Policies and Legislation and its impact on the direct care workforce shortage crisis
Recent historical Policies and Legislation and its role in impacting workforce health
A review of policies and legislation enacted to address the workforce shortage in senior care and improve care quality.
1. American Rescue Plan Act (ARPA)
Passed: 2021
Provisions
Allocated $12.7 billion in additional Medicaid funding for Home and Community-Based Services (HCBS).
Many states used these funds to provide bonuses, wage increases, and training for home care workers.
Impact
Short-term improvements in wages, working conditions, and training for direct care workers.
Expanded access to HCBS, benefiting both workers and patients.
Limitations: Funding was temporary, requiring advocacy to sustain implemented solutions and for permanent solutions.
2. Domestic Workers Bill of Rights (State-Level Legislation)
Enacted in: New York, California, Massachusetts, and other states.
Provisions
Minimum wage and overtime protections for domestic workers, including personal care aides.
Access to paid time off, rest breaks, and protection against workplace harassment.
Impact
Improved working conditions and increased recognition of domestic workers.
Enhanced job satisfaction and retention.
3. The RAISE Family Caregivers Act
Enacted: 2018
Provisions
Created a national caregiving strategy to support family caregivers.
Indirectly benefited professional caregivers by promoting training, support systems, and resource-sharing.
Impact: Helped raise awareness of caregiving needs and laid the groundwork for more comprehensive policies.
4. Workforce Innovation and Opportunity Act (WIOA)
Purpose: Provides funding for workforce development programs, including those for direct care workers.
Impact: Funded training and recruitment programs, addressing skills gaps and bringing new workers into the caregiving field.
5. Raising the Minimum Wage (State-Level Actions)
Provisions: States like California and Washington implemented higher minimum wages, positively impacting direct care workers.
Impact: Improved income for care workers, contributing to workforce stability in states with higher minimum wages.
What’s possible: Policies and Legislation Under Consideration
A review of pending legislation we’re tracking that could further address workforce shortages and improve care quality.
1. Building America’s Health Care Workforce Act (H.R. 468)
Purpose: Extends flexibilities for nurse aide training and certification in nursing homes.
Current Status: Referred to House Committees on Energy and Commerce and Ways and Means.
Likelihood of Passage: Moderate, with bipartisan support but requiring further advocacy.
Impact: Would address immediate staffing shortages by allowing temporary nurse aides to become certified based on their experience.
2. Care Across Generations Act (H.R. 6835)
Purpose: Establishes grants for long-term care facilities to operate childcare programs and create intergenerational activities.
Current Status: Referred to the House Committee on Education and the Workforce.
Likelihood of Passage: Moderate, with bipartisan sponsorship but limited momentum.
Impact: Promotes job satisfaction and retention among caregivers by addressing work-life balance and enhancing intergenerational programs.
3. Nursing Home Workforce Support and Expansion Act of 2024
Purpose: Provides funding and resources to expand and support the direct care workforce across settings despite the Act’s title.
Current Status: Early stages.
Likelihood of Passage: Undetermined.
Impact: Could improve recruitment, training, and retention in nursing home care.
4. Recognizing the Role of Direct Support Professionals Act
Purpose: Formally recognizes the contributions of direct support professionals and highlights the need for workforce support.
Current Status: Early stages.
Likelihood of Passage: Likely to gain support as a recognition-focused bill but may lack substantive workforce solutions.
Impact: Raises awareness of the profession, paving the way for further legislative efforts.
5. Supporting Our Direct Care Workforce and Family Caregivers Act
Purpose: Provides resources for training, financial assistance, and policy reforms for direct care workers and family caregivers.
Current Status: Early stages; detailed progress unknown.
Likelihood of Passage: Depends on bipartisan support and advocacy efforts.
Impact: Could significantly improve workforce recruitment, retention, and care quality.
6. HCBS Access Act
Purpose: Creates a federal program to ensure universal access to Medicaid-funded HCBS and provides resources for workforce development.
Current Status: Proposed but not advanced.
Likelihood of Passage: Moderate; advocates continue pushing for long-term funding solutions.
Impact: Would address structural barriers to care access and improve workforce conditions through wage parity and training.
Conclusion
Enacted Policies: Existing policies like ARPA and state-level Domestic Workers Bills of Rights have provided critical support for direct care workers, improving wages, training opportunities, and working conditions. However, these initiatives often lack the permanence or scalability to fully resolve workforce shortages. As health tech innovators we must ask ourselves, how can we advance workforce health in alignment with, in advance of, or in spite of pending policy and legislation.
Pending Legislation: Proposed bills like the Building America’s Health Care Workforce Act and the Supporting Our Direct Care Workforce and Family Caregivers Act aim to address systemic issues, including training, recognition, and access to services. Advocacy efforts remain essential to push these initiatives forward and ensure their implementation addresses both workforce shortages and care quality effectively.
