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PHI Endorses the Long-Term Care Workforce Support Act

April 15, 2024

Today in Congress, U.S. Senators Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, Tim Kaine (D-VA), and Tammy Baldwin (D-WI) introduced the Long-Term Care Workforce Support Act, a historic piece of legislation designed to systematically improve direct care job quality and address the workforce crisis in long-term care.

PHI enthusiastically endorses this comprehensive bill, which we had the opportunity to inform and which enshrines many of PHI’s long-standing policy priorities related to compensation, training, employment conditions, evaluation, and more. Here, we highlight five promising elements of the Act:

Increased Federal Funding for Long-Term Care Services

The first section of the bill proposes to increase the federal match for long-term care services, with explicit requirements for states to invest the additional funds in bolstering the workforce and improving access to services. One key provision is for states to spend at least 85 percent of the funds on “compensation, benefits, working conditions, and training for direct care professionals and direct care managers.” This permanent increase in federal funding—building on the short-term support provided to states through the American Rescue Plan Act of 2021—is critically needed to strengthen and sustain the direct care workforce.

Further Investments in the Direct Care Workforce

In addition, the bill authorizes the Secretary of Health and Human Services (HHS)—in consultation with other federal agencies—to award a range of grants to support workforce recruitment, training, compensation, and retention. As one example, Section 206 calls for a $10 million investment in demonstration projects on education, training, and career advancement across care settings—and Section 211 allocates the same amount to a national technical assistance center to support states’ workforce efforts. As another example, Section 231 designates grants to establish mental health and resiliency programs for direct care workers. These various grant-funded efforts could offer immediate benefits for participants as well as help build the evidence base on the most effective strategies to scale and sustain.

Creation of a National Training Standards Commission

In alignment with PHI policy priorities, this bill proposes to create a National Direct Care Professional Training Standards Commission under the Secretary of HHS. This provision promises to address the inadequacy, inequity, and inefficiency of the current direct care training landscape by establishing national training standards and supporting states to meet those standards. The bill underscores that training standards should be “competency-based, industry-recognized, and portable across settings and States” and names a broad swath of perspectives that should be represented on the Commission, including organizations that represent older adults, people with disabilities, and direct care workers themselves. Consistent and sufficient training standards would help elevate direct care jobs, strengthen career ladders and lattices, and consistently prepare workers to provide quality care across settings.

Development of a National Direct Care Compensation Strategy

Reflecting another key PHI policy priority, the Long-Term Care Workforce Act directs the Secretary of HHS to convene an Advisory Council to jointly develop a national direct care compensation strategy. According to Sections 402 and 403, the national strategy should recommend actions that the federal, state, and local governments and other actors can take to set a livable wage for direct care workers, including calculating the full cost of labor provided by direct care workers; establishing reimbursement rates that adequately cover labor costs; and tying training and career development to compensation rates, among other recommendations. Achieving livable and competitive wages for all direct care workers is a matter of social justice as well as a critical step toward attracting and retaining a sufficient workforce to meet the growing demand for long-term services and supports.

Enhanced Data Collection, Research, and Evaluation

The bill also includes numerous provisions related to data collection, research, and evaluation, exemplifying the importance of transparency, accountability, and evidence-informed policymaking. For example, Section 101 calls for robust reporting by states and an annual evaluation of the enhanced federal investment in long-term care through 2036—helping ensure effective implementation and impact. Section 221 directs the Secretary of HHS, in coordination with several other federal agencies, to conduct and publish data on direct care worker well-being, filling a critical gap in nationally representative research on this workforce. Most ambitiously, Section 501 calls for the Secretaries of HHS and Labor to commission an external evaluation of the Act, with assessment of workforce outcomes related to recruitment, retention, wages, benefits, working conditions, health, and more.

Beyond These Provisions

The Long-Term Care Workforce Act includes a number of other vital elements, including the creation of a Direct Care Professional Equity Technical Assistance Center; a grant program designed to address wage theft and enhance enforcement of wage and hour laws; provisions related to fair scheduling, workplace violence prevention, and paid sick and safe leave; and more. As such, the bill is a testament to the collective effort of PHI and other experts and advocates across our country to elevate the voices, needs, and rights of direct care workers and the individuals they support.

PHI extends our gratitude to Senators Casey, Kaine, and Baldwin and to the collaborative team involved in shaping this legislation, and we offer our ongoing support and advocacy for this bill as it progresses through Congress. We are hopeful about the bill’s potential to catalyze positive change and committed to ensuring its principles are translated into impactful action.

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