​Our country has a growing elderly population. More people than ever will need long term care. It is critical that our nation’s leaders prioritize, support, and invest in America’s seniors and their caregivers.

Keep in mind that the oldest baby boomers turn 80 in 2025, and there are more than four million people turning 80 in the next five years. America will have 18.8 million people over the age of 80 in 2030. 

Obstacles to Progress

Nursing home care is improving and has a tremendous responsibility and opportunity to serve our nation’s seniors. But access to care is being systemically threatened by a number of issues that providers are working tirelessly to manage: workforce shortages, threats to reimbursement, and a broken oversight system.

How We All Win

At the American Health Care Association (AHCA), we believe there is A Better Way forward, and we stand ready to offer bold solutions that benefit all stakeholders.

“There is a better way forward where we not only sustain the high-quality care that our nation's seniors deserve, but grow and transform it to meet the evolving demands of an aging population," said Clif Porter, president and CEO of AHCA. “Our 2025 policy priorities are proactive solutions that put residents and their caregivers first—without unnecessary bureaucratic hurdles that stifle progress and risk limiting access to care. These policies ensure residents are the center of all policy discussions, and quality is at the core of every solution. We stand ready to work with policymakers to protect access to care and continue delivering for America's aging population."

Seniors and their families need quality, choice, access, and clear information. Caregivers deserve jobs that grow with them, competitive pay and benefits, and opportunities to develop skills and careers. Providers are looking for sustainability and growth, support for improvements to modernize, and an environment to foster innovation. Policymakers must create efficiencies, ensure accountability and transparency, and provide a better return on investment. 

AHCA 2025 Policy Agenda

Our work will remain centered on finding efficient and effective solutions that support the continued delivery of high-quality care to our nation’s seniors and individuals with disabilities.

To achieve those goals, we will prioritize the following:

• Strengthening the long term care workforce.
• Protecting Medicaid.
• Reaffirming the promise of Medicare Advantage.
• Rationalizing the regulatory environment.

Strengthening the Long Term Care Workforce

Nursing homes have been slowly recovering from historic workforce losses during the COVID-19 pandemic. Despite unprecedented efforts to recruit and retain workers, including the highest wage rate increases across health care, nursing homes struggle to compete for workers. While every other health care sector has rebounded, nursing homes still need more than 47,000 workers to return to our pre-pandemic workforce levels.

As the population ages, the demand for long term care is increasing, but younger population is not keeping pace, leading to a growing caregiver shortage. Meanwhile, retirements and COVID-19 are accelerating the shortage as many caregivers have left or are leaving the profession entirely. Across health care, approximately 100,000 registered nurses (RNs) left the workforce, and another 600,000 RNs intend to leave the health care profession by 2027.

It is estimated that by 2028, there will be a nationwide shortage of 100,000 health care workers. The biggest projected deficit is among nursing assistants, the backbone of the long term care workforce.

The shortage of caregivers is creating a challenge in access to care. Workforce shortages in long term care have forced many nursing homes and assisted living communities to limit or deny new admissions, downsize their facilities, or close altogether. Since 2020, 774 nursing homes have closed, displacing 28,000 residents. The overall decline in the number of nursing homes accelerated by nearly four times compared to pre-pandemic rates.

A Better Way

Our solutions for the workforce shortage are multipronged. They include building a stronger pipeline by addressing faculty shortages at nursing schools and streamlining legal pathways for international caregivers to work in the United States. To boost recruitment and retention, we support student loan forgiveness tax credits, affordable housing, and childcare incentives, along with subsidies and grants to schools whose graduates work in long term care.

Grants and scholarships should be available for ongoing training and career ladder programs should be expanded. We also need to expand the ability of nursing homes to offer in-house training programs to develop nurse aides. We will push Congress to help us permanently ban unrealistic staffing mandates and advance these more meaningful workforce solutions. 

Protecting Medicaid

Medicaid is the lifeblood of long term care. Nearly two-thirds of nursing home residents rely on Medicaid to cover their care. In many states, Medicaid fails to cover the actual cost of nursing home care (on average, 82 cents on the
dollar), leaving providers with a significant financial shortfall. Chronic underfunding makes it difficult to invest in
the nursing home workforce, care services, and modernization. For some providers, it means closing their doors altogether.

A Better Way

We must protect and defend Medicaid from cuts. Federal policymakers should require that Medicaid rates be brought up to equal the cost of care and regularly updated to keep pace with increasing operational costs. 

Reaffirming the Promise of Medicare Advantage

Medicare Advantage (MA) plans have seen tremendous growth, as more seniors are attracted to their many perks (out-of-pocket limits, vision, dental, hearing, and other supplemental benefits). More than half (54 percent) of eligible Medicare beneficiaries are enrolled in Medicare Advantage.

Yet, we’re hearing many concerns about MA plans, especially when it comes to access. As patients get sicker, MA plans are too often denying or delaying seniors’ access to necessary post-acute care, including in skilled nursing facilities. From 2019 to 2022, the top three MA insurers denied prior authorization requests for post-acute care at higher rates than for other types of care. As a result, the rate of seniors in the final year of their lives leaving MA plans for traditional Medicare doubled from 2016 to 2022, leaving taxpayers with the bill.

A Better Way

Seniors have earned the right to make choices and changes, and have timely access to medically necessary care. We must put the power to determine the course of care in the hands of medical professionals and patients, rather than in artificial intelligence or insurers. MA transparency and the rating system should be enhanced, so seniors can make informed decisions.

Market competition should be fostered, so seniors have options to select the best plan. And we need to make sure patients, policymakers, and taxpayers are getting the best deal by encouraging insurers to work with providers
to improve outcomes and reduce costs through shared savings programs. 

Rationalizing the Regulatory Environment

We all want safe and high-quality nursing homes. But for decades, America has struggled with a broken oversight system that has failed to produce real change. Federal regulators pile on regulations, guidance, and penalties, while administering enforcement disproportionately.

The current system is inconsistent and ineffective. It does not drive quality improvement among nursing homes or enhance quality of life for residents. Stakeholders across long term care are unsatisfied with the results, and policymakers aren’t getting a return on their investment. 

A Better Way

We must create more effective and balanced oversight that prioritizes quality care while maintaining safety, accountability, and transparency. We can do that by rationalizing the regulatory environment through a variety of areas, including:

• Updating the Five-Star Quality Rating System to provide more complete and useful information to consumers.
• Expanding risk-based surveys nationwide to reduce survey backlog, recognize higher-quality facilities, and incentivize more facilities to qualify.
• Improving access to the Civil Monetary Penalty Reinvestment Program to increase use of funds on quality-improvement initiatives and allow them to be used for workforce programs and technology investments to enhance care.
• Strengthening the Special Focus Facility Program to help poorly performing facilities get better and out of the program.

Quality at the Core

AHCA is dedicated to our mission of improving lives by delivering solutions for quality care. By showing policymakers A Better Way to prioritize, support, and invest in long term care, we can deliver for our residents and patients as well as those who care for them.