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PHCA survey reveals Pennsylvania seniors struggle to age in place

The Pennsylvania Health Care Association (PHCA) released Part 2 of a member survey focused on the challenges facing providers and residents in assisted living residences (ALRs) and personal care homes (PCHs). The results highlight consistent challenges throughout the long-term care continuum, in which Pennsylvanians await care while remaining on admission waitlists and positions remain open in communities. However, survey results revealed another standout challenge: ALR/PCH resident discharges, rendering them unable to age in place.

Thirty-one executive directors responded to PHCA’s survey revealing, on average, eight residents were discharged from ALRs and PCHs in 2022 because they no longer had enough funds to pay for services. Pennsylvania has 1,138 ALRs and PCHs.

In Pennsylvania, senior living services in ALRs and PCHs are not eligible for Medicaid payments to cover resident costs. When an ALR or PCH resident can no longer afford to privately pay for their care the resident is discharged to another setting, commonly a nursing facility, where they are eligible for Medicaid to cover costs — even if their care needs are met at the ALR or PCH. Individuals residing in ALRs and PCHs require some level of care because they can no longer live independently. Examples of reasons why supervised care is needed in senior living include, memory care, physical inabilities and vision impairments, among other conditions.

“This is less about access to care and more about maintaining the right level of care in an environment that our residents call home,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association. “With thousands of residents already waiting to be admitted into nursing homes, we are only further exacerbating the issue and overwhelming the system. Allowing Medicaid to cover the cost of care in assisted living would not only allow a resident to age in place, but it would also benefit Pennsylvania financially at a time when we are preparing to face an eventual fiscal cliff.”

This week, Pennsylvania State Senator Michele Brooks introduced legislation that would create more options for long-term care residents to age in place. Senate Bill 520 would allow ALRs to become Medicaid-eligible providers, while also including licensure waivers for PCHs to convert to an ALR in order to care for Medicaid-eligible residents.

Nearly 100 percent of PHCA’s survey respondents shared they have residents who would benefit from Medicaid to cover the cost of services, with more than one-third of respondents revealing they have 21 or more residents in their building who would benefit. With a rapidly increasing older population, there is anticipation of a growing reliance on Medicaid to cover senior care costs, especially with reports of Americans struggling to save for retirement. A white paper released this week by the National Center for Assisted Living states that roughly one in three older adults aged 65 and older are economically insecure, with incomes below 200 percent of the Federal Poverty Level.

Other takeaways from the survey include an average ALR/PCH waitlist of nearly four people per community, more than a quarter of respondents revealing they have between six and 10 open positions, and that only 25 percent of respondents said they are using contracted agency staff to fill open positions.


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