October 6, 2025
A chaotic political environment exacerbated by a government shutdown has left the senior living and care sector wondering what’s next. But opportunities exist amid the chaos, according to experts.
Telehealth is one such opportunity. After being extended every year since the COVID-19 pandemic, telehealth flexibilities expired Sept. 30. Several types of telehealth visits that have become essential in senior living communities since the pandemic now are on hold until further notice, including those for physical therapy, occupational therapy and speech-language pathology visits.
Pre-COVID visits still covered by telehealth include those for individuals enrolled in an accountable care organization, for mental health visits and for visits covered by commercial insurance. (Visits for nursing home residents in rural and underserved locations are still covered as well.) The Centers for Medicare & Medicaid Services released a memo detailing the effects of the government shutdown on Medicare operations, including telehealth.
The good news, according to Alex Bardakh, Post-Acute and Long-Term Care Medical Association senior director of advocacy and strategic partnerships, is that Congress has consistently extended telehealth in previous budget bills. He told McKnight’s Senior Living that support for telehealth also highlights the notion that telehealth services at this point have become vital to the healthcare ecosystem and should become permanent and “not have them dangle out there and be collateral damage when negotiations stall or fail.”
Ultimately, the decision on whether to continue with telehealth visits during the shutdown is up to each provider based on an assessment of the necessity and health severity of each resident, he said. Providers, Bardakh added, are thinking about the implications of offering or not offering telehealth visits, particularly in cases where a visit could help avoid a potential rehospitalization.
“It’s not what anyone wants,” Bardakh said. “As clinicians, everyone wants to do the right thing for patients.”
In the meantime, PALTmed is recommending in-person visits instead of telehealth visits and, for those companies submitting claims, conducting telehealth visits but holding claims until Congress restores coverage or having residents pay out of pocket.
“Telehealth has proven to be a lifeline for residents in nursing homes and assisted living communities — improving access, reducing unnecessary hospital transfers and supporting continuity of care,” PALTmed wrote in a recent blog post.
Reforming long-term care
In a JAMA Health Forum article, Stuart M. Butler, PhD, scholar in residence at the Brookings Institution, suggested several steps the Trump administration can take to lay the foundation for a comprehensive overhaul of long-term care, which he said is in “dire” need of reform as costs soar for both families and government.
Given the cost of long-term care, Butler noted, many older adults are turning to Medicaid, but the recently enacted HR1 is projected to reduce federal Medicaid dollars, raising concerns that quality and access to care will decline. Those concerns, he added, are impounded by the Trump administration’s immigration policies, because immigrants make up 28% of the direct care workforce.
The changes he suggested:
- Legislation. The Trump administration should urge Congress to expedite the reauthorization of the Older Americans Act, which expired last year, and support the bipartisan Well-Being Insurance for Seniors to be at Home, or WISH, Act, which would encourage private insurers to reenter the long-term care market by mitigating their risk. Increasing the number of people with long-term care insurance, Butler wrote, would significantly reduce the burden on state Medicaid programs.
- Staffing. Adding direct care workers to a proposed “temporary pass” program for immigrants, expanding eligibility for existing visas or even increasing staffing at immigration offices to expedite applicants who qualify for work permits, are ways to approach comprehensive immigration reform, Butler stated. Additionally, standardizing licensing and training standards, as well as bolstering compensation, for direct care workers would support a more professional and cost-effective workforce, he said. Similar to CMS’ Guiding an Improved Dementia Experience, or GUIDE, model, Butler said he is a proponent of pilot programs to evaluate a range of staffing models.
- Housing and services. Older adults want to age in place, Butler pointed out, but he added that the negative effects of social isolation and “expensive yet inadequate” home care require a new look at diverse housing models to better serve older adults. Student-senior housing, in which students live in the homes of older adults; the Green House model currently used in some nursing homes; and senior villages, grassroots organizations that connect older adults to support services in their own neighborhoods, should be explored, he said.
Butler also advocated for federal funding of pilot programs with Federally Qualified Health Centers to explore their potential as service hubs to coordinate services for older adults.