Shapiro’s Budget Proposal Puts Seniors at Risk

Over the past decade, the lack of access to in-home care in Pennsylvania has reached a crisis point. From seniors to medically fragile children, more than 400,000 Pennsylvanians rely on various types of in-home care to live their lives with dignity and security, but today, more than 112,500 caregiver shifts are missed and 27% of nursing hours go unfilled every month across Pennsylvania. 

These services are under severe strain – and sometimes unavailable altogether – because of staff shortages created by a lack of necessary investment, year after year, from our elected leaders in Harrisburg. 

At the core of this issue is the fact that Pennsylvania’s average reimbursement rate for in-home care is only $20.63 per hour – far below what is necessary to support a sustainable workforce. For context, neighboring states like Delaware, Maryland, and New Jersey pay 25-75% more for the same services. As a result, direct care workers are choosing to work across state lines or leave the field in search of better compensation. And who can blame them? In some cases, they can earn at least $5 more an hour working at a fast-food restaurant or gas station than doing the essential work of caring for our most vulnerable neighbors. 

Gov. Shapiro and his administration know this is a problem. In fact, a study commissioned by Shapiro’s administration just recently confirmed what we have been warning for years: Pennsylvania's reimbursement rates for in-home care services are dangerously low, making it impossible to recruit and retain workers needed for the safe delivery of home care.   

The Shapiro administration’s own study recommends that Pennsylvania increase funding for direct care workers by 23% to finally stabilize the caregiver workforce, but instead of following that advice, Shapiro’s budget proposal largely ignored it, offering funding increases for only 6% of the home care workforce, leaving 94% of workers without necessary support.

During recent budget hearings in Harrisburg, Pennsylvania’s Secretary of Human Services, Valerie Arkoosh, was asked specifically about the study and the desperately-needed rate increases, but admitted the Administration has “not budgeted for that.” While the governor has touted his support for seniors, his budget proposal leaves hundreds of thousands of Pennsylvania’s most vulnerable – and the caregivers and nurses they rely on – out to dry. 

The implications of this crisis are profound. Care recipients across the state are increasingly being forced to go without critical services or are being forced into facilities unnecessarily. This lack of investment in caregivers and nurses drives up overall healthcare costs statewide – the average monthly cost of in-home care in Pennsylvania is $4,957, but the average monthly cost of a nursing home is $10,403.

Ignoring this crisis hurts Pennsylvania’s economy, too. Pennsylvania’s home care industry generates $25.6 billion annually and supports nearly 300,000 jobs, while also providing $4.5 billion in federal, state, and local tax revenue. Stabilizing the caregiver workforce would put the state in better financial position over the long term while meeting increasing demand for care.

Even though the governor’s budget largely ignored it, the Shapiro administration’s study does provide legislators on both sides of the aisle a clear roadmap for addressing this ongoing and worsening crisis.

As our lawmakers debate the state budget over the next several months, one thing is clear: inaction is simply not an option. Investing in Pennsylvania’s home care workforce is not just a policy choice – it is a moral and financial imperative for Pennsylvania. 

Along with PHA and other advocates, caregivers, patients, and families across the state are urging their elected officials to stabilize this critical industry and give peace of mind to the hundreds of thousands of families who rely on in-home care. 

The path forward is clear, and the time for action is now. Pennsylvanians deserve better. It’s time to invest in our home care system before this crisis gets even worse.