Already facing a labor shortage, the U.S. seniors housing industry could be dealt a “devastating” blow if president-elect Donald Trump were to limit the number of lower-wage immigrants coming into the country in order to accommodate an increased number of high-wage skilled immigrants, says Jeff Sands, managing principal and general counsel for HJ Sims. “It’s a real issue this industry is grappling with,” especially given the growing number of facilities.
Sands’ comments came during a “State of the Industry and 2017 Outlook” panel at the InterFace Seniors Housing Northeast conference in Philadelphia on Tuesday, Nov. 15.
The U.S. seniors housing market will need to recruit 1.2 million new employees by 2025, Argentum reported in a research report released earlier this year.
Because about 70 percent of the 65-plus population — including many people with cognitive impairment — requires some form of long-term care, according to the U.S. Department of Health and Human Services, the nation’s aging population will create unprecedented demand for the services of the senior living industry in the coming decades.
According to donaldjtrump.com, the president-elect’s campaign website, his immigration controls will result in the selection of immigrants based on their likelihood of success in the United States and their ability to be financially self-sufficient. Furthermore, Trump seeks to protect the economic wellbeing of lawful immigrants already living here by controlling foreign worker admissions. But exactly how those controls would be implemented remains unclear.
Medicaid Under the Microscope
Sands also expressed some reservations about Trump’s desire to turn Medicaid into a block grant program.
Instead of having the federal government support most of the costly program, Trump has said he would give the states a certain amount of money — known as a block grant based on population and poverty levels — to let the states pay for their own medical needs, reports MoneyWatch. (The vast majority of seniors who live in nursing homes rely on Medicaid for their nursing home coverage.)
But no specific changes have been outlined by Trump with regard to the Medicaid program.
“We do a lot of work in the skilled nursing area, and Trump has said on several occasions along with [Speaker of the House] Paul Ryan — one of the few places they agree — that maybe block grants for Medicaid is the way to go,” Sands told a crowd of approximately 200 industry professionals at the Hyatt at the Bellevue Hotel in Philadelphia.
“As a lender, it's a scary thought because right now in the nursing home field, and more and more in the assisted living field, you've got to understand the rules of Medicaid,” said Sands. “[The rules] are basically set through the federal government and the states administer the program. To turn that into 50 separate programs could be a challenge not only to providers, but also to lenders. So, I'm watching that carefully.”
Sands added that a Trump administration could end up benefitting the seniors housing industry in at least one respect.
Trump has talked about expanding dependent care flexible spending accounts and creating other types of relief for families to support not only their children, but also their dependent adult elderly relatives, said Sands. “You could see some movement on that for the first time. So, I’m holding out hope on that one."
Portions of ACA in Limbo
Fellow panelist Lynne Katzmann, president and founder of Juniper Communities, said many seniors housing professionals are wondering aloud what will happen to the Affordable Care Act.
“There have been massive, strong statements during the election campaign that [Trump] will repeal Obamacare,” pointed out Katzmann. “And the reality is that I believe there will be changes in Obamacare, but we need to realize a couple of things. What's likely to be addressed is the access issues — the individual mandate, the employer mandate, that piece of it. That will be the first to be addressed.”
The other piece — which includes the hospital readmission penalties, the evidence-based care and value-based purchasing — isn’t going away, Katzmann believes.
“To repeal Obamacare requires 60 votes in the Senate. The Republicans have 51, so they would have to change the filibuster law. It’s going to take some time. Whatever happens is going to likely be paired with some kind of proposed change in the law.”
Another important point worth remembering is that both the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 and the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 were bipartisan programs, according to Katzmann. Both acts focus on the delivery of quality-based metrics and value-based care.
“It's about how we reorganize care. I think we're all on the same track as far as those things go. In terms of the changes that we’ve seen in how we work with hospitals, how we work with other providers, I don't see that changing under Trump,” said Katzmann. “I do think that some of the money that flows to us will continue to be under pressure, but the value-based care piece will probably remain.”
— Matt Valley