I 

118TH CONGRESS 

2D SESSION H. R. 7605 

To address the worsening long-term care workforce crisis and increase access 

to and affordability of long-term care. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 8, 2024 

Mrs. TRAHAN (for herself and Mr. FITZPATRICK) introduced the following bill; 

which was referred to the Committee on Education and the Workforce, 

and in addition to the Committee on Energy and Commerce, for a period 

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL 

To address the worsening long-term care workforce crisis 

and increase access to and affordability of long-term care. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Safeguarding Elderly 

5 Needs through Innovation and Occupational Resources 

6 Act of 2024’’ or the ‘‘SENIOR Act of 2024’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 


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1 (1) The United States population is aging more 

2 rapidly than ever before, with 10,000 Americans 

3 turning 65 each day. In 2034, for the first time, the 

4 Nation will have more people over the age of 65 

5 than under the age of 18. The population experi6 encing the fastest growth are persons 85 and older, 

7 which is projected to grow 198 percent by 2060. 

8 (2) The Department of Health and Human 

9 Services estimates that 70 percent of Americans over 

10 the age of 65 will require some form of long-term 

11 care in their lifetime. By 2050, the number of Amer12 icans requiring paid long-term care services will tri13 ple from 8,300,00 to 27,000,000. 

14 (3) According to 2020 Census data, more than 

15 40 percent of baby boomers do not have any retire16 ment savings, let alone savings for their long-term 

17 care needs. A recent report by the National Council 

18 on Aging found that up to 80 percent of older adults 

19 would be unable to afford 4 years in an assisted liv20 ing community or more than 2 years of nursing 

21 home care. Put another way, 47,000,000 Americans 

22 aged 60 or above do not have the financial resources 

23 to cover the future care they may need. 

24 (4) Caring for America’s aging seniors will be 

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1 jected to deplete Federal and State Medicaid budg2 ets. The United States spent over $400,000,000,000 

3 on long-term care in 2020, nearly 10 percent of all 

4 national health care spending. 

5 (5) According to the Congressional Research 

6 Service, State and Federal programs account for 

7 71.4 percent of all long-term care spending nation8 wide in 2021. Medicaid and Medicare are, respec9 tively, the first and second-largest public payers, ac10 counting for a combined 64.1 percent of all spend11 ing. Medicaid is by far the largest single funding 

12 source for long-term care, spending approximately 

13 $135,800,000,000 in 2020, a figure that is projected 

14 to reach $466,000,000,000 by 2050. 

15 (6) A 2023 report by AARP, indicates that at 

16 least 9 percent of seniors in skilled nursing nation17 wide have low-acuity levels that do not warrant high 

18 skilled care, but are forced into a skilled nursing 

19 home where assets can be depleted, and Medicaid 

20 can become the primary payer. The report by AARP 

21 indicated that this number is 20 percent in 5 States. 

22 (7) In 2021, the Department of Veterans Af23 fairs testified to Congress that if veterans in need of 

24 long-term care services could choose assisted living 

25 instead of a nursing home, $69,101 per veteran per 


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1 year would be saved by the Department of Veterans 

2 Affairs. 

3 (8) Strengthening cost-effective models of long4 term care services, providing incentives for Ameri5 cans to better afford their care costs, and developing 

6 the workforce needed to care for the Nation’s aging 

7 population will reduce Federal and State Medicaid 

8 spending. 

9 (9) Congregate care models of long-term care 

10 services, such as assisted living, are half the cost of 

11 nursing homes, and less than a third of round the 

12 clock home health aides. 

13 (10) Assisted living provides 24/7 personal care, 

14 chronic disease management, nutrition, room and 

15 board, and socialization. If assisted living were not 

16 an option, as many as 61 percent of senior residents 

17 may be forced into far-costlier skilled nursing facili18 ties at a cost of $43,400,000,000 per year. 

19 (11) The senior living industry lost approxi20 mately 400,000 jobs between 2020 and 2022, leav21 ing the workforce far below prepandemic employ22 ment levels. In order to care for the United States 

23 aging population, the senior care industry will need 

24 to fill more than 20,200,000 jobs by 2040. 


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1 SEC. 3. ADDRESSING THE LONG-TERM CARE WORKFORCE 

2 CRISIS. 

3 (a) WORKFORCE PROGRAMS.— 

4 (1) EXPANSION OF DOL WORKFORCE PRO5 GRAMS.—The Secretary of Labor, acting jointly 

6 through the Assistant Secretary for Employment 

7 and Training and the National Director for the Of8 fice of Job Corps of the Employment and Training 

9 Administration, shall establish new and expand ex10 isting education and training grant programs to sup11 port the expansion of the direct care workforce for 

12 purposes of caring for a rapidly aging population 

13 and providing home and community-based services 

14 to older adults and people with disabilities. Such 

15 programs shall include support for core certification 

16 and training requirements for the direct care work17 force of assisted living facilities. 

18 (2) EXPANSION OF HRSA WORKFORCE PRO19 GRAMS.—The Secretary of Health and Human Serv20 ices, acting through the Administrator of the Health 

21 Resources and Services Administration, shall estab22 lish new and expand existing workforce education 

23 and training grant programs to address shortages in 

24 the direct care workforce serving the rapidly aging 

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1 abilities. Such programs shall include support for 

2 core certification and training requirements for the 

3 direct care workforce of assisted living facilities. 

4 (b) DEFINITIONS.—In this section: 

5 (1) ASSISTED LIVING FACILITY.—The term 

6 ‘‘assisted living facility’’ means any licensed, reg7 istered, certified, listed, or State-regulated residence, 

8 managed residential community, building, or part of 

9 a building that provides, or contracts to provide, 

10 housing with supportive services on a continuing 

11 basis to individuals who— 

12 (A) are elderly or have a mental health, de13 velopmental, or physical disability; and 

14 (B) are unrelated by blood or marriage to 

15 the owner or operator of the residence, commu16 nity, building, or part of a building, if the 

17 owner or operator is an individual. 

18 (2) DIRECT CARE WORKFORCE.—The term ‘‘di19 rect care workforce’’ means a workforce that is com20 posed of individuals who, in exchange for compensa21 tion, provide services at an assisted living facility to 

22 an individual who is elderly or who has a mental 

23 health, developmental, or physical disability, that 

24 promote such individual’s independence, including— 


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1 (A) services that enhance independence 

2 and community inclusion for such individual, 

3 including traveling with such individual, attend4 ing and assisting such individual while visiting 

5 friends and family, shopping, or socializing; 

6 (B) services such as coaching and sup7 porting such individual in communicating 

8 needs, achieving self-expression, pursuing per9 sonal goals, living independently, and partici10 pating actively in employment or voluntary roles 

11 in the community; 

12 (C) services such as providing assistance 

13 with activities of daily living (such as feeding, 

14 bathing, toileting, and ambulation) and with 

15 tasks such as meal preparation, shopping, light 

16 housekeeping, and laundry; or 

17 (D) services that support such individual 

18 at home, work, school, or any other community 

19 setting. 

20 SEC. 4. SENIOR CARE COST REDUCTION PROGRAM. 

21 Part A of title III of the Older Americans Act of 1965 

22 (42 U.S.C. 3021 et seq.) is amended by adding at the end 

23 the following: 


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1 ‘‘SEC. 317. SENIOR CARE COST REDUCTION PROGRAM. 

2 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Assistant 

3 Secretary, acting through the Administration, shall estab4 lish a ‘Senior Care Cost Reduction Program’ for making 

5 allotments to States to administer monthly cost reduction 

6 amounts to assist low-income seniors to reside and receive 

7 services in assisted living facilities located in the State as 

8 an alternative to more costly institutional care. 

9 ‘‘(b) STATE APPLICATION.—In order to be eligible to 

10 receive an allotment under this section, the State shall 

11 submit an application to the Assistant Secretary at such 

12 time, in such manner, and accompanied by such informa13 tion as the Assistant Secretary may reasonably require. 

14 ‘‘(c) COST REDUCTION AMOUNT.— 

15 ‘‘(1) INITIAL AMOUNT.—Upon establishment of 

16 the Program, the monthly amount provided by the 

17 State to eligible recipients shall be $1,000. 

18 ‘‘(2) ADJUSTMENTS IN CONSUMER PRICE

19 INDEX.—Beginning one year after the establishment 

20 of the Program, and each subsequent year, the 

21 monthly amount required under paragraph (1) shall 

22 be increased by the percentage, if any, by which the 

23 Consumer Price Index for all urban consumers (all 

24 items; United States city average) for the most re25 cent calendar year exceeds the Consumer Price 


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1 Index for the previous calendar year, rounded to the 

2 nearest dollar. 

3 ‘‘(d) ELIGIBILITY.—In order to be eligible for a cost 

4 reduction amount under this section, the individual 

5 must— 

6 ‘‘(1) submit an application to and be approved 

7 by the relevant State agency tasked with admin8 istering the Program; 

9 ‘‘(2) be at least 70 years old as of the date of 

10 application; 

11 ‘‘(3) be accepted for admission as a resident in, 

12 or currently reside in, an assisted living facility 

13 which has been approved by the relevant State agen14 cy to participate in this Program; 

15 ‘‘(4) be either a ‘chronically ill individual’ (as 

16 defined in section 7702B(c)(2) of the Internal Rev17 enue Code of 1986) or eligible to receive long-term 

18 services and supports under the relevant State’s 

19 Medicaid program; and 

20 ‘‘(5) be determined to be financially eligible, 

21 pursuant to subsection (e). 

22 ‘‘(e) FINANCIAL ELIGIBILITY.—An individual is fi23 nancially eligible under this section only if the individ24 ual’s— 


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1 ‘‘(1) net monthly income is less than the ap2 proved monthly fees for the services provided at the 

3 assisted living facility; 

4 ‘‘(2) net annual income is not higher than 60 

5 percent of the median income for the State in which 

6 the individual resides, as determined by the Sec7 retary of Housing and Urban Development; and 

8 ‘‘(3) resources are not greater than $19,000 if 

9 single, or $25,000 if married. 

10 ‘‘(f) IMPLEMENTATION.—The Secretary, acting 

11 through the Assistant Secretary, may issue such regula12 tions as may be necessary to carry out this section. 

13 ‘‘(g) ASSISTED LIVING FACILITY DEFINED.—As 

14 used in this section, the term ‘assisted living facility’ 

15 means any licensed, registered, certified, listed, or State16 regulated residence, managed residential community, 

17 building, or part of a building that provides, or contracts 

18 to provide, housing with supportive services on a con19 tinuing basis to individuals who— 

20 ‘‘(1) are elderly or have a mental health, devel21 opmental, or physical disability; and 

22 ‘‘(2) are unrelated by blood or marriage to the 

23 owner or operator of the residence, community, 

24 building, or part of a building, if the owner or oper25 ator is an individual.’’. 


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1 SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 

2 Amounts that have been returned to or recovered by 

3 the Health Resources and Services Administration or the 

4 Department of the Treasury, including all amounts re5 turned or recovered after the date of enactment of this 

6 Act, from amounts made available and disbursed to eligi7 ble health care providers for health care-related expenses 

8 or lost revenues attributable to coronavirus under the 

9 heading ‘‘Public Health and Social Services Emergency 

10 Fund’’ in title VIII of division B of Public Law 116–136, 

11 title I of division B of Public Law 116–139, and title III 

12 of division M of Public Law 116–260, are authorized to 

13 be appropriated to carry out this Act and the amendment 

14 made by this Act. 

Æ 


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