Pennsylvania Gov. Josh Shapiro
Pennsylvania Gov. Josh Shapiro (Credit: Tom Williams / CQ-Roll Call, Inc via Getty Images)

A proposed $11.7 million investment in Pennsylvania’s master plan on aging is being celebrated by leaders in the senior living industry for prioritizing the needs of older adults, but experts expressed disappointment that the funding doesn’t directly affect providers or workers.

Last spring, Gov. Josh Shapiro (D) signed an executive order to develop a 10-year Master Plan for Older Adults. His proposed 2024-2025 budget, released Tuesday, backs up that order with almost $12 million in investments geared toward ensuring access to quality care and services for older adults in the Keystone State.

Other proposals that would affect the state’s older adults include an investment of $1.9 million to create the Alzheimer’s Disease and Related Disorders Division at the Department of Aging, $10 million to permanently fund the Department of Health’s Long-Term Care Transformation Office and $765,000 for adequate staffing to respond to complaints and ensure stability within long-term care facilities.

The Long-Term Care Transformation Office provides guidance and assistance to assisted living communities, personal care homes and other long-term care settings across the state. The office is focused on long-term care workforce resiliency, infection prevention and control, emergency preparedness and sustainable outbreak response operations. 

The Pennsylvania Assisted Living Association said that the office has been an “invaluable resource” to many personal care homes and assisted living communities through initiatives, including the Long-Term Care Resiliency, Infrastructure Supports, and Empowerment, or RISE, program and the Quality Investment Pilot. PALA also recently collaborated with the LTC Transformation Office to identify practicable policy solutions to support workforce development in senior living, PALA Executive Director Susan Saxinger told McKnight’s Senior Living.

The budget proposal also includes $1.9 million for the home- and community-based services program, to allow the Department of Human Services to engage in a multi-year growth strategy to expand the number of individuals participating in the HCBS program. In addition, the budget proposes increasing reimbursement rates for the program by 12%. 

Budget shortfalls

Pennsylvania Health Care Association President and CEO Zach Shamberg said that many of the governor’s budget priorities fund government agencies related to long-term care rather than the providers and workers themselves. 

“We must ensure that any new funding dedicated to long-term care is a direct benefit to the constituency of providers, workers and residents,” Shamberg told McKnight’s Senior Living. 

More broadly, he said, PHCA has been advocating for assisted living to become a Medicaid-eligible provider in the state, but the budget proposals provide no allotment for the expansion of government funding for senior care services. 

“Pennsylvania remains only one of three states nationwide that does not make assisted living residences eligible for Medicaid,” Saxinger said. “Forty-seven other states recognized the tremendous health benefits seniors receive in assisted living and the significant savings to the state’s Medicaid budget that can be achieved by allowing Pennsylvania seniors to utilize their Medicaid benefits that they have earned to lower the cost of their living situations.”

Similarly, a requested increase in Social Security income funding to support the care of older adults and those with disabilities in personal care homes also was not included in the budget proposal. Saxinger said that the 2022-2023 state budget increased the state portion of the SSI payment for the first time since 2006, but it was not enough to cover daily expenses.

“The hard truth is that personal care homes are closing in Pennsylvania,” she said. “Many of these personal care homes served the low-income SSI residents. Thes homes could not continue to operate because of the increased cost for operation and workforce shortages.”

PALA is asking for an SSI funding increase that directly supports communities struggling to care for low-income older adults.

PHCA’s proposed Enhancing Care With Incentivized Payments, or ECWIP, program — a new approach to supplement nursing home care funding based on quality outcomes — also was not included in the budget proposal.

“This is important to note for the senior living community, because by not supporting the highest level of care — skilled nursing care — senior living communities will continue to struggle to place residents at nursing homes,” Shamberg said. “This is another reason why Medicaid eligibility is essential for senior living.”

AARP Pennsylvania commended the proposals to support family caregivers and improve the health and financial security of older adults by ensuring access to safe and affordable housing, equitable and reliable transportation, and health, social and support services for the more than 280,000 Pennsylvanians living with Alzheimer’s disease.

“On behalf of our 1.8 million members, we are encouraged that the governor’s proposed budget includes measures that will be elevated through the commitment made to create and implement a Master Plan on Aging, which is focused on restructuring policy, programs and funding to support older Pennsylvanians to live and age well,” AARP Pennsylvania State Director Bill Johnston-Walsh said in a statement

LeadingAge Pennsylvania praised Shapiro for supporting older adults through the proposed investments, adding that it will continue to work alongside aging services providers to “build a strong workforce, improve efficiencies and effect positive change” through its LTSS Evolve initiative. 

The organization launched the initiative last year to identify and change “antiquated, redundant and burdensome” long-term services and supports rules, regulation policies and guidance through collaboration with state policymakers and other stakeholders.

“As the budget process moves forward, we will continue to strongly advocate for long-term care providers who are grappling with rapidly rising costs, a well-documented workforce shortage, and increasing nursing home staffing minimums that can’t be ignored and must be funded,” LeadingAge PA President and CEO Garry Pezzano said in a statement.