ASHA Legislative / Regulatory Policy Agenda
A robust, targeted plan to address industry priorities
ASHA’s policy priorities include front burner issues as well as long-term concerns that require the attention of policymakers. Priorities are identified by regular communication with membership and ASHA committee participants. The overarching goal is to support the advancement of the senior living industry. What follows is a brief summary of ASHA’s current policy initiatives. (For more detailed information about these issues, ASHA Members can visit the Members Area section of the website.)
The senior living industry is facing an unprecedented shortage of workers which will only intensify going forward given the characteristics of the nation’s aging population. People are living longer and require more care. Without an adequate workforce to care for these seniors, much is at risk. To address the current worker shortage, ASHA is seeking a new visa category that will allow senior living providers to hire foreign workers on a temporary, or long-term basis. There are more than 20 non-immigrant visa categories for people traveling and working in the U.S., but none of them are suited for the caregiver, dietary aid, med tech and other critical positions in the long-term care industry. Congress needs to reform the broken immigration system to ensure the needs of seniors can be met now and in the future.
The Veterans Administration (VA) is actively evaluating its approaches to long-term care, shifting resources from nursing homes to home-and-community-based services (HCBS). To advance this approach, legislative proposals are under consideration in Congress to allow eligible veterans in need of long-term care to live in an assisted living community. This would be conducted under a pilot study to be assessed by the VA and the veterans themselves for effectiveness and satisfaction. The assisted living communities must be Medicaid-certified to avoid additional regulatory oversight. Operators who currently offer occupancy under the Medicaid waiver program will be well-suited to participate in this pilot program. We are confident the results of the pilot will positively inform future policy decisions related to caring for all seniors.
Bipartisan efforts to establish a national advisory commission on long-term care services is under consideration by Congress. The commission would assess and provide regular reporting to Congress on service delivery, financing, workforce adequacy, and other issues related to long-term care. The goal is to help increase access by seniors and people with disabilities to services that support daily living.
ASHA is advocating that the Commission include a senior living representative, given the integral position we hold in the long-term care delivery system. We also can bring expertise to the table on each of the identified areas of study such as serving a non-Medicaid population and long-term care insurance needs. These efforts underscore the broader need to develop a national plan for long-term care.
Changes in federal rules regarding Medicare Advantage (MA) programs create new flexibility to cover supportive services, such as those offered in senior living. This may open opportunities for those providers who can demonstrate improved resident health metrics. Entry into the MA market requires collaboration with other providers, additional investment in data collection and technology platforms, and for some providers, a willingness to assume risk (as well as potential benefits). ASHA continues to monitor advances in these new arrangements and to educate policymakers on the positive health outcomes that can be achieved for residents in MA programs.
Every state provides comprehensive oversight of seniors housing. State and local government understand the unique circumstances in their communities and can best ensure compliance with the rules they establish. ASHA has historically opposed duplicative federal senior living regulation since it would increase costs, discourage investment, and impede innovations in caring for the frail elderly.
It is critically important that research under the National Alzheimer’s Disease Plan is fully funded. Alzheimer’s is the most expensive disease in America. More than 6.2 million people aged 65 and older live with Alzheimer’s today. By 2025, the number is projected to reach 7.2 million—a 16% increase. Funding Alzheimer’s research is a critical component to heighten our nation’s response to the disease.
The existing housing finance system provides critical liquidity to the multifamily sector, including seniors housing. ASHA monitors the changing loan capacity at the government-sponsored enterprises (Freddie Mac and Fannie Mae), HUD financing programs and advocates for continued access to private investment sources such as REITs and Private equity. The association works to sustain senior living’s access to capital and engage on policy changes that impact this access.
