Legislation Introduced Fights Shortage Of Home Health, Long-Term Care Workers

WASHINGTON—U.S. Senator Kirsten Gillibrand held a virtual press conference to announce the Long-Term Care Workforce Support Act (S 4120), legislation that would address a nationwide shortage of long-term care workers. Long-term care workers, including certified nursing assistants, personal care aides and home health aides, allow seniors to age with dignity, but low wages, understaffing and poor working conditions in the field have led to a severe shortage of workers. This shortage means that seniors have to wait months or even years without getting the assistance they need. Gillibrand’s legislation would make major federal investments to strengthen and expand the long-term care workforce, including in rural and underserved communities. 

Most long-term care workers earn unacceptably low wages, a release from Gillibrand said. Of the 3.7 million aides in home health or personal care in 2022, half earned under $30,000 annually. As a result, many rely on SNAP and other public assistance programs, while others leave for better-paying and less physically demanding work. Inconsistent hours, wage theft and unpaid overtime are also rampant in the industry. The Long-Term Care Workforce Support Act would help address these industry-wide issues, incentivizing existing long-term care workers to stay in the field and attracting additional workers to join it. 

“Long-term care workers are too often forced out of the industry because of low wages, poor working conditions and lack of opportunities for advancement,” Gillibrand said. “This has serious consequences for our older adults, who struggle to get the care they need. By providing federal funding to improve compensation and training and implementing robust worker protections, this legislation would help retain current long-term care workers and attract new individuals to work in the industry. It will give some of our most essential health care workers the respect they deserve and make sure our seniors are cared for. I’m determined to get this passed.” 

Specifically, the Long-Term Care Workforce Support Act would: 

• Help Home- and Community-Based Services (HCBS) agencies retain staff and reduce vacancies and turnover by providing them with additional federal reimbursement for serving Medicaid recipients. These additional funds would allow HCBS agencies to provide higher compensation and better benefits to workers. Specifically, the bill would increase the Federal Medical Assistance Percentage (FMAP) by 10 percentage points for state Medicaid long-term care services.
• Provide $100 billion in federal grants over five years to states to expand the long-term care workforce. These grants will help provide eligible individuals—including those in rural and underserved communities that are facing severe home health care worker shortages—with opportunities for education, training and career advancement.
• Improve labor protections and benefits for long-term care workers. The legislation would expand protections against wage theft, implement fair scheduling practices, ensure the right to meals and rest and require all employers to provide paid sick time. It would also give the Secretary of Labor the authority to investigate and take action against any violations. 

A release from bill sponsor Sen. Bob Casey said 92% of nursing home respondents and nearly 70% of assisted living facilities reported significant or severe workforce shortages. In 2022, a survey of nursing homes showed more than 50% of the facilities were limiting the number of new admissions due to staffing vacancies or shortages. Another recent survey of HCBS providers showed all 50 states experiencing homecare worker shortages, and 43 states reported that some HCBS providers have closed due to worker shortages.  

In 2022, the median hourly wage for all direct care professionals was $15.43, with homecare aides earning $14.51. One in eight direct care professionals live in poverty, 75% earn less than the average living wage in their state, and 46% rely on public assistance, such as Medicaid, food assistance, or supplemental benefits. In addition to low wages, these workers report high levels of burnout and professional fatigue due to the daily physical and emotional demands of their jobs, lack of respect for the care that they provide, and health and emotional effects from battling the COVID-19 pandemic. Most direct care professionals are women, immigrants, and people of color, further perpetuating racial, gender and economic inequalities. 

Co-sponsors: Senators Casey (PA), Kaine (VA), Baldwin (WI), Wyden (OR), King (ME), Gillibrand (NY), Fetterman (PA), Duckworth (IL), Heinrich (NM), Welch (VT), Blumenthal (CT), Stabenow (MI), Smith (MN), Van Hollen (MD), Murray (WA), Sanders (VT), Klobuchar (MN), Brown (OH), Butler (CA), and Merkley (OR).

Endorsing Organizations: Caring Across Generations, the Long Term Care Community Coalition (LTCCC), PHI, the National Alliance for Direct Support Professionals (NADSP), the National Disability Rights Network (NDRN), the National Association of Councils on Developmental Disabilities (NACDD), the National Organization of Social Security Claimants’ Representatives (NOSSCR), Cure SMA, the Gerontological Advanced Practice Nurses Association (GAPNA), the Gerontological Society of America (GSA), the Muscular Dystrophy Association (MDA), the Academy of Doctors of Audiology, the American Academy of Audiology, the American Physical Therapy Association, the Hartford Institute for Geriatric Nursing at New York University, the National Association of State Ombudsman Programs (NASOP), the Council on Social Work Education, the National Association of Social Workers (NASW), the Coalition to End Social Isolation and Loneliness, the American Geriatrics Society (AGS), the National Domestic Workers Alliance (NDWA), Care in Action, the National Coalition on Aging (NCOA), the National Council on Independent Living, the National Respite Coalition, the American Association of Respiratory Care, the Autism Society of America, the Autistic Self Advocacy Network, the American Association on Health and Disability, the National Health Council, the Lakeshore Foundation, Justice in Aging, VOR – Voice of Reason, SEIU, AFSCME, the National Alliance to End Homelessness, the Alliance for Expanding America’s Workforce, the National Partnership for Families & Women, Jewish Health Foundation, Association of People Supporting Employment First (APSE), the Center for Excellence in Assisted Living (CEAL@UNC), American Speech-LanguageHearing Association (ASHA), and RespectAbility.