home care


Pennsylvania is an aging state. By 2025, more than 20% of state residents will be 65 or older, according to projections from the U.S. Census and the Pennsylvania State Data Center. With these changing demographics come many questions about how we can best manage and pay for the health needs of our citizens. There are myriad issues related to that topic. Here’s just one that is worthy of discussion: “How can we provide crucial care for our loved ones if agencies can’t attract and retain enough home care workers?” That’s the question that was raised by Susan Heinle, CEO of Visiting Angels York, in an op-ed that appeared in Saturday’s LNP.

Our Age Wave is becoming an Age Tsunami.

That’s how Samuel T. Frankhouser, a retired associate dean of Alvernia University and chair of the 55-plus adult ministry committee at Ephrata Church of the Brethren, summarized the changing demographics of our population in an op-ed that appeared in the May 12 Sunday LNP.

Writing about May’s designation as Older Americans Month, Frankhouser noted: “Understanding (the tsunami’s) implications will help determine much about how the United States will move forward in support and care of the growing number of older people.”

We can’t solve all of the issues surrounding care of Pennsylvania’s seniors in this space today, but we want to consider the point Heinle made in her Saturday op-ed.

It’s a point about our seniors. And dignity. And smart fiscal sense – that is, allocating more of our limited taxpayer funds to best take care of senior citizens who have earned the right to live safely in their homes if they wish it.

The state Legislature has not passed a Medicaid rate increase for home care in five years. Because of that, Heinle notes, Pennsylvania’s home care agencies are falling behind in hiring and, crucially, retaining those who do the work of caring for those who want to remain in their homes but need regular assistance.

We believe strongly that Pennsylvanians should have the freedom to remain in their homes, whenever reasonably possible. To remain a part of their neighborhoods. Their communities.

It’s about a level of comfort and dignity to which they are entitled. Often, it’s about remaining with family. And a better quality of life.

We also believe home care is often the most fiscally responsible route in caring for seniors, the one with the potential to be the most prudent use of taxpayer dollars.

And so this industry of helpers, in turn, needs some help from Harrisburg now.

After this half-decade of no increases, the Pennsylvania Homecare Association, which represents about 700 agencies, is asking state lawmakers “for a 10% Medicaid rate increase for personal assistance services and to standardize the rate across all regions of the state.” It notes that current Medicaid reimbursement ranges from $17.52 to $19.52 per hour and is dependent upon geographic location. When everything is accounted for, the Pennsylvania Homecare Association says agencies are losing money. Which means they’re in no position to retain sufficient numbers of workers.

“Five years ago, home care agencies worried only about losing workers to other agencies, but today we are competing against Amazon, other retailers and the fast-food industry,” Heinle notes. “In fact, agencies regularly see a 70% employee turnover. We need to ask ourselves: How can we provide crucial care for our loved ones if agencies can’t attract and retain enough home care workers?”

Operating costs have risen for agencies over the past half-decade, too. Mandatory criminal background checks have increased from $8 to $22 per year, while compliance fees and workers compensation are also higher.

We agree with the Pennsylvania Homecare Association’s call for a Medicaid rate increase. It’s needed to keep up with the industry’s costs, and it’s needed to encourage growth within a sector of health care that will require more workers each year, as the state’s population ages.

And it’s cost-efficient — a market force we should encourage. The cost of a home care worker is $4,315 a month, the Pennsylvania Homecare Association states. That’s compared to the $10,114 average monthly cost of nursing home care. Even with a 10% rate increase, caring for residents in their homes would still be only half the cost of full-time nursing home care. (The nursing home industry is, of course, important and also in need of help in this state. That’s an editorial for another day.)

Plus, as Heinle notes, you’re getting more personal attention for that lower cost: “Home care workers provide four to 20 hours of care a day per client, while nursing homes are required to provide only 2.7 hours of direct personal care per day.”

Gov. Tom Wolf seems to recognize the value of home care. His spokesman, J.J. Abbott, told the Pittsburgh Tribune-Review earlier this year: “(Wolf) remains open to input on areas where there could be need to address rates due to higher costs in the health care system but believes the conversation is more complicated than just giving more taxpayer funding to privately operated nursing homes.” We’d like Wolf to be more specific and vocal on this issue.

And we should let our representatives in Harrisburg know that home care funding is a priority. More than 67,000 Pennsylvania seniors and adults with disabilities currently receive home-based care.

Finally, this discussion can’t just be about an agency retaining a certain number of home care workers, but about the quality of their performance. We want this field to thrive and attract skilled and compassionate workers. As we age, we become more vulnerable; the people we invite into our homes to care for us ought to be those dedicated to the profession of elder care.