(The Center Square) – Pennsylvania house members say that aging in place is a major priority for them as the state’s elderly population continues to grow.
Homecare services, deemed unskilled, to support daily activities like bathing, dressing, and cooking are essential to creating that possibility for them.
Yet providers across the state are struggling to hire enough staff to cover the needs of the state’s 300,000 homecare recipients. Unable to offer comparable hourly wages, the industry is losing its potential recruiting pool to gig work and jobs in the service industry.
“We are in crisis. The crisis isn’t coming. We are not planning for it. It’s actively here,” said Mia Haney, CEO of the Pennsylvania Homecare Association at a meeting of the House Aging and Older Adult Services Committee.
The average hourly wage for homecare workers in the state is between $13 and $14, making it hard to compete with other industries. Even within healthcare, counterparts performing the same tasks from within care facilities earn more.
Home care advocates say the discrepancy doesn’t add up given the value of homecare. Seniors who are able to stay at home have better outcomes, fewer hospitalizations, and less health care costs overall. The average cost per month for home care is just under $5,000, while the monthly cost in an institutional setting exceeds $10,000.
Laura Ness, President of the Pennsylvania Homecare Association Board of Directors, says that’s in part because many residents in facilities are paying for more care than they need. Often homecare recipients only require a few hours of assistance on a given day. Other expenses like housing, food, and utilities are paid into the community like anyone else’s.
Those few hours a day can provide for flexible work opportunities, but it’s difficult work.
“It takes a very special individual to be able to go into someone’s home,” said Ness, who noted that conditions within homes vary. Workers who take on the commitment often become like family to their clients, creating an emotional attachment that adds both to the rewards and the stress of the job.
Haney described scenarios where providers find themselves in offices, unable to send anyone to a job while elderly clients wait at home for someone to come help them with a bath or a meal.
Advocates say that one major obstacle to developing the workforce is the Medicaid reimbursement rate for homecare, which is capped at $20.63 per hour, about $17 of which Haney says goes toward the workforce. The figure is all-inclusive, meaning providers have to cover all of their expenses within that rate, including overtime wages and benefits.
According to Haney, it is lower than every bordering state by upwards of $4.50, and the commonwealth is constantly losing members of the workforce who are passionate about this kind of work to neighboring states.
Homecare is not covered by Medicare or third party insurance like hospice and home healthcare, which involve nursing in shifts and skilled work like occupational and physical therapy. The majority of recipients receive this care through the state’s Community Health Choices or pay privately.
Community Health Choices works with just three Managed Care Organizations within the state who coordinate care for patients – UPMC, AmeriHealth Caritas, and PA Health and Wellness. All three organizations have currently closed networks, meaning they are not accepting additional providers even as the demand for care grows.
“We cannot continue to kick the can down the road and not address this,” said Haney.
With the churn rate for the industry at over 70%, providers are forced to spend much of their time working toward recruiting and incentivizing workers. To create a sustainable model moving forward, advocates say addressing the low Medicaid reimbursement rate is just a first step.
