OHCA The Oregon Caregiver Fall/Winter 2019

The Oregon Caregiver FALL/WINTER 2019 www.ohca.com 12 PUBLIC POLICY W orkforce is the number one challenge facing most long term care providers across the continuum of care. The National Investment Center for Seniors Housing and Care (NIC) recently completed a study that found the U.S. will need 2.5 million new long term care workers by 2030. With record unemployment levels drying up the supply of new workers today and a demographic boom on the horizon, the demand for qualified caregivers is unlikely to subside even if the economy enters into a recession. Workforce is also one of the most chal- lenging issues for those of us working in public policy to drive meaningful change. The issue is simply too big. The long term care workforce climate is affected by a wide variety of factors: macro-economic forces, public education and career training programs, affordable housing, wages and benefits offered by other health and human service providers and non-health care sectors, Medicaid and Medicare reimbursement rates, and multiple other aspects of public policy at the federal, state, and local levels. It is clear that long term care providers themselves ultimately have the most direct influence in addressing the challenges of hiring, training, and retaining workers. There are, however, some public policy initiatives worthy of pursuing at the state and federal levels. The American Health Care Association (AHCA), OHCA’s national affiliate, is advocating for immigration policies that will help the U.S. meet the growing demand for caregivers. AHCA policy on immigration includes the belief that, “The ability to recruit and train immigrants is key, and we support legislation that would help expand opportunities for migrants, ‘Dreamers,’ and those with temporary protected status.” At the federal level, the issue of immigra- tion is perhaps more controversial today than in any time in the post-war era. Nonetheless, immigration is central to the U.S. being able to meet its health care workforce needs. According to a study conducted by Dr. Leah Zallman, an assistant professor of medicine at Harvard Medical School, “Immigrants [...] account for about 23% of employees in the long-term care sector. About 27% of direct care workers—home health and personal care nurses and aides—are immigrants, and immigrants also account for a full 30% of the housekeeping and mainte- nance workers at nursing homes.” Dr. Zallman notes that “Attempts to limit immigration overall are damaging, but so are efforts to only allow highly educated and wealthier immigrants into the country.” However, it is clear that it will be some time before our federal immigration policies are reformed. In the shorter term, a tangible policy change for our sector is being considered by the current Congress. Reps. Dwight Evans (D-PA) and Ron Estes (R-KS) have introduced bipartisan legislation, the Nursing Home Workforce Quality Act , that would allow skilled nursing facilities (SNFs) that have been forced to suspend in-house certified nurse assistant (CNA) education programs after receiving a certain level of penalties to resume those programs once quality standards are met. Currently, nursing centers “that receive a threshold number of penalties for defi- ciencies in quality” have a two-year mandatory suspension placed on in-house CNA certification programs. At the state level here in Oregon, a number of OHCA members are working with SEIU 503 on a workforce training collaborative that seeks to increase the number of certified nursing assistants (CNAs) and other certified staff to work in nursing facilities. OHCA is also exploring public policy options that would provide incentives for nurses to seek employment in long-term care settings. For example, a scholarship or tax credit program that rewards nurses entering underserved health care sectors including long term care, public health, and behavioral health. These sectors do not receive the same reimbursement and financial resources as acute care providers and struggle to compete for workers. OHCA welcomes comments and ideas from our members that might help providers address workforce challenges at the state policy level. Phil Bentley, J.D., is the Senior Vice President of Government Relations at OHCA. Policy Prescriptions to Address Caregiver Workforce Challenges By Phil Bentley, J.D., Oregon Health Care Association