The Texas Assisted Living Association (TALA) successfully lobbied state legislators to dedicate $46 million in American Rescue Plan Act of 2021 (ARPA) funds for assisted living providers. It is a win that Carmen Tilton, vice president of public policy at TALA, says was possible due to her participation in the Argentum Public Policy Institute.
When the federal government passed the $1.9 trillion ARPA stimulus to help the country recover from economic and health effects of the COVID-19 pandemic, states were given some discretion as to how those funds would be used. Importantly, the federal stimulus, signed into law in March 2021, gave states a great deal of flexibility. They could use it to “respond to the far-reaching public health and negative economic impacts of the pandemic and to provide premium pay for essential workers,” among other things.
From Bad to Worse
In Texas, lawmakers had already heard from multiple groups, including TALA, about the challenging labor market – and how a massive state deal for contract nursing staff had worsened it.
Although nursing homes got a small portion of labor contracted under the arrangement, the acute care system benefited most. Assisted living communities got a fraction of a percent of the labor contracted under the plan.
“That large state contract exacerbated a really difficult and expensive contract labor market,” recalls Tilton. Assisted living providers, she says, had been “disproportionately hit with high staff costs, particularly when trying to bring in contract staff to fill in for staff who were burning out, getting sick, staff who needed some time away.”
For most of 2020 and 2021, Center for Disease Control and Protection (CDC) guidance required assisted living staff members testing positive for COVID-19 to stay away from work for two weeks. “I think it’s easy now to feel like it wasn’t that big of a deal, but in fact it was an incredibly huge deal,” Tilton recalls.
Becoming Optimistic
As the pandemic eased in mid-2021, conversations in Austin, the Texas capital, and elsewhere turned more optimistic. But TALA’s message to legislators continued to focus on the severe and ongoing effects of COVID-19. TALA told legislators, “Even if the rest of the world is moving on, we are still living it, and this is still exceptionally impactful.”
By the time the legislature met to allocate ARPA funds in October 2021, assisted living workers had been “holding on so tightly for so long,” says Tilton. “They were exhausted, and communities were looking for opportunities and the ability to give their staff some breathing room.”
TALA members were also worried about losing workers to other health care providers, many with deeper pockets, who were actively working to fill vacancies. “Our communities did tremendously well both on infection prevention and control and managing cases once something popped up,” recalls Tilton. “When I look nationally, I am so grateful and impressed at what assisted living communities in Texas were able to do for a state as large and as diverse as ours. It would be painful to lose them for more money.”
A Big Win
After an intense lobbying campaign to win a fair proportion of the state’s ARPA funding for assisted living providers in Texas, TALA’s efforts paid off in November 2021, when Texas Gov. Greg Abbott signed Senate Bill 8 allocating ARPA federal dollars. The measure included a dedicated pool of more than $46 million for assisted living communities.
By late summer 2022, rules and a request for proposals for the competitive grant program had been issued. The rules “had a few different exclusionary criteria. It had a prioritization. You had to provide a fair bit of information all in one document. It was quite a bit,” Tilton says.
TALA provided step-by-step instructions to members directly and to the broader senior living community in its free TALAView newsletter. TALA members also received:
- Personalized assistance to help them interpret the state’s guidance
- Help with the application and subsequent required reporting
- Alerts about potential issues that would impact an applicant’s eligibility
The state agency managing the grant received more than 900 applications. Tilton says there are approximately 2,100 assisted living communities in the state.
Communities began to receive notices of awards in late 2022, and checks were cut by February 2023. Nearly two in three (63%) TALA members received a grant, with an average award amount of $89,000.
Rewarding Workers
Those that received a grant had through July 2023 to spend it.
Most communities, Tilton says, spent the grant money by rewarding staff with merit bonuses. “Staff who had been with the communities, who had stuck by them throughout the pandemic, who had gone above and beyond,” says Tilton, were rewarded for their commitment and, in many cases, personal sacrifices. Only staff in direct care roles were eligible under terms of the federal grant.
Many communities used the funding to bolster upskilling programs that offer workers who show special aptitude and desire the opportunity to develop new skills. Some of these workers earned new certifications, such as the Certified Medication Aide credential, while others attended continuing education courses, including a state-mandated course to become an assisted living community manager.
Other communities put grant money toward scholarships, sending workers to nursing school, and to recruitment efforts at community colleges. In other cases, communities purchased software to streamline the onboarding experience for new employees and to improve staff scheduling processes.
“They tried to spend those dollars not just in ways to recognize staff who had been so crucial during the pandemic, but also to facilitate the growth and professional development of those same team members,” Tilton says.
Role of Federal Advocacy
Looking back on TALA’s successful lobbying effort, Tilton says, “our federal elected officials may not fully understand how assisted living operates, how we care for residents, and who our residents are, particularly in a state like Texas where we don’t have Medicaid expansion.”
The Argentum Public Policy Institute, she says, “gives us in Texas an opportunity to talk to our elected officials in Washington, DC and help them understand how assisted living works, specifically in Texas.”
In those meetings, Tilton has been able to share information that shows how different assisted living is in Texas. For example, she says more than half of assisted living licenses (53%) are for communities with 16 or fewer residents, a reflection of both the state’s expansive geography and diverse culture.
“We’re not nursing homes. We don’t look like nursing homes. We don’t act like nursing homes. That’s part of it, to say, ‘Have you ever seen a nursing home with 16 residents in it? We are a different model. We are a more flexible model. Our needs are different. Our responsibilities are different, and our residents are different’,” says Tilton.
On the federal level, Tilton observes that elected officials spend their days talking to other elected officials from other states. “They may have a picture of assisted living that is reflective of how other states look and operate. [Argentum’s Public Policy Institute] allows us the opportunity to say, ‘Yes, I know that’s what New York does. I know that’s what Oregon does. But in Texas, you need to understand that more than half of your active licenses are for homes in neighborhoods. They’re in cul-de-sacs. They’re in subdivisions. And that means that our needs and our challenges are very, very different.”
Although the TALA advocacy effort in Texas was key to winning the state’s dedicated grant allocation for assisted living, Tilton says it was Argentum’s advocacy at the federal level that opened the door. Argentum succeeded in making ARPA dollars flexible, meaning they could be spent in assisted living and residential care.
“That was really about shifting the narrative,” says Tilton, “and helping [elected officials] to understand that every time [they] pass something, or pass funding, for quote-unquote health care, if you are not explicit about what you mean by ‘health,’ it is not necessarily flowing to the full spectrum of health care.”
“It was the flexibility at the federal level that made it possible for us to advocate at the state level to get dedicated dollars just for assisted living communities. Had we been blended in with other health care providers, as other funds had done previously, like the state contract for contract labor, we would have seen the same disproportionate response.”
Looking Ahead
Educating elected leaders is an ongoing job. Although the effort to win dedicated ARPA funding for assisted living in Texas is in the past, Tilton says she continues to worry about the tone and rhetoric in Washington.
“You know, it is easier to villainize long term care and elder care than it is to identify areas of excellence – and not because we don’t have areas of excellence. We excel every single day. Our families, by and large, love us,” she adds. “But when we are villainized for easy clicks or for easy engagement, it makes it harder to recruit more people into our sector because the public perception becomes overwhelmingly negative.”
Nonetheless, Tilton says she is “hopeful for the staff who received training and upscaling, the people who were caregivers who are now med techs or wellness directors… I think this particular crop is going to be very good. They’re battle tested, that’s for sure.”
Shaping Elected Leaders’ Perceptions
The Argentum Public Policy Institute, taking place March 11-13 in Washington, DC., is an opportunity to help shape elected leaders’ perceptions of senior living.
The event comes on the heels of Congressional hearings and negative media coverage of the industry. It is more critical than ever for industry leaders to show up in force for the Argentum Public Policy Institute. Participants will help educate elected leaders about the industry and emphasize the valuable services it provides to seniors in our communities. For more information or to register for the event, visit the Argentum website.
