Why are PA home care providers upset about Shapiro’s budget plan?

Agencies that employ home care workers are struggling to retain staff and meet the needs of clients due to low reimbursement rates from the state.
The lack of adequate funding for home care services could have significant consequences for Pennsylvania’s aging population, as many prefer to receive care at home rather than in nursing facilities.

Advocates for workers who offer home-based care to elderly, disabled people in Pennsylvania are expressing frustration about Gov. Josh Shapiro’s new spending plan, which they say does not provide enough money to pay these aides a living wage.

Money for these care workers flows from the Medicaid program, enabling low-income adults who qualify for a nursing facility to stay in their own homes and age in place. Providers help these people perform normal daily activities, like getting dressed in the morning, cooking meals, doing laundry and running errands.

However, Pennsylvania’s reimbursement rates for these services is woefully inadequate, according to Mia Haney, CEO of the Pennsylvania Homecare Association.

Shapiro’s spending plan for the coming year does provide a $21 million increase for about 8,500 workers who offer direct services outside the umbrella of a care agency. Administration officials say that, because of limited funding, the state can’t provide rate hikes for the roughly 270,000 agency workers in the commonwealth.

A recent study estimated that bringing hourly wages up to par would cost about $856 million, a sum that officials say just doesn’t fit in this year’s budget.

But agencies that receive this funding say they’re shedding employees who are finding higher-paying jobs at gas stations and fast-food restaurants

The resulting staffing shortages mean they sometimes can’t cover shifts at client homes. Carl Berry, CEO of Community Resources for Independence, said his Erie-based agency had to craft a triage plan to make sure they’re prioritizing the highest-need clients when they don’t have enough manpower.

His agency also faces limitations in the hours it can offer new clients, he said.

“We cannot serve weekends. We cannot serve evenings,” he said. “And disabilities don’t stop at five o’clock on a Friday.”

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What’s the problem?

Agencies that provide these care services receive reimbursement from the state at a rate of $20.63 per hour, an amount that is supposed to cover the business overhead and the caretaker’s wages, according to the Pennsylvania Homecare Association.

That rate hasn’t budged much in the past decade, only climbing by about $1.90, the association reported. Pennsylvania trails comparable states in its reimbursement rates, and hourly wages for workers in these programs lag behind what’s paid in the labor market for similar services, according to a recent state study.

The analysis performed for the Pennsylvania Office of Long-Term Living estimated it would cost the state about $856 million to hike pay for these care workers even to the lower end of market rates.

That’s a big chunk of money, Haney acknowledges. But if the state doesn’t take action, it’ll only keep growing as the rates continue to fall further behind.

“What happens when you don’t pay people the right amount of money and you’re this far from where you need to be is you’re jeopardizing quality every day,” Haney said.

Her group is trying to convince the Pennsylvania General Assembly to add this funding into the budget before they adopt it this year. The budget deadline is June 30.

Patti Tirpak has worked at Community Resources for Independence for about 16 years and has seen many of her colleagues leave for higher-paying jobs. She’s stayed because of the relationships she’s built with her clients.

But she says she’s on food stamps because she struggles to afford groceries.

“The fact that I could get a job at Walmart and make more money than I do taking care of people is a little disheartening,” she said.

Why is home-based care important?

Pennsylvania’s population is graying, and by 2030 one in five residents are expected to be over the age of 65.

Oftentimes, home-based care is less expensive than nursing home care, and many people would prefer to live on their own rather than in a residential setting. State policymakers are looking to support services that let people age in their communities and “stay connected to their friends and neighbors.”

Richard Fickes, a Meadville resident who has used CRI services for years, said he needs about 19 hours a week of care from Tirpak and another aide.

But the 62-year-old, who has spina bifida and uses a wheelchair, said he would much rather live independently at home than end up in nursing care.

“It allows me to do what everybody else does — being in control of my own life,” he said while driving Tirpak to the grocery store. “Go where I want to go, do what I want to do, eat what I want to eat.”

What does Shapiro’s administration say?

Val Arkoosh, Pennsylvania’s health services secretary, said in a budget hearing the first week of March that there isn’t enough money this year to boost rates across the board.

“Given what’s a very tight budget year this year and given the size of the potential cost to the general fund for increases in the other areas, we decided to start with the direct care workers in the participant-directed program,” she told state lawmakers.

The administration targeted roughly 8,500 direct care providers because they often lack benefits that come with working for an agency, Arkoosh told state lawmakers. The $21 million state increase will unlock an additional $26 million in federal funds, she said, and this bump will help provide wage hikes and paid leave.

Arkoosh also said the increased pay could help these care workers afford health insurance, a benefit that often comes with employment at an agency.

However, the state’s rate study reported that these direct care providers already receive rates set to reflect their lack of benefits, Haney noted.

Bethany Rodgers is a USA TODAY Network Pennsylvania investigative journalist.

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