Argentum Update – Senate Aging Committee Hearing

This information is provided by national association partner, Argentum.

The U.S. Senate Special Committee on Aging held its hearing on assisted living, its first in more than twenty-years specifically focused on our industry. Committee Chairman Bob Casey (D-PA) focused his remarks on the perceptions of unaffordable costs of care, workforce challenges including low caregiver compensation and inadequate training, and a lack of standards and transparency. A recording of the hearing is available here (approximately 2-hours). The hearing included two action items:

• A request from Democratic senators for the GAO to issue a study on assisted living costs and transparency for consumers;
• A call for stories from families on their experiences in finding care and understanding and affording the costs of care.

Argentum submitted written testimony into the Congressional Record, covering cost-effectiveness of assisted living, high resident satisfaction, taxpayer savings, workforce needs, and resident safety. We have also been working closely with each office on the Aging Committee to ensure that lawmakers understand the assisted living model and differences with skilled nursing and other sectors.

As Senator Casey has requested stories from families, it is now particularly important that assisted living residents, their family members, and caregivers share their stories through our grassroots campaign “Why I Love My Assisted Living Community.” As lawmakers consider federal involvement of our industry, we need to ensure they hear the personal stories from their constituents on why they chose their community, how it makes them a home, how it helps meet their daily personal care needs, and how it has improved quality of life or health outcomes.

Key Takeaways:

• There was no direct call for legislation and no announcements for a subsequent or series of hearings on assisted living. Chairman Casey alluded to “policy solutions” informed by the inquiry to Brookdale, Sunrise, and Atria, but not specific legislation.
• While there was not a clear indication of next steps by lawmakers, as the Senate is collecting family stories, we remain vigilant in our efforts to mitigate any additional Congressional activities, to include hearings, inquiries, and legislation.
• The issue of elopements was not a prominent feature of the hearing, with one senator calling them “mercifully rare.” No witnesses described a personal connection to a fatality from an elopement or inadequate care.
• Senator Elizabeth Warren (D-MA) highlighted concerns with the role of private equity and REITs, claiming that it, “strips the assets, cuts the staff, and sends the quality of care down the tubes.”
• The lack of transparency on costs found bipartisan consensus, with the Long Term Care Community Coalition (LTCCC) testifying in support of a centralized and standardized database on assisted living.
• A call for national standards had mixed agreement. The LTCCC called for “National Standards to Promote Quality, Safety, and Integrity in Assisted Living” which some lawmakers supported in connection with federal spending; other lawmakers cautioned against one-size-fits-all approaches that hamper innovation.
• Witness Julie Simpkins, testifying on behalf of Gardant Management Solutions, provided strong testimony on behalf of the industry, particularly Gardant’s role with caring for low-income seniors, the importance of private investment, and how to meet the workforce challenges.

Private Investment and Government Oversight

As anticipated, the most contentious portion of the hearing came from Senator Elizabeth Warren (D-MA). She called attention to her 2020 inquiry of 11 senior living operators on the impact of COVID-19 in assisted living communities, which identified roughly one in 15 COVID-19 fatalities nationwide having occurred in assisted living. This inquiry resulted in a Congressional report and legislation that called for greater oversight of the industry; the legislation was not advanced in the 2020 session of Congress and was not subsequently reintroduced. Warren also called attention to the 2018 Government Accountability Office (GAO) report that identified 20,000 serious health and safety concerns and called on the GAO to finalize its recommendations.

Warren also asked about the threats that seniors face in assisted living, which witness Richard Mollot of the Long Term Care Community Coalition advised increased harm from higher acuities of residents and financial exploitation due to increased involvement of private equity and more sophisticated operators. Warren then asked about the impact of private equity on residents, asking what happens when it “slashes jobs,” to which Richard Mollot responded that when private equity comes into a sector they often “pillage” it.

Call for Transparency and National Standards

Both Democratic and Republican senators called for increased transparency of costs to the consumer. Senator Mike Braun (R-IN), the ranking member on the committee, made repeated points about the overall lack of transparency in the health care sector and cautioned about industries that do not increase transparency themselves could invite federal government intervention and oversight, which may ultimately lead to higher costs. He promoted S. 1130, the Health Care PRICE Transparency Act 2.0, a bipartisan effort to increase competition and transparency in health care.

Many senators called the average cost of care in their state unaffordable for most families, especially those who don’t qualify for low-income programs or have substantial retirement savings. While many senators cited the average cost of care, witness Patricia Vessenmeyer, whose husband was in a memory care community in Virginia, reported paying nearly $13,000 per month for care. Senator Raphael Warnock (D-GA) described this as seniors mortgaging their retirement to afford care.

Richard Mollot called for establishing “National Standards to Promote Quality, Safety, and Integrity in Assisted Living.” He also called for establishing a national assisted living database, similar to a cost compare database in other health sectors, for consumers to better shop for care and understand their care options and overall costs. That database should include: staffing (levels and competencies), ownership, charges for residential and care services, and citation history (including how those citations were corrected and any penalties that were imposed). Senator John Fetterman (D-PA) in his questions suggested that operators who use federal funding should have to meet federal standards.

Julie Simpkins shared Gardant’s experience with Home and Community Based Services (HCBS) waiver programs, which she described as promoting a local model and collaboration, and better able to meet the personal care needs of each resident. Senator Pete Ricketts (R-NE) asked several questions about unintended consequences of standardization and avoiding a one-size-fits-all approach that nursing homes have at the federal level, and advised preserving state regulation for flexibility and innovation.

Workforce Development

Senator Mike Braun (R-IN) focused much of his remarks on the need for workforce development, both in the industry and more broadly. He called attention to S. 110, the Jumpstarting Our Businesses by Supporting Students (JOBS) Act and S. 2853, the Train More Nurses Act as efforts to meet the workforce shortages. He also protested the Biden Administration’s independent contractor rule, which he argued could eliminate existing caregiving jobs. Senator J.D. Vance (R-OH) also asked about labor shortages and the need to invest in the workforce, citing the need for 7 million more long-term care workers by 2030.

In her testimony, Jennifer Craft Morgan of the Gerontology Institute at Georgia State University, cited that the typical direct care worker makes about $15 an hour and “face dangerous working conditions, persistent occupational segregation, have limited access to paid leave, and experience very little career advancement.” In response to a question, Julie Simpkins shared Gardant’s experience in recruiting and retaining a workforce by connecting with caregivers’ passion, developing their skills, and envisioning a career.

Elopements

There was little discussion directly related to elopements. Senator J.D. Vance (R-OH) specifically called the rate of elopements “mercifully rare” in noting that there were only 2,000 noted elopements among the more than million residents cited by the Washington Post study, and of that 98 fatalities. Julie Simpkins noted in both her prepared and spoken remarks that they often overreport, including for instances when a resident exits and immediately returns with the help of a staff member. None of the witnesses described a personal connection to a significant elopement or fatality due to inadequate care.

Argentum’s Next Steps and How You Can Help

• Argentum staff are continuing outreach to Aging Committee members and their staff to share state-specific data and to tell the story of assisted living.
• We are working collaboratively with our State Partners and other industry partners to coordinate messaging and outreach.
• We will monitor developments on Capitol Hill for interest in additional hearings, inquiries, or other activities related to assisted living.