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 consider-
ation 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Safeguarding Elderly 
Needs through Innovation and Occupational Resources 
Act of 2024’’ or the ‘‘SENIOR Act of 2024’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) The United States population is aging more 
rapidly than ever before, with 10,000 Americans 
turning 65 each day. In 2034, for the first time, the 
Nation will have more people over the age of 65 
than under the age of 18. The population experi-
encing the fastest growth are persons 85 and older, 
which is projected to grow 198 percent by 2060. 
(2) The Department of Health and Human 
Services estimates that 70 percent of Americans over 
the age of 65 will require some form of long-term 
care in their lifetime. By 2050, the number of Amer-
icans requiring paid long-term care services will tri-
ple from 8,300,00 to 27,000,000. 
(3) According to 2020 Census data, more than 
40 percent of baby boomers do not have any retire-
ment savings, let alone savings for their long-term 
care needs. A recent report by the National Council 
on Aging found that up to 80 percent of older adults 
would be unable to afford 4 years in an assisted liv-
ing community or more than 2 years of nursing 
home care. Put another way, 47,000,000 Americans 
aged 60 or above do not have the financial resources 
to cover the future care they may need. 
(4) Caring for America’s aging seniors will be 
the single most expense domestic priority and is pro-
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jected to deplete Federal and State Medicaid budg-
ets. The United States spent over $400,000,000,000 
on long-term care in 2020, nearly 10 percent of all 
national health care spending. 
(5) According to the Congressional Research 
Service, State and Federal programs account for 
71.4 percent of all long-term care spending nation-
wide in 2021. Medicaid and Medicare are, respec-
tively, the first and second-largest public payers, ac-
counting for a combined 64.1 percent of all spend-
ing. Medicaid is by far the largest single funding 
source for long-term care, spending approximately 
$135,800,000,000 in 2020, a figure that is projected 
to reach $466,000,000,000 by 2050. 
(6) A 2023 report by AARP, indicates that at 
least 9 percent of seniors in skilled nursing nation-
wide have low-acuity levels that do not warrant high 
skilled care, but are forced into a skilled nursing 
home where assets can be depleted, and Medicaid 
can become the primary payer. The report by AARP 
indicated that this number is 20 percent in 5 States. 
(7) In 2021, the Department of Veterans Af-
fairs testified to Congress that if veterans in need of 
long-term care services could choose assisted living 
instead of a nursing home, $69,101 per veteran per 
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year would be saved by the Department of Veterans 
Affairs. 
(8) Strengthening cost-effective models of long- 
term care services, providing incentives for Ameri-
cans to better afford their care costs, and developing 
the workforce needed to care for the Nation’s aging 
population will reduce Federal and State Medicaid 
spending. 
(9) Congregate care models of long-term care 
services, such as assisted living, are half the cost of 
nursing homes, and less than a third of round the 
clock home health aides. 
(10) Assisted living provides 24/7 personal care, 
chronic disease management, nutrition, room and 
board, and socialization. If assisted living were not 
an option, as many as 61 percent of senior residents 
may be forced into far-costlier skilled nursing facili-
ties at a cost of $43,400,000,000 per year. 
(11) The senior living industry lost approxi-
mately 400,000 jobs between 2020 and 2022, leav-
ing the workforce far below prepandemic employ-
ment levels. In order to care for the United States 
aging population, the senior care industry will need 
to fill more than 20,200,000 jobs by 2040. 
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SEC. 3. ADDRESSING THE LONG-TERM CARE WORKFORCE 
CRISIS. 
(a) WORKFORCE PROGRAMS.— 
(1) EXPANSION
OF
DOL
WORKFORCE
PRO-
GRAMS.—The Secretary of Labor, acting jointly 
through the Assistant Secretary for Employment 
and Training and the National Director for the Of-
fice of Job Corps of the Employment and Training 
Administration, shall establish new and expand ex-
isting education and training grant programs to sup-
port the expansion of the direct care workforce for 
purposes of caring for a rapidly aging population 
and providing home and community-based services 
to older adults and people with disabilities. Such 
programs shall include support for core certification 
and training requirements for the direct care work-
force of assisted living facilities. 
(2) EXPANSION
OF
HRSA
WORKFORCE
PRO-
GRAMS.—The Secretary of Health and Human Serv-
ices, acting through the Administrator of the Health 
Resources and Services Administration, shall estab-
lish new and expand existing workforce education 
and training grant programs to address shortages in 
the direct care workforce serving the rapidly aging 
population and providing home and community- 
based services to older adults and people with dis-
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abilities. Such programs shall include support for 
core certification and training requirements for the 
direct care workforce of assisted living facilities. 
(b) DEFINITIONS.—In this section: 
(1) ASSISTED
LIVING
FACILITY.—The term 
‘‘assisted living facility’’ means any licensed, reg-
istered, certified, listed, or State-regulated residence, 
managed residential community, building, or part of 
a building that provides, or contracts to provide, 
housing with supportive services on a continuing 
basis to individuals who— 
(A) are elderly or have a mental health, de-
velopmental, or physical disability; and 
(B) are unrelated by blood or marriage to 
the owner or operator of the residence, commu-
nity, building, or part of a building, if the 
owner or operator is an individual. 
(2) DIRECT CARE WORKFORCE.—The term ‘‘di-
rect care workforce’’ means a workforce that is com-
posed of individuals who, in exchange for compensa-
tion, provide services at an assisted living facility to 
an individual who is elderly or who has a mental 
health, developmental, or physical disability, that 
promote such individual’s independence, including— 
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(A) services that enhance independence 
and community inclusion for such individual, 
including traveling with such individual, attend-
ing and assisting such individual while visiting 
friends and family, shopping, or socializing; 
(B) services such as coaching and sup-
porting such individual in communicating 
needs, achieving self-expression, pursuing per-
sonal goals, living independently, and partici-
pating actively in employment or voluntary roles 
in the community; 
(C) services such as providing assistance 
with activities of daily living (such as feeding, 
bathing, toileting, and ambulation) and with 
tasks such as meal preparation, shopping, light 
housekeeping, and laundry; or 
(D) services that support such individual 
at home, work, school, or any other community 
setting. 
SEC. 4. SENIOR CARE COST REDUCTION PROGRAM. 
Part A of title III of the Older Americans Act of 1965 
(42 U.S.C. 3021 et seq.) is amended by adding at the end 
the following: 
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‘‘SEC. 317. SENIOR CARE COST REDUCTION PROGRAM. 
‘‘(a) ESTABLISHMENT OF PROGRAM.—The Assistant 
Secretary, acting through the Administration, shall estab-
lish a ‘Senior Care Cost Reduction Program’ for making 
allotments to States to administer monthly cost reduction 
amounts to assist low-income seniors to reside and receive 
services in assisted living facilities located in the State as 
an alternative to more costly institutional care. 
‘‘(b) STATE APPLICATION.—In order to be eligible to 
receive an allotment under this section, the State shall 
submit an application to the Assistant Secretary at such 
time, in such manner, and accompanied by such informa-
tion as the Assistant Secretary may reasonably require. 
‘‘(c) COST REDUCTION AMOUNT.— 
‘‘(1) INITIAL AMOUNT.—Upon establishment of 
the Program, the monthly amount provided by the 
State to eligible recipients shall be $1,000. 
‘‘(2) 
ADJUSTMENTS
IN
CONSUMER
PRICE 
INDEX.—Beginning one year after the establishment 
of the Program, and each subsequent year, the 
monthly amount required under paragraph (1) shall 
be increased by the percentage, if any, by which the 
Consumer Price Index for all urban consumers (all 
items; United States city average) for the most re-
cent calendar year exceeds the Consumer Price 
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Index for the previous calendar year, rounded to the 
nearest dollar. 
‘‘(d) ELIGIBILITY.—In order to be eligible for a cost 
reduction amount under this section, the individual 
must— 
‘‘(1) submit an application to and be approved 
by the relevant State agency tasked with admin-
istering the Program; 
‘‘(2) be at least 70 years old as of the date of 
application; 
‘‘(3) be accepted for admission as a resident in, 
or currently reside in, an assisted living facility 
which has been approved by the relevant State agen-
cy to participate in this Program; 
‘‘(4) be either a ‘chronically ill individual’ (as 
defined in section 7702B(c)(2) of the Internal Rev-
enue Code of 1986) or eligible to receive long-term 
services and supports under the relevant State’s 
Medicaid program; and 
‘‘(5) be determined to be financially eligible, 
pursuant to subsection (e). 
‘‘(e) FINANCIAL ELIGIBILITY.—An individual is fi-
nancially eligible under this section only if the individ-
ual’s— 
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‘‘(1) net monthly income is less than the ap-
proved monthly fees for the services provided at the 
assisted living facility; 
‘‘(2) net annual income is not higher than 60 
percent of the median income for the State in which 
the individual resides, as determined by the Sec-
retary of Housing and Urban Development; and 
‘‘(3) resources are not greater than $19,000 if 
single, or $25,000 if married. 
‘‘(f) 
IMPLEMENTATION.—The 
Secretary, 
acting 
through the Assistant Secretary, may issue such regula-
tions as may be necessary to carry out this section. 
‘‘(g) ASSISTED LIVING FACILITY DEFINED.—As 
used in this section, the term ‘assisted living facility’ 
means any licensed, registered, certified, listed, or State- 
regulated residence, managed residential community, 
building, or part of a building that provides, or contracts 
to provide, housing with supportive services on a con-
tinuing basis to individuals who— 
‘‘(1) are elderly or have a mental health, devel-
opmental, or physical disability; and 
‘‘(2) are unrelated by blood or marriage to the 
owner or operator of the residence, community, 
building, or part of a building, if the owner or oper-
ator is an individual.’’. 
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SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 
Amounts that have been returned to or recovered by 
the Health Resources and Services Administration or the 
Department of the Treasury, including all amounts re-
turned or recovered after the date of enactment of this 
Act, from amounts made available and disbursed to eligi-
ble health care providers for health care-related expenses 
or lost revenues attributable to coronavirus under the 
heading ‘‘Public Health and Social Services Emergency 
Fund’’ in title VIII of division B of Public Law 116–136, 
title I of division B of Public Law 116–139, and title III 
of division M of Public Law 116–260, are authorized to 
be appropriated to carry out this Act and the amendment 
made by this Act. 
Æ 
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