It is the dream of most seniors in the Commonwealth to live out their ‘golden years’ in their own home. And more than 400,000 residents rely on in-home care to do so.

But the Pennsylvania Home Care Association (PHA) is sounding the alarm that the help needed for seniors to remain in their homes is running dry. And it plans to use its Advocacy Day on Wednesday to make sure that legislators in Harrisburg hear their concerns.

Mia Haney, executive director of the PHA, specifically wants the governor and the General Assembly to address the crisis before it worsens.

“We have over 112,000 missed shifts for direct care workers every single month,” she said. “And for nurses, we have 27 percent of authorized hours not being filled because there’s simply not enough nurses. The direct care worker crisis, the nursing shortages, they are all well known.

“These are national issues. They’re not exclusive to Pennsylvania, but (we are) in a predicament, because we have had over a decade of policy decisions where we’ve just decided that it is not the year to address rates. Or it’s not the year to take a look at this population and prioritize them.”

The PHA is a statewide organization of nearly 700 home health, home care and hospice providers dedicated to bringing care home. According to its website, PHA members provide quality home and community-based care for people of all ages across the Commonwealth. PHA and its members advocate and collaborate to improve professional standards in the industry and ensure access to quality home health care throughout the Commonwealth.

Haney said the PHA supports direct care workers, nurses and therapists that support the activities of daily living, such as grooming, housekeeping and preparing meals, if necessary. “This is really enabling and empowering those individuals to be independent, to stay where they want to stay, and to promote their ability to stay at home as long as possible.”

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. By 2030, more than a third of Pennsylvanians will be at retirement age, meaning hundreds of thousands more Pennsylvanians are likely to require in-home care in the coming years.

But years of placing the issues on a back burner have caught up with the Commonwealth.

“We’ve kicked the can down the road one too many years,” said Haney, “or maybe five too many years. What we’re left with is that we have the lowest reimbursement rate in the region.”

Gov. Josh Shapiro often likes to use rates of neighboring states to support his policies, including his proposal to raise Pennsylvania’s minimum wage from $7.25 per hour.

In Pennsylvania, the average hourly wage for home care workers, including home health aides and personal care assistants, typically ranges from $14 to $18. Neighboring states Delaware, Maryland and New Jersey pay 25% to 75% more.

Starting wages for a team member at the Sheetz convenience store chain are between $14.50 and $16 per hour. Home care workers are well aware that more money can be made elsewhere.

Haney said the Commonwealth’s reimbursement rate is similarly low.

“Our neighboring states are reimbursing the same services, sometimes 25-75% higher than Pennsylvania,” she said. “What that leaves us with is uncompetitive wages for workers, and if we can’t compete on wages, those workers go elsewhere. They’ll go to those neighboring states, or they’ll go to other industries. We need to be adding workers to our industry, because we’ve got such a growing demand and aging population. What’s happening is the opposite. We’ve got a stagnant workforce that’s not growing and the demand is growing exponentially.”

As one example, West Virginia raised its rate for personal assistance services to $25.44 per hour, while Pennsylvania continues to languish at $20.63 on average.

“And that’s an average actually,” Haney pointed out. “In Pittsburgh, which is closest to West Virginia, their rate is under $20 per hour.

In February, PHA expressed disappointment that the governor’s proposed budget included a funding increase for only 6% of home care workers in the participant-directed service model, in which recipients self-manage their caregivers.

Specifically, the budget allocates $21 million to increase direct care worker wages for “those who provide services to adults with physical disabilities and seniors in the participant-directed model through Community HealthChoices.”

What would she say to Shapiro?

“Why are other states that don’t have as large aging populations … why are they doing more for their populations than we are here in Pennsylvania. We’re the seventh oldest state in the nation. We need to be supporting our aging population, and instead, we’re ignoring the issue and kicking the issue to the next year.”

Haney said her organization has exhausted its patience, as Brooklyn Dodgers’ fans used to say, “waiting for next year.”

“Frankly, every year is a tough budget year. This year is exceptional. We’ll give you that every year is a tough budget year. We hear that all of the time. We need to make a decision that our aging population, our physically disabled population, our children with complex medical needs, we need to decide that they are a priority for us here in Pennsylvania, and that keeping people home is a priority.”

There is also the concern that a shrinking workforce will hurt rural Pennsylvanians the most, where access to staff and to workers will be limited.

“It makes it harder for those workers to pick up a shift for a low wage when it’s going to take them 30 minutes to get there, and that 30 minutes might be unpaid time.”

Since 2014, in a period where inflation has risen 36%, rates for personal assistance services have risen just $1.91, according to Haney.

“It leaves us in a situation where really quality becomes an issue. If you can’t get staff to get to a case, and you’ve got somebody who’s immobile waiting for a caregiver to come to get them out of bed, and that caregiver is not coming, we’ve got a major issue.

“What they do is so important, it really requires empathy and compassion, but also a skill set,” she continued. “I’ve been in this industry for almost 20 years, and I tell caregivers and nurses every day there are things that they do that I just wouldn’t be as good at. It’s not something everyone can do. Taking care of a child and taking care of a sick adult or an aging adult are two very different circumstances, and we need to recognize and appreciate and acknowledge the great work that they do and how important they are.

“You know, during COVID, they were the heroes, right? ‘Oh, the home care workers are keeping people out of the hospitals. They’re keeping people home.’ We need to support them, and we were singing their praises. And then as COVID unwound, it was like, ‘Oh, back to normal.’ Sorry, have any money for you? So it’s really it’s just important to continually tell them how important they are, so that we can develop their careers, so that we can make this a profession that people want to go to.”