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Pennsylvania Department of Health has improved its oversight of nursing homes, but a lot more needs to be done to address a looming elder care crisis, Auditor General Eugene DePasquale said Tuesday.

Although his office billed its latest report as following up on a 2016 audit of nursing home oversight, half of it focused on issues beyond the department.

“By 2040, nearly 25% of Pennsylvania’s population of about 13 million will be 65 or older, compared with 15% in 2010,” it said. “Pennsylvania must be prepared to meet the long-term care needs of well over 3 million older adults, many of whom lack the necessary financial resources to pay for such care.”

Here are some key takeaways.

‘Case for increasing Medicaid funding is clear’

Medicaid reimbursement barely budged in recent years, and nursing homes have long been pleading for increases, saying they’re losing lots of money on the many patients covered by that program.

The report said there’s a clear case for more funding, describing an obligation state and federal legislators have to make sure it’s adequate — and observing that good care for older adults is expensive and difficult to find in many parts of the state.

Significant changes, impact unclear

The department has significantly changed its oversight since 2016, the report said, but “the extent to which these changes have led to improved quality of care is unclear.”

One 2016 criticism was low use of fines, and the report noted that those multiplied more than fivefold to $2.3 million in 2018. It suggested publicly tracking how fines impact care and said if viewed “as simply the cost of doing business,” they’re unlikely to change behavior.

The report also recommended analysis of nursing home surveys to “address discrepancies and patterns of inconsistency.”

New regulations coming

Department spokesman Nate Wardle said it’s working on updating nursing home regulations last changed 20 years ago, and expects to unveil its proposals by the end of the year, with a review process taking more than a year.

The report mentioned that effort, saying some of the changes the audit recommends may be addressed there.

Staffing requirements in question

The report says Pennsylvania’s daily staffing requirement of 2.7 hours of direct care per resident is below the federal recommendation of 4.1 hours, with the “complicated and controversial” issue being reviewed as part of the regulatory overhaul.

“Some experts argue that mandated direct care hours improve quality and health outcomes, while others say that the regulation is burdensome and that the number of hours is not the best key metric on which to focus,” it says.

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