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Chester County Press

Increased Medicaid funding for senior services can restore access to care for older Pennsylvanians

05/02/2024 12:36PM ● By Garry Pezzano

In 2020, Twining Village in Bucks County was sold.

In 2021, Westminster Village at Allentown in Lehigh County was sold.

In 2022, both the Charles Morris Nursing and Rehabilitation Center in Pittsburgh and the Mercy Center Nursing Unit in Luzerne County closed.

Last November, Shook Home in Chambersburg was sold.

The list goes on.

It's no longer just a threat that Pennsylvania's mission-driven nursing homes will close due to chronic Medicaid underfunding. They are closing. When closure is avoided, they are often bought by profit-driven corporate entities with no ties to the local community.

Since the pandemic, senior care providers have been forced to close at least 25 nursing homes across the commonwealth.

Nursing homes, also called skilled nursing facilities, play an essential role in the healthcare ecosystem, serving tens of thousands of Pennsylvanians daily. While the pandemic certainly provided unique challenges, the continued workforce shortage and underfunding of Medicaid have made nursing home closures and sales to profit-motivated entities a harsh reality for Pennsylvania families who desperately need care for their loved ones.

These closures have contributed to the loss of 2,588 certified nursing home beds since 2020, which is especially concerning given more than 2.2 million Pennsylvanians are 65 and over.

Of the nursing home beds still available, nearly one in four are currently unable to be used due to the ongoing workforce shortage and insufficient Medicaid reimbursement, according to a new survey of LeadingAge PA members. In fact, 48 percent of nursing homes surveyed had to turn away patients from hospitals within the last three months for the same reasons. This has impacted the healthcare system upstream, with the top 15 hospitals in the state reporting a nearly two-day increase in the average length of stay for those expecting to be discharged to a nursing home from 2020 to 2023.

The difference between reimbursement rates and actual costs of care reached a massive $1.2 billion gap in 2022. While recent rate increases have helped some, a significant shortfall remains. It is also worth noting that mandated state staffing ratios are set to increase for the second year in a row. Consequently, providers are grappling with unprecedented workforce shortages worsened by these new, underfunded state staffing mandates.

If given an increase in Medicaid rates, nursing homes could hire more workers and increase the number of available beds. With the requirement that 70% of nursing home costs be allocated to the bedside (including staffing and salaries), our survey shows that 93 percent of respondents would prioritize increasing starting wages and wages for existing staff. More staff would mean more available beds for residents.

The challenges don't stop with skilled nursing facilities; they extend to other aspects of the aging services ecosystem, including Pennsylvania's Living Independence for the Elderly (LIFE) program. LIFE, known as PACE in other states, offers comprehensive health and support services to over 8,000 older Pennsylvanians. Its focus is on helping individuals age well in their homes and communities. However, LIFE also lacks sufficient funding. Since 2008, it has only seen a 2.8% net increase, failing to keep up with rising costs and inflation. This is becoming a crisis, with LIFE currently receiving 24% less than similar programs in surrounding states and 55% of what a similar individual would cost the state under the Community HealthChoices managed care option.

Therefore, to help its members better serve one of America's fastest-growing aging populations, LeadingAge PA is advocating for a $70 million increase in Medicaid funding for nursing homes and a minimum of $8.9 million, plus inflation, for Pennsylvania's LIFE program in the upcoming 2024-25 state budget.

It's time to stop pitting different sectors of the aging services ecosystem against each other. Instead, we must look at all the options available to older adults as they age and work to ensure that seniors can receive care and services in the setting that best fits their wants and needs.

As we've said many times, Pennsylvania can begin to answer this critical healthcare challenge by raising Medicaid reimbursement rates and, in doing so, move closer toward the aging services system that our seniors deserve. The commonwealth should strive to ensure that all those who need care can access high-quality services when and where they need them.

We can't change the past. However, we can prevent its repeat, as we saw with Twining Village, Westminster Village, Charles Morris Nursing and Rehabilitation Center, Mercy Center Nursing Unit and Shook Home.

Let's work together to do the right thing.

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