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10 Min Read
June 1, 2023

Healthcare Workforce Crisis Legislative Roundup

by Morris Isaacson

So far this year, there’s been an extraordinary amount of attention paid to healthcare workers. More precisely, the lack of them. Three years after COVID blindsided the medical (and our) world, our healthcare workforce is spent and depleted. It’s an unsurprising development considering the amount of pressure and stress the healthcare system experienced during the pandemic.


Today, many healthcare workers and caregivers feel burnt out. And they are leaving the profession in record numbers. The resulting workforce shortage is being felt everywhere, but nowhere more so than in home and long-term care.


According to the HCP 2023 Benchmarking Report for home care, home health and hospice, three-quarters of post-acute care providers have had to turn away patients in 2023. More troubling, the industry report found that 53.5% of home care providers and 60.3% of home health providers have consistently denied care since the start of the year due to workforce shortages.


The healthcare staffing crisis has garnered increasing attention from legislators, government leaders and healthcare industry advocates in the first few months of 2023. There’s been a flurry of activity around the issue, and it’s easy to lose track of all that’s happened. To help you stay caught up, here’s a quick recap of some of the most important developments so far this year.


Thursday, February 16


The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on the healthcare workforce crisis.


From McKnight Senior Living:


Healthcare workforce shortages were front and center at Thursday’s Senate Health, Education, Labor and Pensions Committee hearing, and senior living industry advocates made their voices heard through submitted testimony or public statements.


Mark Parkinson, president and CEO of the American Health Care Association / National Center for Assisted Living, said in a statement issued before the hearing that “the pandemic has taken a physical and emotional toll on our healthcare workers, especially our nation’s long-term caregivers.” Nursing homes, he said, have experienced the worst job loss of any healthcare sector.


“For years, we have called on our nation’s leaders to help us address long-term care’s workforce challenges,” Parkinson added. “As historic labor shortages continue to limit seniors’ access to care, inaction is no longer an option.”


Thursday, March 30:


Following a wave of nurse strikes through the first several months of the year, Rep. Jan Schakowsky  (D-OH) and Sen. Sherrod Brown (D-OH) reintroduced the Nursing Staffing Standards for Hospital Patient Safety and Quality Care Act.


“Numerous studies have shown that safe nurse-to-patient staffing ratios result in higher quality care for patients, lower health care costs, and an overall better workplace for nurses,” said Rep. Schakowsky in a press release. “The need for federal safe staffing standards is about nurses, patients, and everyone’s lives. This bill will improve the health of patients by improving nursing care—establishing minimum registered nurse-to-patient ratios in hospitals, providing whistleblower protection for nurses who advocate on behalf of their patients, and investing in training and career development to retain hardworking nurses in the workforce.”


Tuesday, April 18:


The Biden Administration unveiled a sweeping executive order aimed at expanding Americans’ access to affordable, high-quality early and long-term care. The Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers describes access to long-term care as “critical to our Nation’s economic growth and economic security.”


The order identified the following priorities with respect to healthcare workers:


  • Enhance job quality for long-term care workers. The President is committed to improving the quality of long-term care jobs in this country so that Americans can get the reliable, high-quality care they deserve—whether it is in their homes and communities or in nursing homes. To advance the President’s long-term care priorities, the Executive Order directs HHS to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.


  • Support family caregivers. Without adequate resources, family caregiving can affect caregivers’ physical and emotional health and well-being and contribute to financial strain. These negative consequences are felt most acutely by women, who make up nearly two-thirds of family caregivers and who drop out of the workforce at higher rates than men. To provide greater support to family caregivers, the Executive Order directs HHS to consider testing a new dementia care model that will include support for respite care (short-term help to give a primary family caregiver a break) and make it easier for family caregivers to access Medicare beneficiary information and provide more support to family caregivers during the hospital discharge planning process. Additionally, VA will consider expanding access to the Program of Comprehensive Assistance for Family Caregivers and provide more mental health support for caregivers enrolled in that program. These actions build on the 2022 National Strategy to Support Caregivers.


  • Advance domestic workers’ rights. Care workers should be supported, valued, and fairly compensated, and care workers should have the free and fair choice to join a union. In particular, domestic workers providing care for our loved ones are often underpaid and subject to discrimination and abuse. To provide greater protection for these workers, the Department of Labor will publish a sample employment agreement so domestic child care and long-term care workers and their employers can ensure both parties better understand their rights and responsibilities.


The reaction to the executive action was mixed, with healthcare industry advocates and operators chiming in with concerns.


“[T]oday’s Executive Order brings much-needed attention, but not adequate solutions, to the long-term care sector,” said LeadingAge, the association of non-profit providers of aging services in a released statement.


“LeadingAge has long advocated for an all-of-government approach to ensuring greater access to aging services — and addressing the workforce crisis must be the top priority,” said Katie Smith Sloan, the group’s President and CEO, in the release.


Thursday, April 20:

Following the Biden Administration announcement, Rep. Schakowsky and healthcare industry advocates continued to press for federal minimum staffing standards and unions for nursing home workers during the Care Can’t Wait Summit in Washington, DC.


From a McKnight Senior Living article reporting on the event:  


An executive order announced Tuesday by Biden in part calls for expanding the as-yet detailed nursing home staffing mandate and tying Medicare payments to nursing home staff retention. The sentiment is well and good, provider groups say, but it is not enough. 


“Turnover metrics are important, but we need significant, meaningful aid to help address the root causes of turnover and offer more competitive, good-paying jobs,” Holly Harmon, senior vice president of quality, regulatory and clinical services at AHCA and the National Center for Assisted Living, said Tuesday.


LeadingAge President and CEO Katie Smith Sloan, who attended the president’s speech, said the announcement indicates that the federal government has been listening to long-term care industry advocates but that the order is “still getting it wrong on nursing homes” and “bolsters the home care workforce while punishing nursing home providers for shortages.”


Monday, June 5: 


AHCA/NCAL is holding a Congressional Briefing on Capitol Hill to advocate for minimum staffing standards and other workplace improvement measures in the long-term care industry. 


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