Lutheran Services in America Meets with CMS Administrator, Continues Driving Home the Impact of the Direct Care Workforce Crisis

June 14, 2022

We are continuing our work to raise awareness of the impact on access to care as a result of the ongoing workforce shortage crisis in direct care—and drive action in the Biden Administration that will help address the problem.

Making the Case for Change

In March, the Centers for Medicare and Medicaid Services (CMS) announced a sweeping Skilled Nursing Facility (SNF) initiative that includes more than 20 proposed actions, including implementing a minimum staffing requirement, increasing frequency of compliance surveys and dramatically increasing penalties for deficiencies.  No funding is provided for additional staff required by nursing homes.

In response, Lutheran Services in America wrote a letter to CMS administrator Chiquita Brooks-LaSure outlining our concern about the lack of understanding of the workforce shortages facing skilled nursing providers and the result that older adults will not have access to the care they need. We also invited our members and their networks to participate in our advocacy campaign to Brooks-LaSure and members of Congress and conducted a survey of our SNF providers to collect hard data to strengthen our messages.

Strength in Numbers

Illustrating the strength in numbers when we come together as the voice of a $23 billion faith-based network, we secured a meeting with CMS Administrator Brooks-LaSure on May 26 with four of our member CEOs:

During this meeting, we shared that we’ve already reduced services for older adults because of workforce shortages—for example, 1 percent of the population of Lindsborg, Kansas, is waiting to be admitted to a skilled nursing facility and over 100 older adults in one Minneapolis hospital alone can’t be discharged because there are no skilled nursing beds available.

We highlighted the limited options for older adults who are frail and need higher level skilled care today because of workforce shortages—and that an unfunded mandate to expand staffing requirements would mean we would have to turn away more people.

We talked about the dedicated caregivers—the frontline heroes—and the extensive efforts our members make to recruit and retain staff in this competitive environment. But with Medicaid reimbursement rates that don’t fully meet the costs of care (e.g., losing $90/day on 70 percent of the population served), even the prison commissary in one rural community pays staff more than Medicaid provides.

We also shared the exorbitant fees paid to staffing agencies to secure additional workers to continue to empower older adults. For example, outside staffing agencies were 27 percent of the nursing budget for one member—where two years ago they were $0. Another cited paying staffing agencies $90/hour for a Certified Nursing Assistant, clearly not sustainable.

Next Steps

We recommended bringing our provider voice into CMS’s plans and that CMS should focus on helping expand the workforce through immigration and other levers to expand the pipeline and expand Medicaid reimbursement to cover the cost of care.

Now, CMS is also seeking public comments on the minimum staffing requirement, and we’ve shared our message with them there as well.

Our advocacy work isn’t over, and we still need your help and your voice to continue making progress, but we know our message is beginning to break through and for that, we thank you for your continued support.

Fed Acknowledges “Critical Role” Nonprofits Play

June 02, 2020

The Federal Reserve Board continues to develop guidelines for the Main Street Lending Program. Authorized under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, this low-interest loan program for mid-sized businesses with up to 15,000 employees provides funding to be used to retain at least 90 percent of the recipient’s workforce. This program is especially important given that the Paycheck Protection Program currently doesn’t provide funding for nonprofits with more than 500 employees.

Unfortunately, as of April 30, the Federal Reserve has published an FAQ indicating that nonprofits are NOT currently eligible for this program (see Question E6). However, the Fed has stated that it recognizes “the critical role that nonprofit organizations play throughout the economy and [is] evaluating a separate approach to meet their unique needs.”

Given that the CARES Act provides the Federal Reserve with the authority to include nonprofits in this program, we will continue to urge senators to support nonprofits through this program and to include our key priorities in their next round of coronavirus relief legislation. Join us by using our advocacy tool to ask your senators to support health and human services nonprofits through the Main Street Lending Program and CARES 2.0.

Internship Reflections: Jayleen Velez

December 10, 2021

Saying farewell to the fall 2021 Lutheran Services in America interns!

Each semester, Lutheran Services in America hosts interns from Lutheran College Washington Semester, a personalized internship program in Washington, D.C. where students live, study, and intern while earning a full semester of academic credit from their college.

The fall 2021 Lutheran Services in America interns were nothing shy of amazing with a great “can-do” spirit met with a smile when given new tasks and projects. While we are sad to say farewell, we are excited for their future endeavors and wish them the best of luck during their senior years.

The following is a reflection from Jayleen Velez on her time in D.C. with Lutheran Services in America.

I’ve spent the fall 2021 semester interning at two different organizations in Washington, D.C. At Lutheran Services in America, I interned with the Member Engagement team working closely with my supervisor, Susan Newton, on various initiatives. I also interned at Play Sports Academy and served as a coach to preschoolers and first graders, teaching various sports and skills. Although I enjoyed my internship at Play Sports Academy tremendously, I feel that my internship experience at Lutheran Services in America gave me a chance to develop new skills and practice techniques. From developing an annotated agenda to designing a process flow charts, the behind the scenes work that Lutheran Services in America does to bring its members and partners together around big goals is eye opening.

What I will remember most about my time as an intern at Lutheran Services in America is the amazing staff and their coaching and opportunity to serve throughout all the projects that I worked on. It has helped me not only grow into a better intern and student, but also inspired me to pursue a career in service. I will be graduating from Gettysburg College in spring 2022 and will be going to work as Director of Business Operations at Play Sports Academy in New York City. I am excited to take the skills and techniques that I have learned at Lutheran Services in America and apply it to my new position.


By Jayleen Velez, Intern

Internship Reflections: Izzy Mack

December 14, 2021

Saying farewell to the fall 2021 Lutheran Services in America interns!

Each semester, Lutheran Services in America hosts interns from Lutheran College Washington Semester, a personalized internship program in Washington, D.C. where students live, study, and intern while earning a full semester of academic credit from their college.

The fall 2021 Lutheran Services in America interns were nothing shy of amazing with a great “can-do” spirit met with a smile when given new tasks and projects. While we are sad to say farewell, we are excited for their future endeavors and wish them the best of luck during their senior years.

The following is a reflection from Isabel “Izzy” Mack on her time in D.C. with Lutheran Services in America.

I made the best decision moving to Washington, D.C. to gain internship experience. I’ve been able to network, learn and grow in my intern role in the Lutheran Services in America Development Office. This experience has also opened my eyes to the extraordinary work that the 300 nonprofit organizations Lutheran Services in America network do every day to meet their mission. In addition to my internship at Lutheran Services in America, I also interned with Brett Parson, a retired Lieutenant for the Metropolitan Police Department that consults, trains and speaks on contemporary law enforcement issues and policing strategies with police departments all over the world. Balancing both internships blessed me with the opportunity to see two different aspects of nonprofit work in Washington, D.C. and the power of people across the country and the world working together to transform lives and communities.

As I prepare to graduate from Roanoke College this month, I’ve decided to pursue a degree in the legal field and know that these internship experiences have equipped me with new skills and knowledge that will continue to inspire me and help me follow my calling and professional journey.

The adventures I’ve experienced during these last three months living in Washington, D.C. have exceeded my wildest dreams. I’ve enjoyed getting to know the city. Recently, Washington, D.C. got even more exciting on a Saturday morning trip to the Eastern Market, where I met Vice President Kamala Harris. I waited for a perfect window to ask for a photo and the Vice President was lovely and delighted to take a picture with me. It was an amazing moment that I will treasure forever.


By Isabel “Izzy” Mack, Intern