Home healthcare worker shortage driven by Pennsylvania's stagnant reimbursement rates, advocates say
For many seniors and people with disabilities, staying in their own homes can mean greater independence and a better quality of life. But across Pennsylvania, a shortage of home healthcare workers is making that increasingly difficult.
Staffing shortages can force family members to miss work to care for loved ones or prevent medically complex patients from leaving hospitals and rehabilitation facilities.
Danielle Perry, who lives with cerebral palsy, is now enjoying independent living in her own apartment after leaving a rehabilitation center. She credits her home healthcare aide with helping make that possible.
"I came from a rehabilitation center and in that place, they treated us bad, real bad," said Perry.
Her aide with Patriot Home Care helps with daily tasks, including showering, preparing meals, grocery shopping, cleaning and laundry.
"What I like now is that I can take a shower every day and put on clean clothes," said Perry.
"It's more enjoyable," she added. "I get to do what I want and get to have my freedom and things like that."
But advocates say access to that kind of care is becoming harder to find.
According to the Pennsylvania Homecare Association, approximately 112,500 home care shifts go unfilled across the state each month because of low reimbursement rates. The association also reports that one in four authorized nursing hours never take place.
Michelle Scott, a branch manager with Patriot Home Care, says agencies are struggling to compete with other industries for workers.
"I've had caregivers personally tell me, 'I'm going to Target, I'm going to Giant Eagle,' so they'll leave caregiving and go be a cashier or work in fast food because the fast food industry is literally paying more," said Scott.
Scott sometimes needs to step in as an aide herself when the agency cannot find someone to pair with a new client. She says the wages agencies can afford to pay caregivers are a major challenge.
"An average wage would probably be $13 an hour, and you will hear people tell you, 'Five Guys pays more than that,'" Scott said. "'I can't live off of that.'"
Scott adds the reimbursement agencies receive does not leave much room to increase wages.
"The agency is paid $19.32 an hour. We in turn have to pay that caregiver, we have to pay taxes, we have to pay medical, we have to pay different insurances," said Scott.
Industry advocates say stagnant state reimbursement rates are also contributing to gaps in care for medically complex patients. They say some patients remain in skilled nursing facilities because home healthcare services are not available, while families of medically fragile children face challenges securing the care they need.
Because so many people who rely on home healthcare services are enrolled in Medicaid, advocates say the state's reimbursement rates have a significant impact on the broader workforce.
According to figures provided by the Pennsylvania Homecare Association, Pennsylvania's Medicaid reimbursement rate trails neighboring states.
The association provided the following rates:
- Pennsylvania: $20.63
- Ohio: $28.96
- West Virginia: $26.9
- New York: $36.31
- New Jersey: $26.68
- Maryland: $25.58
- Delaware: $31.00
State Rep. Lindsay Powell, a Democrat representing the 21st District, says the staffing challenges are especially concerning in Allegheny County as its older population grows.
"Advocates, both those receiving care and those giving the care, have raised this as a growing issue, especially in Allegheny County where we are going to see an increase of our population over 65, I think rivaling some spots in Florida," Powell said. "We will be some of the oldest counties in the nation."
Powell serves on the House Aging and Older Adult Services Committee. She says the state needs to look at both reimbursement rates and ways to make caregiving a more attractive career.
Pennsylvania Senate Resolution 238 recently passed with bipartisan support. The resolution directs the Legislative Budget and Finance Committee to study Medicaid reimbursement rates and workforce challenges. The study is intended to provide lawmakers with an independent, government-led assessment of the relationship between Medicaid reimbursement, staffing shortages, and access to care.
