For the senior living industry, the incoming Biden administration and Democratic control of Congress means new opportunities for advocacy and education — and potentially some pitfalls in the form of new and tighter regulations.
The presidential election and the Georgia Senate races have resulted in the Democrats taking the White House and narrow control of Congress. That election “sea change” means the senior living industry has a newfound chance to impact relevant legislation and regulations, according to Maggie Elehwany, senior vice president of public affairs at Argentum.
The opportunity is underscored by the Covid-19 pandemic, which has in just a year’s time upended senior living operations and resulted in the deaths of more than 380,000 Americans, many of them older adults.
“It’s important for us to tell our story on Capitol Hill,” Elehwany said during an Argentum webinar Thursday. “We have been a little bit under the spotlight in the federal advocacy world for quite some time, and really felt the need [to do that] during this past year in light of Covid.”
But along with some new chances for education, Democratic control of the U.S. government also could bring some challenges for providers in the form of new oversight, legislation and regulations, Elehwany said. And that is why it’s important for the industry and for providers to make their voices heard early.
To aid that process, the industry association today announced the launch of Argentum Advocates, a program designed to educate and engage senior living advocates by offering advocacy assistance, access to members of Congress, seminars and briefings. The program is free and open to everyone, including providers who aren’t Argentum members.
‘Defining who we are’
With 68 new members in Congress and many more newcomers on the state and local level, the senior living industry will have plenty of opportunities to share its story and make new inroads with lawmakers.
It’s paramount for the industry to educate lawmakers on the fundamentals of the senior living industry and what differentiates it from other kinds of senior housing, according to Paul Williams, vice president of government relations at Argentum.
“Most people don’t know specifically what we do, particularly with relation to nursing homes,” Williams said. “So, the first thing we do … is defining who we are.”
Part of that process is explaining to lawmakers that, despite a lack of federal oversight, the senior living industry is indeed regulated in all 50 states, Williams said. It’s important for the industry to define the kind of services it provides older adults, and to explain that senior living residents tend to be older and live with more comorbidities than seniors who live in the general population.
It’s also crucial to stress to lawmakers that the industry is largely private-pay — a big distinction from the nursing home industry, which receives many more federal and state dollars.
“It’s also very important that they know that private-pay, and even Medicaid senior living and care, helps preserve the social safety net,” Williams said. “Because we’re a vital industry that’s able to provide affordable private-pay options for seniors, we are able to preserve Medicaid and some of the other publicly funded options that are so needed.”
And senior living providers must continue to advocate for more federal support in dealing with the Covid-19 pandemic, including through more funding and vaccine prioritization, Williams said.
Part of that effort means educating lawmakers on how much providers have spent to deal with the pandemic, and how much revenue they have lost as a result of it.
Of the roughly $175 billion allocated for distribution under the Provider Relief Fund, assisted living providers stand to receive just $3 billion, or 1.7%, he added.
And time is of the essence. A recent survey showed that as many as 50% of Argentum’s members anticipate facility closures in the next year if conditions do not improve.
“Your message to state capitals and to the Hill is to remember that this is unsustainable in the long term,” Williams said. “And that the relief is needed, and needed now.”
What to expect ahead
The inauguration of President-Elect Joe Biden is still days away and two senators-elect remain to be seated, but Argentum has already outlined some of the legislation and policies the senior living industry can expect in the future.
The industry association expects that Congress will pass another Covid-19 relief bill as early as March, likely with more Provider Relief Fund dollars and new funding for vaccine distribution — although how broad and how large the bill might be remains a “fairly large question mark,” Elehwany said.
The senior living industry should also expect more attempts at federal oversight similar to what Sens. Elizabeth Warren (D-Mass.), Ed Markey (D-Mass.) and Rep. Carolyn Maloney (D-N.Y.) sought to do last year with the Assisted Living Facility Coronavirus Reporting Act.
“We anticipate [more] legislation to be reintroduced in the near future, either in an identical or fairly recent format, as it has been in this last Congress,” Elehwany said. “I think we can see some new legislation, also, on infection prevention and control, emergency preparedness, a lot to do with worker and resident safety, and we may see some new OSHA changes.”
Additionally, the Democratic Congress and Biden administration likely will back union-friendly legislation and federal regulations, some of which may complicate the senior living labor landscape, Williams said.
These include reduced time for union elections; more disclosures for businesses that use consultants and attorneys for legal matters relating to labor management and relations; and a push for union “card checks,” which Williams said are at risk for fraud. Meanwhile, the chances of Covid-19 liability protection for the senior living industry have dimmed considerably in recent months, according to Williams.
From the White House, providers can expect an early and dedicated federal response to Covid-19. That will likely include new mask mandates and education campaigns, the rebuilding of the White House Pandemic Response Unit and renewed calls for more federal relief.
The Biden administration has also pledged to administer 100 million Covid-19 vaccine doses in his first 100 days in office. To achieve that goal, the administration plans to allow more flexibility in who can receive the vaccine, such as by opening it up to all older adults. But it’s important for providers to continue to stress in the meantime that there’s a good reason to prioritize them for vaccine doses.
“We’re going to do everything we can to make sure that assisted living communities remain in that high-priority phase, and that and that vaccines are distributed in as rapid a fashion as possible,” Elehwany said.
On the regulatory front, senior living providers should expect proposed regulations and reporting requirements on infection prevention and control, staffing, emergency preparedness, employee safety and patient/resident socialization, according to Elehwany. That is in addition to rolling back some Trump-era regulations and reinstating other prior regulations, such as those relating to the Affordable Care Act.
“The regulatory season begins late in spring and continues throughout the summer … and there is a response that goes out to the public for their comment before the rule is formally promulgated,” Elehwany said. “That’s the period when we really need to look at these regs and fight them with full force, both with our written comments and our advocacy efforts.”
But above all else, providers should heed a lesson from 2020 and “expect the unexpected.”
“Some emergency, some crisis always comes and seems to supersede things,” Elehwany said. “All the more reason for us to join together.”
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