June 5, 2025

Committee on Health, Council of DC
Makeda Vanderpuije, Executive Director, LeadingAge DC
Re: Proposed FY 26 Budget for the Department of Health Care Finance (DHCF)

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Good afternoon, Chairperson Henderson and members of the Committee on Health. Thank you for your committed support of DC’s older adults and for the opportunity to testify today.

My name is Makeda Vanderpuije and I am the Executive Director of LeadingAge DC, representing mission-driven organizations serving older adults across the District, including nursing homes, assisted living, affordable housing, Senior Villages, home and community-based services, and Life Plan Communities (CCRCs). I am also a District resident and an active member of the District of Columbia Coalition on Long Term Care’s Workforce Development Committee.

As an advocate for essential safety-net organizations across the aging continuum of care, my role is to ensure the voices of our hardworking providers are heard. These organizations are on the front lines, facing increasing threats to their sustainability and very survival. Supporting them now is crucial to strengthening their ability to prepare for the future of aging services and to meet the profound demographic shifts our city and communities are already experiencing.

Mayor Bowser’s proposed FY26 budget reflects ever tightening budget constraints and difficult decisions about where to direct finite resources. We applaud the nimble efforts to ensure that older adults did not lose Medicaid coverage and that long term care provider payments rates were not diminished in the midst of an extremely challenging budget environment. Regrettably, it falls short of the undeniable demographic imperative to make investments in the aging services workforce and systems.

In just a year, the oldest Baby Boomers will begin to turn 80, an age when the need for assistance with tasks of daily living significantly increases. Our District's older adult population (65+) is projected to increase by nearly 25% by 2030. The U.S. Census Bureau projects that the population aged 85 and older will nearly double by 2035 and almost triple by 2060. We cannot ignore this rising tide of need.

It is especially troubling then that DC’s long-term care industry is experiencing a severe workforce shortage. Last fall, over 4,000 Certified Nurse Aides and Home Health Aides – 30% of the workforce – did not renew their licenses. Professional caregivers who make it possible for family members to work in a fulfilling profession, and for elders to be cared for and age with dignity, are leaving the field for jobs that are less difficult, require less training and pay more money. The median hourly wage for direct care workers in 2023 was a meager $16.72 – significantly lower than comparable entry-level positions. This issue is compounded by broader national policies impacting the immigrant workforce, who are often vital to this sector. Without competitive wages, we risk a calamitous shortage of the very individuals who will be essential for our aging residents.

The proposed elimination of enhanced wages for direct care service professionals starting in FY27 is not just shortsighted; it is a desertion of the residents, professionals, and stakeholders who worked with this Committee and other Councilmembers to pass the CNA Amendment Act of 2024, and a critical threat to our city's ability to care for its most vulnerable residents and visitors.

While we recognize that finding or creating revenue to fund needed pay increases, workforce training, and other continuum supports is challenging, this is an investment in the health of our residents that we cannot afford to overlook. The Mayor’s Grow DC financial plan aims to safeguard the economic viability of our city, but needs to ensure that elders, other medically vulnerable populations, and professional caregivers are not left behind.

We question the prudence of a near- 1 Billion- dollar subsidy for construction of a sports and entertainment project intended to appeal to visitors, when the need to invest in the long term care workforce serving vulnerable community members remains dire, yet is overlooked.

We must recognize that a thriving long term care workforce is a cornerstone of our city's fiscal health. This sector actively contributes to our economy by creating essential jobs and establishing a durable model of care that bolsters the entire healthcare system. When direct care workers receive fair compensation through increased wages, they have more disposable income, directly stimulating our local economy and supporting local businesses.

Beyond this direct economic injection, consider the indirect savings: when we have sufficient staff, individuals can receive care in appropriate, less intensive settings. This directly reduces the burden on our emergency medical services and hospitals, and by improving health outcomes, it ultimately leads to lower long-term costs for critical programs like Medicaid and Medicare.

The current moment demands immediate, coordinated intervention and improved communication with and between various stakeholders. Together, educational institutions, training providers, consumers, family members, advocates, community organizations, long term care providers, and government agencies, should be supported in ensuring a sustainable workforce and a robust plan that meets the needs of the future’s intergenerational communities.

Direct care workers deserve a living wage that supports their families without needing to rely on overtime and public benefits to make ends meet. It is our duty to enable access to timely, quality care to support good health and manage health challenges before they become more costly.

Mission-driven providers ought to be able serve those in the community who need care, while keeping their employees well paid and their facilities safe and open. Young people and those looking for a career change should see professional caregiving as a fulfilling career with potential for wage growth and professional advancement. Our elders have so much to contribute to our communities, sharing hard-earned wisdoms, providing childcare and mentorship, volunteering and so much more.

LeadingAge DC members and the direct care professionals that they employ are committed to providing high-quality care, services, and supports that empower aging residents to live with meaning, purpose and dignity. To do so, they need your continued support and a coordinated all-of-government approach to finding long-term solutions for this workforce crisis, as well as reimbursement at a level that allows them to cover costs and pay a fair, living wage to direct care workers and other licensed professionals.

LeadingAge DC and the Coalition are ready and willing to support the Committee and continuum partners in realizing a future where all District residents can age well and thrive. I welcome any questions that you may have.