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Investing in Senior Care Shouldn’t be an Age-Old Problem
Pennsylvania’s Medicaid reimbursement program falls short of repaying providers on average more than $60 a day per resident. More than 70% of all care provided at a nursing home is for low income residents reliant on Medicaid to pay for their care costs. PHCA
It’s no secret that Pennsylvania is an aging state.
Our fastest-growing demographic is adults aged 80 and older. By 2023, there will be the same number of adults aged 65 and older as young adults and children aged 19 and younger.
But what isn’t widely discussed is how, as a state, we can guarantee high-quality care for this vulnerable, venerable, and rapidly growing group within our communities –– particularly if we don’t invest in that care or have enough workers to provide that care.
The baby boomer generation – a generation that is still not far from having the largest population cohort – has aged into the demographic most in need of long-term care. At the same time, we’re sounding the alarm on a statewide access-to-care crisis. If we can’t ensure care options for our seniors now, what will tomorrow look like as that segment of the population continues to demand more?
Age is a commonality we all share. Each day, we grow older. We live in the moment and we may dream about retirement, but we often refuse to consider our later years in life – the years when we will inevitably need more support and more health care services. And more immediately, those services may be needed by our parents or grandparents.
As we get older, our income also becomes fixed. This has left tens of thousands of seniors across Pennsylvania to rely on government services to pay for their care. This, too, is a growing trend.
Medicaid – a state government service funded by taxpayers – is the primary payor source for low-income seniors who need care either at a nursing facility or at home. Unfortunately, here in Pennsylvania, Medicaid isn’t allowed to be used in an assisted living community, further limiting care options.
That same payor source has historically failed to keep pace with rising health care costs. Today, the Medicaid shortfall – or the cost of care vs. what the state actually re-pays providers for that care – has reached upwards of $65 per resident per day.
With nearly 45,000 residents reliant on Medicaid to re-pay their providers – more than 70 percent of all nursing home care – you can quickly see the lack of sustainability with a more than $1 billion shortfall.
Pennsylvania has now reached a critical point where care options need to be expanded to meet the demand. We need to make appropriate investments in the care we will likely all need one day – the same level of care our fastest-growing demographic needs right now.
With limited care options, seniors often find themselves admitted to a hospital because there aren’t enough beds available in a long-term care community or enough workers to provide care at home. To be cared for in a hospital – room, meals, and basic care without the need for surgery, lab fees or doctor fees – costs, on average, $2,838 a day for a semi-private room, according to a recent state hospital report.
At a nursing facility, the average reimbursement from the state to a provider for a resident on Medicaid for a room, meals, therapy, clinical care, activities, transportation, medical equipment and other needs is only $240 a day. That’s just $10 per hour.
This disparity suggests that we don’t value care the same way. It suggests that caring for seniors is less important than caring for others. Funding senior care should not be an age-old problem – it needs to be a priority today.
We may not want to think about getting old, but we certainly need to think about investing in the services that will support us when we do. If we can’t support and sustain care today for our older loved ones and neighbors, it won’t be available for any of us tomorrow.
Zach Shamberg is the president and CEO of the Pennsylvania Health Care Association