OPED: Wolf budget plan ignores needs of aging citizens

People today need help with clinically complex medical conditions that make even basic care challenging.

W. Russell McDaid
Pennsylvania Health Care Association

There’s no denying that as a state, Pennsylvania is getting older. Our commonwealth currently ranks fourth nationally in the percentage of people 65 and older, with individuals living longer than ever before. By 2030, the number of Pennsylvanians age 85 and older will exceed 400,000.

These demographics pose enormous challenges, especially for the state’s skilled nursing facilities. An estimated 70 percent of people turning 65 this year will require long-term care in their lifetime, with the need most intense among those 85 and older.

Increasingly, when aging Pennsylvanians seek long-term care, the level of care they require is much more advanced. People today need help with clinically complex medical conditions and debilitating afflictions such as dementia or Alzheimer’s disease. Many are near the end of life with serious health complications that make even basic care challenging.

With patient acuity (sickness) on the rise, there is greater dependency on caregivers to provide the intensive, around-the-clock, restorative care that people need.

Despite long hours and pay that lags behind hospitals and other health-care settings, caregivers in skilled nursing facilities are the lifelines for families who can no longer care for their loved ones. These men and women care deeply about the individuals and families they support and look after, and often are the strongest advocates for those under their care.

Unfortunately, even though skilled nursing facilities employ more than 120,000 caregivers statewide, the availability of trained, qualified workers remains a challenge. The Pennsylvania Health Care Association (PHCA) is working with the Department of Labor and Industry and local work force investment boards to improve recruitment, training, retention and career advancement.

We recognize that having the right personnel is critical in meeting these growing demographic challenges and delivering quality care. But so is adequate funding.

For more than a decade, PHCA has warned that skilled nursing facilities face a crisis as a result of chronic under-funding. Roughly two-thirds of all people living in skilled nursing facilities rely on Medicaid to pay for their care. Based on current Medicaid reimbursement levels, skilled nursing facilities are paid $25.43 per day less than their actual costs of providing care. That is a gap of $9,300 annually, on average, for every Medicaid resident in their care. It’s simply unsustainable.

Neither the governor’s proposed budget, nor the version recently passed by the House, does anything to close that gap, keeping funding flat. In fact, state funding for our “greatest generation” with the greatest needs has been flat in four of the last six years. That’s simply unacceptable, especially as costs continue to rise as care becomes more complex.

Pennsylvanians agree. Polling by Opinion Access Corp. shows that nine in 10 commonwealth voters believes that cutting state Medicaid funds for skilled nursing facilities is unacceptable. Eight in 10 said they believe cuts could have a negative effect on the quality of care.

The concern voters expressed in that poll is already a reality for many skilled nursing facilities with high Medicaid populations. These centers cannot upgrade buildings, make capital improvements or invest in technology. And, they have a harder time paying competitive wages that would increase staff retention and drive quality.

Despite all these challenges, many people are surprised to learn that skilled nursing facilities remain the most cost-effective place to care for a Medicaid-eligible Pennsylvanians who require around-the-clock care. It would cost Medicaid almost double to care for someone at home for 24 hours a day, seven days a week.

No one should be in a skilled nursing facility if they don’t need the type of intensive care that these centers provide. But if state funding keeps lagging behind the true cost of providing care, then there may be nowhere for seniors to go when they need care the most.

— W. Russell McDaid is president and CEO of the Pennsylvania Health Care Association.