocates hope that this legislation is a harbinger of policy change to come. Longer term reform will have to await additional legislation, including a major infrastructure bill, which is being touted by the Administration as the next major legislative priority. Few details about what might be included in that proposal have been made public, but it is possible that among the issues to be addressed will be funding to reduce the long waiting list for in home elderly care services, nursing home and long-term care reform, and the expansion of training programs for older workers.

This is a critical moment for America’s seniors and we are fortunate to have some of our nation’s leading experts, as well as senior members of Congress, including Senator Ben Cardin (D-MD) and Congresswoman Lori Trahan (D-MA), joining us our four-part event series on the new Congress, the Biden Administration and longevity. We hope that you will tune in for these events.

Events

Click on any of the events below to learn more about the “What Should Congress Do?” discussion series