Categoria: senior living

Senior Living: Government Lets Health Plans That Ripped Off Medicare Keep Money

By Fred Schulte,

Kaiser Health News

Medicare Advantage plans for seniors dodged a major financial bullet recently as government officials gave them a reprieve for returning hundreds of millions of dollars in government overpayments — some dating back a decade or more.

The health insurance industry had long feared the Centers for Medicare & Medicaid Services would demand repayment of billions of dollars in overcharges the popular health plans received as far back as 2011.

But in a surprise action, CMS announced last month that it would require next to nothing from insurers for any excess payments they received from 2011 to 2017. CMS will not impose major penalties until audits for payment years 2018 and beyond are conducted, which have yet to be started.

While the decision could cost Medicare plans billions of dollars in the future, it will take years before any penalty comes due. And health plans will be allowed to pocket hundreds of millions of dollars in overcharges and possibly much more for audits before 2018. Exactly how much is not clear because audits as far back as 2011 have yet to be completed.

In late 2018, CMS officials said the agency would collect an estimated $650 million in overpayments from 90 Medicare Advantage audits conducted from 2011 to 2013, the most recent ones available. Some analysts calculated overpayments to plans of at least twice that much for the three-year period.

CMS is now conducting audits for 2014 and 2015.

The estimate for the 2011-13 audits was based on an extrapolation of overpayments found in a sampling of patients at each health plan. In these reviews, auditors examined medical records to confirm whether patients had the diseases for which the government reimbursed health plans to treat.

Through the years, those audits — and others conducted by government watchdogs — have found that health plans often cannot document that they deserved extra payments for patients they said were sicker than average.

The decision to take earlier audit findings off the table means CMS has spent tens of millions of dollars conducting audits as far back as 2011 — much more than the government will be able to recoup.

In 2018, CMS said it pays $54 million annually to conduct 30 of the audits. Without extrapolation for years 2011-17, CMS won’t come near to recouping that much.

CMS Deputy Administrator Dara Corrigan called the final rule a “commonsense approach to oversight.” Corrigan said she did not know how much money would go uncollected from years prior to 2018.

Health and Human Services Secretary Xavier Becerra, meanwhile, said the rule takes “long overdue steps to move in the direction of accountability.”

“Going forward, this is good news. We should all be happy that they are doing that (extrapolation),” said former CMS official Ted Doolittle. “I do wish they were pushing back further (and extrapolating earlier years). That would seem to be fair game.”

David Lipschutz, an attorney with the Center for Medicare Advocacy, said he was still evaluating the rule, though he added it was unclear whether the agency is using its entire authority.

“It is our hope,” Lipschutz said, “that CMS would use everything within their discretion to recoup overpayments made to Medicare Advantage plans.”

Mark Miller, the executive vice president of health care policy for Arnold Ventures — who formerly worked at the Medicare Payment Advisory Commission, a congressional advisory board — said extrapolating errors found in medical coding have always been a part of government auditing. (Kaiser Health News receives funding support from Arnold Ventures.)

“It strikes me as ridiculous to run a sample and find an error rate and then only collect the sample error rate,” he said, “as opposed to what it presents to the entire population or pool of claims.”

In January, KHN released details of the 90 audits from 2011 to 2013, which were obtained through a Freedom of Information Act lawsuit. The audits found about $12 million in net overpayments for the care of 18,090 patients sampled for the three-year period.

In all, 71 of the 90 audits uncovered net overpayments, which topped $1,000 per patient, on average, in 23 audits. CMS paid the remaining plans too little on average, anywhere from $8 to $773 per patient, the records showed.

Since 2010, the federal Centers for Medicare & Medicaid services has threatened to crack down on billing abuses in the popular health plans, which now cover more than 30 million Americans. Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies, including Humana, UnitedHealthcare, Centene and CVS/Aetna.

But the industry has successfully opposed extrapolating overpayments, even though the audit tool is widely used to recover overcharges in other parts of the Medicare program.

That has happened despite dozens of audits, investigations and whistleblower lawsuits accusing Medicare Advantage of costing taxpayers billions of dollars a year in overcharges.

CMS expected to collect $479 million from overpayments in 2018, the first year of extrapolation, Corrigan said. Over the next decade, she said, it could recoup $4.7 billion.

Medicare Advantage plans also face potentially hundreds of millions of dollars in clawbacks from a set of unrelated audits conducted by the Health and Human Services inspector general.

The audits include an April 2021 review that accuses a Humana Medicare Advantage plan in Florida of overcharging the government by nearly $200 million in 2015.

Carolyn Kapustij, the Office of the Inspector General’s senior adviser for managed care, said the agency has conducted 17 such audits that found widespread payment errors — on average, 69% for some medical diagnoses.

In these cases, Kapustij said, the health plans “did not have the necessary support (for these conditions) in the medical records, which has caused overpayments.”

“Although the MA organizations usually disagreed with us,” she added, “they almost always had little disagreement with our finding that their diagnoses were not supported.”

While CMS has taken years to conduct the Medicare Advantage audits, it has also faced criticism for permitting lengthy appeals that can drag on for years. These delays have drawn sharp criticism from the Government Accountability Office, the watchdog arm of Congress.

Leslie Gordon, an acting director of the GAO health team, said that until CMS speeds up the process, it “will fail to recover improper payments of hundreds of millions of dollars annually.”

KHN senior correspondent Phil Galewitz contributed to this report.

Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at Kaiser Family Foundation. KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Crisis Looms As Aging Boom, Dementia Increase Demand For Care For Elderly

At the outset of the COVID-19 pandemic, in early 2020, about 4.5 million Americans were paid to work in eldercare, most at nursing homes, assisted-living facilities or as in-home aides.

Over the next 24 months, more than 240,000 of those workers left the profession, a decline that made eldercare one of the country’s hardest-hit industries, at least in terms of pandemic-related job losses.

Worse, thousands of the people who “left” eldercare did so because they were no longer alive.

Whatever the cause, the worker exodus helped spark a human and economic disaster. Many nursing homes became COVID-19 hot zones, in part because of short staffing. Some operators, particularly in rural areas, closed their doors. And misery became rampant, as thousands of older people died while receiving barebones care and with no family at their side.

But many experts, in and outside the industry, say that crisis was more than a pandemic-era emergency, it was a glimpse of America’s possible future.

By all accounts demand for age-related health care is about to far outstrip supply, particularly with the coming growth of two demographic groups, people 85 and older and people with Alzheimer’s or other forms of dementia. And without big changes to eldercare – an issue that experts note is not yet a national conversation – millions of American lives could be upended.

“It’s about a lot of things,” said Joe Diaz, the Southern California regional director for the California Association of Health Facilities, a trade group that represents about 1,200 nursing homes in the state, when asked about the coming squeeze on eldercare.

“But, mostly, it’s about age.”

And, Diaz, echoing others in the industry, added this:

“It’s going to affect everybody, not just older people.”

Age and Alzheimer’s The eldercare industry has regrouped a bit since the worst of the pandemic. Federal data shows the number of nursing homes nationally grew by about 2% over the past year, to slightly more than 26,500. (There are about 4,000 nursing homes and assisted living centers in Los Angeles, Orange, Riverside and San Bernardino counties.) Also, the number of Americans living in nursing homes and assisted-living facilities has grown to about 2 million.

But the professional side of eldercare is only a sliver of the actual work done taking care of older people. And it’s not growing anywhere near fast enough to keep pace with a self-explanatory trend that demographers call the aging boom, which is already well underway in the United States and in most other advanced economies.

The coming explosion of older people within the population will create so much need that industry experts believe it could force a collective re-think when it comes to how America handles age-related health care.

Rich Southard president of a Home Instead franchise in Whittier. (Photo by Jeff Gritchen, Orange County Register/SCNG) “The effects of this will spread,” said Rich Southard, who owns the Whittier-area franchise for Home Instead, a company that provides in-home eldercare services.

“There’s never going to be enough bed space for all of the older people who are going to need it. That’s just the reality.”

Current population trends back him up.

The Census Bureau projects that by 2032 there will be more older Americans (age 65 and up) than children (age 18 and under), a rarity in human history. By 2060, the pool of Americans age 65 and older will account for roughly one-quarter of the country’s population. The demographics of Florida and New Hampshire – states with currently outsized retiree populations – soon will be the norm nationwide.

But from an eldercare perspective, two specific projections could be more important: the expanding population of old people and the rise of people with Alzheimer’s disease and other forms of dementia.

First, within the broader aging boom, the fastest growing cohort is the oldest of the old, people 85 and up. America currently has about 7 million people in that age range; by 2050, the number will be 18.6 million. And, within that group, the number of Americans age 100 and older is forecast to grow from about 90,000 today to nearly 400,000.

Statistically, these are the people most likely to need care. While just 1.1% of people ages 60 to 74 live in a nursing home, that shoots up to 15% when you’re talking about people 85 and older. And a much larger pool – roughly two-thirds of people in the 85-and-up crowd – can still live independently or with family because they get regular help from paid workers or unpaid family members, friends, spouses and others.

A Home Instead caregiver helps a client get dressed. (Courtesy of Home Instead)

A caregiver with Home Instead helps a client into a bathtub (Courtesy of Home Instead)

Numbers suggest the aging boom is already reshaping Southern California. Over the past decade, the number of people ages 65 and up has grown in Los Angeles (up 34%), Orange (up 41.6%), Riverside (up 40%) and San Bernardino (up 45.4%) counties. And by the mid-2030s each of those counties is expected to see the number of people age 75 and older grow between 55% and 65%.

All of this aging, nationally and locally, is creating – or forcing – an explosion in unpaid caregiving.

As of 2020, there were 41.8 million people taking care of somebody 50 years old or older, a 22% increase in such caregivers since 2015, according to a study from AARP. The help provided by this volunteer army ranges from cooking and housekeeping to navigating a loved one’s insurance and medical care, bathing, lifting them in and out of bed, and dressing.

If current trends hold, as many as 85 million Americans could be providing such help by 2050.

The AARP study also pointed out that the professional and volunteer worlds of caregiving are inextricably linked. As beds in nursing homes and other professional settings become tougher to find, the pool of older people living independently becomes frailer. That means more help from – and more strain upon – their caregivers.

That, too, is already happening.

“Not only are more American adults taking on the role of unpaid caregiver, but they are doing so for adult recipients who may have increasingly complex medical or support needs,” the AARP report found.

The report also found that while most (60%) caregivers say taking care of elders is “difficult but rewarding,” there are myriad downsides, ranging from lost income to frustration to depression. About 1 in 4 (23%) said caregiving has made their own health go downhill.

Local caregivers say the experience, good and bad, is life-changing.

“There’s no way every family can do this. No way,” said Lia Alvarez, a 58-year-old former librarian in Long Beach who left her job three years ago to care for her aging mother (also in Long Beach) and her mother-in-law (in Downey).

“I’m at capacity. And the people I help are both really sweet, and their needs aren’t that intense yet. And I’m not the only person in the family who does it; my husband and our kids and my sister, everybody pitches in.

“But it’s pretty crazy,” she added. “I can’t imagine what it will be like when this is happening in every family.”

The second Census projection that figures to reshape American life is this: The number of people with Alzheimer’s disease or some other form of dementia is growing even faster than the broader aging boom.

Between now and 2060 the number of Americans with Alzheimer’s is expected to grow from 6 million to about 13.8 million, or slightly more than the current population of Pennsylvania, according to federal data and studies by the national Alzheimer’s Association. In Southern California, the number of Alzheimer’s and other dementia patients figures to jump from about 710,000 today to about 1.5 million.

And while Alzheimer’s and other forms of dementia are tragic – the disease is a key cause of death, particularly for older women and people of color – it also eats up a lot of money. In 2021, the cost of medical care for Alzheimer’s and other dementia ran to about $321 billion nationally, a number that’s expected to reach $1 trillion a year by 2050.

The dementia boom is leading its own world of unpaid caregiving. About 11 million Americans currently provide volunteer care for people with some form of dementia, labor that two years ago would have been valued at $271.6 billion. (In Southern California, about 670,000 people provided unpaid dementia-related care that would have been worth about $13.7 billion.)

Even within the many ominous projections related to eldercare, experts and caregivers view the dementia boom as a potential time bomb.

“I watch every day to see if my two moms are showing any signs. So far, nothing,” said Long Beach caregiver Alvarez.

“But if that happens, I don’t know what we’ll all do.”

Machines, people, money Even as the age- and dementia-related forecasts begin to play out, the staffing crisis is clouding the eldercare industry.

A survey released last summer by the American Health Care Association/National Center for Assisted Living found that 3 in 5 nursing homes have limited new admissions because they don’t have enough workers. And the survey, which tracked 759 nursing home providers, found that 3 in 4 believe the lack of workers might eventually push them out of business.

“I had way more service calls this week than I did from job applicants,” said Whittier-based in-home caregiver employer Southard.

Like many in the industry, Southard noted that a lot of ideas are being floated to boost staffing and to fix eldercare in ways that could stave off some of the changes that figure to happen as America ages up. Few, so far, are close to becoming reality.

Technology is often part of that discussion. Some devices (blankets that can read a person’s temperature and sleep patterns; sensors that can tell if a person is becoming frailer by tracking their movement, or even the sound of their voice) are already hitting the market. Others (robots to lift people in and out of beds) are in development.

But Southard, like others, said that while he welcomes new tech that will help his clients, he’s doubtful we’re close to anything that will supplant his workforce.

“I don’t think you can replace touch,” he said. “It really matters.”

Another key to the eldercare solution is immigration.

The staffing shortage in nursing homes (which is pushing more eldercare back to families) has grown worse as American immigration policies have hardened and the number of new arrivals, overall, has slowed. Eldercare has traditionally employed many of those people, from physicians and trained nurses to lower-skilled aides. The Eldercare Workforce Alliance notes that as many as 80% of hands-on workers in nursing homes and assisted living centers were born in another country.

Though the group doesn’t offer specific proposals, it does urge lawmakers to “review carefully all immigration-related legislation and regulations for their potential impact on the health care workforce.”

But two basics – pay and respect – are essential.

Though people who are good at caring for older people possess a variety of positive human traits – patience, respect, communication – those traits don’t qualify as official job “skills,” and unskilled labor in eldercare typically earns minimum wage. Southard’s company stays slightly ahead of minimum, currently paying $16 to $20 an hour, but he noted that he also offers health care, 401 (k) options and other benefits aimed at keeping good employees.

“We’re trying to make it a possible career for people,” Southard said.

But Southard also said higher pay alone isn’t going to fix the long-term problem. Rising costs, he noted, will price out a lot of older people on fixed income, shifting eldercare back to families that can afford it the least.

“The state report on workforce said we will need 600,000 new caregivers in California in the next few years. Where are we going to get them? How are we going to train them? Those are a couple of the questions we have to answer,” Southard said.

“But, really, there are a lot of questions like that.”

Senior Living: How Seniors Can Prevent Heart Disease And Live A Healthier Life

By Dr. Daniel H. LaMont,

Contributing writer 

Cardiovascular disease is the leading cause of death in adults.

And for older adults, there is an even greater cause for concern, since about 21.7% of American adults who art at least 65 reported having coronary heart disease, a stroke or both, according to the Centers for Disease Control and Prevention.

Older adults are statistically more likely to have heart disease for many reasons. Plaque rupture, atrial fibrillation, loss of vascular compliance, obesity, hypertension and diabetes all contribute to this increased incidence of cardiovascular disease.

Daniel H. LaMont, M.D., FACC, FSCAI, cardiologist, MemorialCare Heart & Vascular Institute at Saddleback Medical Center. (Photo courtesy of MemorialCare) The National Council on Aging notes that heart disease is a broad term that includes a variety of conditions, such as coronary artery disease, irregular heartbeat, problems with the heart valves, problems with the heart muscle and hereditary (congenital) defects.

Approximately 80% of heart disease deaths occur in people who are aged 65 or older, according to the American Heart Association. Dying from cardiovascular disease is 10 times more common than any other cause of death in seniors. No matter how old you get, knowing the risk factors of heart disease is the first step in preventing — or taking steps to reverse — heart disease, helping you live longer.

Know your risk for heart disease There are many behavioral factors that can contribute to an older adult being at risk for heart disease. But it’s important to know even as you age, you can still work to minimize risk factors. So don’t give up on yourself! Major risk factors for heart diseases include:

High blood pressure. High cholesterol. Smoking. Obesity. Diabetes. Lack of physical activity. Poor eating habits. Another factor that adds to older adults’ risk of heart disease is genetics. It is important to understand and know your family history of heart disease. Genetic factors sometimes play a role when it comes to high blood pressure, heart disease and other related conditions. And when genetic risks are combined with unhealthy lifestyle habits, it can increase the risk of heart disease greatly.

Know the symptoms of heart disease In the early stages of heart disease, symptoms are not always noticeable, especially in older adults. Since older adults tend to have more aches and pains, please don’t minimize any of these symptoms and always speak to your physician if you are feeling an onset of any of these symptoms with exertion:

Chest, shoulder, arm, neck, jaw or back pain or pressure. Shortness of breath when active, or while lying flat. Lightheadedness when standing up. Dizziness or imbalance when walking. Confusion. Headaches. Easy onset fatigue. Swelling in the ankles, feet, legs, stomach and/or neck. Intermittent weakness or numbness in an arm or leg. Intermittent loss of vision in one eye. Intermittent slurred speech. It is essential to visit your doctor regularly to help ensure your heart is healthy and to catch early signs of heart disease.

Preventing or lowering risk? When found early, heart disease is much easier to treat and manage than when it is in a later stage. It’s easier to take a walk around your house, for example, if you aren’t carrying an oxygen tank with you.

Here are some things you can do now to help lower your risk of heart disease:

Being more active: Start by walking around the house, gardening, doing water aerobics and looking into what classes your local senior center might offer. Talk with your doctor about the activities that would be best for you. Quit smoking: If you still smoke, it’s time to quit. There are many smoking cessation classes available specifically for seniors. Eat healthy: Follow a heart healthy diet by eating more fruits, vegetables and foods high in fiber. I’m sure you still have some of your favorite pies or dishes that may not be as healthy but try to limit those to special occasions. Stay hydrated: Seniors get dehydrated quicker than anyone else – as we age, our body starts to dry out more; you may notice it in your skin and hair. But seniors really should be mindful of drinking at least eight 8-ounce glasses of water a day. Lower your alcohol consumption: Alcohol, when paired with medicine, can have diminishing effects, so it’s important to not drink as much as you age. Manage your stress: Stress can manifest itself in older adults in more physical ways, such as headaches and insomnia – so be mindful of this. Control your diabetes: Follow your doctor’s advice to manage diabetes by taking prescribed medications as directed. Control your blood pressure and/or cholesterol: Don’t forget that it’s important to take medication. But lifestyle changes can always help you. Light exercise and choosing not to eat saturated fats or trans-fat foods can significantly improve your health. It is never too late to start taking care of your heart. No matter your age, it is important to have egular physicals and ask your doctor whether regular cardiovascular screenings and risk reduction visits make sense for you. Along with living a healthy lifestyle, heart evaluations can help detect heart disease early – at its most manageable stage.

Dr. Daniel Lamont is a cardiologist at MemorialCare Saddleback Medical Center and has been practicing for 20 years. He graduated from Brown University Medical School in 1991 and specializes in cardiology and interventional cardiology.

Senior Living: As Long-Term Care Staffing Crisis Worsens, Immigrants Can Bridge The Gaps

By Michelle Andrews,

Kaiser Health News

When Margarette Nerette arrived in the United States from Haiti, she sought safety and a new start.

The former human rights activist feared for her life in the political turmoil following the military coup that overthrew President Jean-Bertrand Aristide in 1991. A few years later, Nerette, then 29, left her two small children with her sister in Port-au-Prince, came to Miami on a three-month visa — and never went back.

In time, she was granted political asylum.

She eventually studied to become a nursing assistant, passed her certification exam and got a job in a nursing home. The work was hard and didn’t pay a lot, she said, but “as an immigrant, those are the jobs that are open to you.”

A few years later, her family joined her, but her children didn’t want to follow her career path. When she was a teenager, Nerette’s daughter, now 25, would ask, “Mom, why are you doing that?” Her daughter, Nerette said, considered the work underpaid and too physical.

After many years, Nerette, now 57, left nursing home work for a job with the Florida chapter of the labor union SEIU1199, which represents more than 25,000 health workers. As the local’s vice president for long-term care, she is keenly aware of staffing challenges that have plagued the industry for decades and will worsen as aging baby boomers stretch the limits of long-term care services.

The U.S. is facing a growing crisis of unfilled job openings and high staff turnover that puts the safety of older, frail residents at risk. In a tight labor market where job options are plentiful, long-term care jobs that are poorly paid and physically demanding are a tough sell. Experts say opening pathways for care workers to immigrate would help, but policymakers haven’t moved.

In the decade leading up to 2031, employment in health care support jobs is expected to expand by 1.3 million, a nearly 18% growth rate that outpaces that of every other major occupational group, according to the federal Bureau of Labor Statistics. These direct care workers include nurses of various types, home health aides, and physical therapy and occupational therapy assistants, among others.

Certified nursing assistants, who help people with everyday tasks like bathing, dressing and eating, make up the largest proportion of workers in nursing homes. In the decade leading up to 2029, nearly 562,000 nursing assistant jobs will need to be filled in the United States, according to a far-reaching report on nursing home quality published last year by the National Academies of Sciences, Engineering and Medicine.

But as the U.S. population ages, fewer workers will be available to fill those job openings in nursing homes, assisted living facilities and private homes. While the number of adults 65 and older will nearly double to 94.7 million from 2016 to 2060, the number of working-age adults will grow just 15%, according to an analysis of census data by PHI, a research and advocacy organization for older people and those with disabilities.

Immigrants can play a crucial role in filling those gaps, experts say. Already, about 1 in 4 direct care workers are foreign-born, according to a 2018 PHI analysis.

“We do think that immigrants are critical to this workforce and the future of the long-term care industry,” said Robert Espinoza, executive vice president of policy at PHI. “We think the industry would probably collapse without them.”

Nursing homes and other long-term care facilities have long struggled to maintain adequate staff. The problem worsened dramatically during the pandemic, when those facilities became hotbeds for coronavirus infections and deaths. More than 200,000 residents and staff members died during the first two years of the pandemic, representing about a quarter of all coronavirus-related deaths during that time.

Since March 2020, the long-term care industry has lost more than 300,000 jobs, bringing employment to a 13-year low of just more than 3 million, according to an analysis of BLS payroll data by the American Health Care Association and the National Center for Assisted Living.

Immigration policies that aim to identify potential workers from overseas to fill long-term care job slots could help ease the strain. But unlike other countries facing similar challenges, the U.S. generally hasn’t made attracting direct care workers from abroad a priority.

“Immigration policy is long-term care policy,” said David Grabowski, a professor of health care policy at Harvard Medical School, whose research focuses on the economics of aging and long-term care. “If we really want to encourage a strong workforce, we need to make immigration more accessible for individuals.”

Most of the roughly 1 million immigrants to the U.S. annually are family members of citizens, though some come in on employment visas, often for highly skilled jobs.

On his first day in office, President Joe Biden proposed comprehensive immigration reform that would have created a pathway to citizenship for undocumented workers and revised the rules for employment-based visas, among other things, but it went nowhere.

“There hasn’t been a lot of interest or political will behind opening up more immigration opportunities for mid- to lower-level care aides such as home health aides, personal health aides and certified nursing assistants,” said Kristie De Peña, vice president for policy and director of immigration policy at the Niskanen Center think tank.

The Biden administration didn’t respond to requests for comment.

Some local and regional organizations, though, are working to connect immigrants with health care jobs.

Ascentria Care Alliance provides social services, refugee resettlement and long-term care services in five New England states. With state and private philanthropic funding, the organization is beginning to help refugees from Ukraine, Haiti, Venezuela and Afghanistan get the supportive services they need — language, housing, child care — to enable them to take health care jobs at Ascentria’s long-term care facilities and those of health care partners.

The group has long helped refugees resettle and find jobs in traditional settings like warehouses or retailers, said Angela Bovill, president and CEO of Ascentria, which is based in Worcester, Massachusetts. “Now we’re looking at what it would take to move them into health care jobs.”

The alliance is applying to the Department of Labor for a grant to scale up the program.

“If we get it right,” Bovill said, “we’ll build a pathway and a pipeline to move at the fastest rate from immigrant to effective health care worker.”

Some long-term care experts say the U.S. can’t afford to drag its feet on putting policies in place to appeal to immigrants.

“We’re competing with the rest of the world, other countries that also want these workers,” said Howard Gleckman, a senior fellow at the Urban Institute.

Canada, for instance, is going all in on immigration. In 2022, it welcomed more than 430,000 new permanent residents, the most in its history. Immigration accounts for almost 100% of Canada’s labor force growth, and by 2036, immigrants are expected to make up 30% of the population, the government said.

In the U.S., immigrants account for about 14% of the population, according to an analysis of census data by the Migration Policy Institute.

Canada’s Economic Mobility Pathways Pilot aims to identify and recruit refugees who have skills Canadian employers need. In January, after visiting a refugee camp in Kenya, recruiters offered jobs in Nova Scotia to 65 continuing care assistants.

In a December survey of 500 U.S. nursing homes, meanwhile, more than half said staffing shortages have forced them to turn away new residents.

These staffing challenges, industry representatives said, are likely to become an even heavier lift, with more closed facilities, units or wings, after the Biden administration announced last year that it would establish minimum nursing home staffing requirements.

A government mandate alone won’t solve long-standing problems with inadequate training, pay, benefits or career advancement, experts said.

“Young people aren’t going to clean 10 to 15 patients for $15 an hour,” Nerette said. “They’ll go to McDonald’s. We need to face that reality and come up with a plan.”

Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at Kaiser Family Foundation. KFF is an endowed nonprofit organization providing information on health issues to the nation.