A proposal that would establish a home- and community-based workforce standards board is a “significant misstep” that would result in increased costs for long-term care residents, according to senior living experts.
The Oregon legislature is considering HB 3838 / SB 1138, which would create an HCBS board that would set minimum working and training standards as well as provide “remedies” for those who violate those standards.
In written testimony submitted to the state House Committee on Labor and Workplace Standards, which held a hearing on the issue on Monday, National Center for Assisted Living Executive Director LaShuan Bethea called Oregon’s regulatory environment “one of the most comprehensive of any state.” But she urged the committee to carefully consider the bill’s potential effects on the state’s assisted living providers and residents.
“The nation has looked to Oregon as a model for a home- and community-based system that is innovative, well-funded and supports high-quality standards of care that our seniors deserve,” Bethea said in written testimony. “The proposed HCBS Workforce Standard Board would upend this collaboration and the progress Oregon has made by turning this decades-long collaborative process into a unilateral one.”
Bethea said the board could establish new rules and processes that may conflict with existing state regulations. It also could set pay and staffing standards unilaterally, bypassing the legislative process, which could result in assisted living communities that have limited resources passing increases on to consumers — or closing.
“Right now, Oregon is best-in-class for caregiver training requirements, worker supportive policies, protections and rights to organize, and holds facilities and employers accountable in meeting those high standards,” Bethea wrote. “We urge you to oppose this bill and allow all stakeholders to continue to use the current process to find ways to collaboratively continue to support workers, providers and consumers.”
Bill would ‘devastate’ system, groups say
The Oregon Health Care Association and LeadingAge Oregon joined other community-based care groups in opposing the bill, saying it would “devastate” the state’s system of care for older adults and people with disabilities by increasing costs, reducing affordability and diminishing options for care.
Rather than solve a problem, the coalition said, the bill would create “countless” new ones, including increasing costs for residents and Medicaid providers, adding “unnecessary and confusing” bureaucracy, ignoring employee privacy rights, and handing “unprecedented legal authority” to special interest groups.
In testimony on Monday before the House committee, LeadingAge Oregon CEO Kristin Milligan said the bill would have a “tremendous financial impact directly on Oregon’s seniors without any consideration or analysis of its consequences.”
Specifically, she said, the bill fails to require analysis of the fiscal effects of any standards the board creates for the state’s private-pay consumers and services providers. Noting that Medicare and most private insurance plans do not cover assisted living, memory care or other community-based services, Milligan said that the bill would increase costs for the 59% of Oregon’s private-pay residents who reside in such settings.
“This bill will increase costs for consumers, making facilities unaffordable for a larger portion of seniors on fixed incomes, and will force more people onto Medicaid, a fragile system already at risk,” she testified.
The bill also threatens the state’s continuing care retirement / life plan communities, she said, by failing to consider the complexities of staffing those communities that provide multiple housing options and levels of care.
Nine of the state’s 12 CCRCs are 100% private pay, and only three accept Medicaid, Milligan noted. In addition, she said, many communities provide discounted care through foundations for residents who spend down their resources, and those foundations also support staff members through scholarships.
“What happens when these private funds are depleted because a growing number of residents can no longer afford their monthly fees?” Milligan asked. “This bill jeopardizes the financial stability of providers who support seniors without relying on Medicaid dollars.”
Milligan said the bill will not improve care, expand the workforce, support employee choice, support providers or advance nonprofits charitable missions that keep older adults off of Medicaid.
Oregon Health Care Association CEO Phil Bentley also testified, saying that the most significant challenge facing Oregon’s long-term care system is the state’s ability to afford the increasing cost of care. He said that Oregon’s long-term care system has struggled since the COVID-19 pandemic due to staffing shortages, funding challenges and new regulatory requirements.
“These struggles have had real impacts on our regulatory climate,” Bentley said. “We are now considered a challenging and expensive place to operate and provide care.”
Some providers are leaving the state, others are avoiding new projects and rural communities are experiencing community closures in the face of rising demand. HB 3838, Bentley said, would accelerate this trend.
The bill would provide the board jurisdiction over a vast array of policy areas already governed by other state agencies, he said. The board’s jurisdiction would cover six to eight care settings that serve different consumers with differing care needs, various payer sources, and are governed under various regulatory agencies and systems. Bentley called the volunteer board’s mission “impossible.”
In addition, he said, the bill would undermine the interests of workers who could earn higher wages, because it would force workers under a statewide collective bargaining agreement.
Source: McKnights Seniorliving
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