By Garry Pezzano

As Pennsylvania’s baby boomer generation continues to age, the commonwealth’s system is failing to meet the growing demand for nursing home care, the LIFE program and other critical aging services.

In fact, at a time when we should be expanding services, nursing homes are removing beds and scaling back services due to a persistent workforce shortage and inadequate Medicaid funding support. Despite increases in recent years, there is a chasm between the cost of care and what providers are reimbursed. A decade ago, Pennsylvania knew this was coming. Providers repeatedly sounded the alarm as the senior population increased and the working-age population declined. Now, we’re facing a reality with fewer options available for seniors who can no longer safely care for themselves on their own.

Between November 2024 and January 2025, nursing home providers were forced to turn away at least 2,443 seniors because of a lack of available beds, according to a recent survey conducted in part by LeadingAge PA. The report, “How Workforce Shortages Across Pennsylvania’s Health Care Continuum Affect Access to Care,” revealed that nearly half of all nursing home providers limited or denied admissions due to overly rigid staffing regulations. Over half indicate double-digit vacancies despite raising pay rates and increasing recruiting efforts for direct-care staffing positions.

Our government must recognize that these challenges don’t only impact nursing homes; this crisis is now impacting our hospital partners upstream. That same survey found that 70 percent of hospitals have seen emergency room wait times increase due to workforce shortages, as reported by members of the Hospital and Healthsystem Association of PA (HAP).

Meanwhile, insufficient Medicaid funding threatens the success of Pennsylvania’s Living Independence for the Elderly (LIFE) program, which serves more than 8,000 older adults wishing to remain at home by providing coordinated care, social engagement, medical services, personal care assistance, nutritional support and transportation as an alternative managed-care option.

Unfortunately, with rising costs, the situation is only worsening. Many aging services providers are running out of options and being forced to make difficult decisions, including closing their doors and limiting access to care in local communities. Every year since 2020, reputable facilities have closed or been sold, including Twining Village in Bucks County, Westminster Village at Allentown in Northampton County, the Vincentian Marian Manor in Pittsburgh and Wesley Enhanced Living Burholme in Philadelphia. Just last month, a Luzerne County nursing home announced it had no choice but to close due to its inability to sustain operations. Others are combining operations to stay financially viable.

Simply put, the system is broken, and the commonwealth is falling short. Providers continue to be paid only a fraction of the cost to provide this necessary level of care. We estimate most of our members are reimbursed only 45 percent to 60 percent of their actual care costs.

After all other avenues are exhausted, there’s only one way left to attempt to make up the reimbursement shortfall for Medicaid residents without turning them away entirely: raise rates on private pay residents. This means residents who prepared financially for their retirement care are seeing their resources depleted faster than ever before, ultimately resulting in more Medicaid-eligible seniors. That simply isn’t fair and not sustainable.

Approximately 70% of nursing home residents, and nearly all LIFE participants in Pennsylvania, currently rely on Medicaid for their care. If we cannot find a way to reduce the gap between costs and reimbursement for providers, they will continue to reduce Medicaid beds, deepening the existing access to care crisis.

The solution must be a fair and consistent funding system that will rise to meet the needs of Pennsylvania’s aging population — or we’ll continue to gamble with the care Pennsylvania’s older population deserves.

We cannot be more clear: Pennsylvania has not allocated sufficient resources or put the proper mechanisms in place to ensure continued access to care and support for some of the most vulnerable individuals in our state. State lawmakers, the Shapiro administration and stakeholders must come together to establish a predictable and sustainable funding system for nursing homes and LIFE providers.

Let's be candid. LeadingAge PA members consider caring for older adults an honor, a privilege and a responsibility. These individuals are retired teachers, pastors, police officers, Little League coaches and civic leaders. They dedicated their lives to bettering their communities, only to outlive their resources through no fault of their own. When we fail to invest in the organizations whose mission is to care for them, we fail to invest in the heart of Pennsylvania — in those who came before us and now depend on us to ensure they have the care they need and deserve.

Garry Pezzano is the president and CEO of LeadingAge PA. Follow him on LinkedIn and X @GarryPezzano and learn more about aging services at leadingagepa.org.