State’s home care program has big problems, advocates say

HARRISBURG, PA. » Advocates for people with disabilities gathered at the state Capitol on Tuesday to protest what they say is the eroding quality of home care services under Pennsylvania’s new managed care system, problems being accelerated by the pandemic.

Part of the problem, they say, is the increased difficulty in getting direct care workers and the need to pay them more through the state’s Medicaid reimbursement system.

Gov. Tom Wolf’s administration and lawmakers, they say, should use federal dollars approved by Congress, as well as higher federal reimbursement rates, to boost wages for direct care workers.

“They have new possibilities for using this money in ways that are effective,” said Shona Eakin, CEO of Voices for Independence, an Eriebased home care services provider.

Wolf’s administration is awaiting approval from the federal government on its plan to use a higher Medicaid reimbursement rate for home-based care under the American Rescue Plan signed by President Joe Biden in March.

The plan for the money includes increasing reimbursement rates and direct care worker wages while the money lasts, Wolf’s administration said.

While the administration was unable to give details about the boost in the pay, the administration wants to use state dollars to make the increases permanent, said Jamie Buchenauer, a deputy secretary for long-term living in Wolf’s Department of Human Services.

Buchenauer could not immediately say how much money that might require, although it would require approval by lawmakers.

Low pay and high turnover have long been the reality for the ranks of direct care workers in home care settings and nursing homes.

But finding direct care workers is harder now because of the pandemic, they say. The average home care worker makes $12 an hour, and many direct care workers took a break during the pandemic and never returned, Eakin said.

Eakin’s workforce went from 1,069 before the pandemic to 763 now, while her overtime costs shot up from $227,000 in 2019 to $573,000 this year to care for about 800 people, she said.

Overtime costs aren’t reimbursed by Medicaid, and neither is personal protective equipment, paid days off or double-time pay on holidays, Eakin said. Meanwhile, direct care workers are so hard to find that Eakin has had to turn away 40% of the people who contact her agency seeking home care services, she said.

Wolf’s administration, over the past few years, put home care services for tens of thousands of elderly and disabled under managed care contractors in an effort to save money.

The plan involved moving thousands of people back into their homes and out of the more expensive settings of nursing homes.