Pa. ‘ill-prepared’ to care for older residents, faces disaster without fast action: state officials

On July 23, 2019, Pennsylvania Secretary of Health Dr. Rachel Levine and Auditor General Eugene DePasquale warned Pennsylvania must to many things fast to care for the state's surging population of older people.

By David Wenner

Pennsylvania must do a better job of keeping nursing home residents safe, including making sure there are enough aides to care for time and denying or taking the licenses of bad nursing home operators.

On top of that, it must prepare for the surge of Pennsylvania residents who will soon need nursing home care or other help, including addressing a looming, severe shortage of nurses and aids to care for them.

Those are the conclusions of state Auditor General Eugene DePasquale and Secretary of Health Dr. Rachel Levine, who on Tuesday followed up on a 2016 audit of nursing homes which found assorted areas in need of improvement.

Much of the 2016 audit focused on the state health department’s ability to catch and punish nursing homes that don’t provide adequate staffing or otherwise fail to provide good care for residents. The 2016 audit faulted the health department in some areas and made assorted recommendations for improvements.

“I think we’ve made strides but we must do an even better job,” DePasquale said.

Levine, who heads the health department, stood next to him during a briefing at the Capitol and said she largely agrees with his conclusions, which are outlined in a report called “Who Will Care for Mom and Dad?”

Levine said her department has ramped up efforts to inspect nursing homes and crack down on violations. For example, she said the health department in 2018 issued 165 fines totaling $2.3 million, up from 11 fines totaling $62,000 in 2014.

Still, DePasquale said assorted things need further monitoring, including the health department’s use of “provisional licenses” to spur nursing homes to improve. The department applied the measure only three times in 2018, after using it up to 38 times in recent years. Levine said the department has become more aggressive with provisional licenses, using the tactic 24 times so far this year.

DePasquale further said the department must provide better data to shed light on which homes are truly improving.

Levine said her department is in the process of coming up with a new state regulation for minimum hours of daily care received by nursing home residents. Pennsylvania’s present regulation, last updated about 20 years ago, requires at least 2.7 hours per day. But many experts and unions representing nursing home workers have long said at least four hours is needed, especially given the increased level of sickness and frailty of the typical nursing home resident.

Levine said her department is working with experts to come up with the appropriate amount, and hopes to release the figure for public comment by the end of the year. Levine said the state had gone too long without revising the regulation.

Much of the focus of DePasquale and Levine on Tuesday was on warning about a twin crisis of more Pennsylvanians needing some form of help or care, and a shortage of workers to care for them.

According to DePasquale, about 3 million Pennsylvania residents — nearly a quarter of the population — will be 65 or older by 2040. By 2030, there will be 38 older and potentially dependent state residents for every 100 working-age residents, he said.

At the same time, a high proportion of older people in need of care will lack the means to pay for it, making them dependent on government programs.

Levine and DePasquale said there must be a wide-ranging effort including state agencies, the senior care industry, colleges and others to create and provide services and the needed workforce.

That includes addressing the low pay that is making it hard to adequately staff nursing homes and retain competent workers. DePasquale stressed that caring for the old and frail requires highly skilled and caring people, and Pennsylvania must find a way to provide adequate wages and benefits while also making it a meaningful, satisfying career.

DePasquale said older Pennsylvanians will go without sufficient care and suffer greatly if the state fails to begin preparing quickly. Younger people will also suffer under the burden of caring for dependent loved ones who lack other means of obtaining help, he said.

LeadingAge PA, a trade group representing non-profit nursing homes, said in a news release it largely agrees with DePasqaule’s follow-up findings. The organization attributed much of the staffing and workforce shortages to what it says is insufficient funding from the state’s Medicaid program, which covers the costs of the majority of the 90,000 residents of Pennsylvania nursing homes.

LeadingAge said the homes lost $630 million caring for those residents, and was denied a request for a 2.8-percent funding increase in the 2019-20 budget.

“The problem is becoming more than a staffing issue. Some of the best facilities in Pennsylvania are struggling to remain open, while others are forced to sell to out of state, low quality operators. It is our hope that state lawmakers will begin addressing this funding crisis in next year’s state budget. We’re running out of time,” the statement from LeadingAge CEO Adam Marles said.

Levine stressed on Tuesday her department investigates all complaints involving nursing homes, including those made anonymously. She said anyone with a complaint should call 1-800-254-5164. Levine said the her department has provided extensive training to staff to increase their ability to spot and verify problems at nursing homes and also to enforce federal standards.  (Click to Continue)

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Pa. ‘ill-prepared’ to care for older residents, faces disaster without fast action: state officials