PA Homecare Assn: State budget must include a 10% increase for direct care workers, raise for pediatric & adult shift nurses, to stem PA’s worsening home care crisis

FOR IMMEDIATE RELEASE 

PA Homecare Assn CEO: “We understand that this is a challenging budget year, but Pennsylvania simply cannot afford to ignore our state’s devastating home care crisis any longer”

Lemoyne, Pa. (April 8, 2025) – As more than 360 in-home caregivers, patients, and advocates head to Harrisburg tomorrow to directly lobby lawmakers, the Pennsylvania Homecare Association (PHA) announced that it will request a 10% increase in reimbursement rates for personal assistance services, requiring a $370 million investment in this year’s state budget to support direct care workers. In recognition of budget constraints, this request is far below what the Shapiro Administration’s recent study on the home care crisis recommended: a 23% increase in reimbursement rates, requiring a $800+ million investment.  PHA is also requesting an increase in reimbursement rates for pediatric and adult shift nurses from $50/hour to $59/hour. 

Despite his own study’s recommendations, Governor Shapiro’s budget proposal largely ignored Pennsylvania’s home care crisis, proposing a mere $21 million investment to provide a 10% rate increase for a small fraction of the direct care workforce under the participant-directed services model. The Governor’s budget proposal offered no increase in reimbursement rates for pediatric and adult shift nurses or for agency employed direct care workers, which make up 96% of Pennsylvania’s direct care workforce.

PHA’s $370 million request would provide a 10% increase to all of Pennsylvania’s 150,000+ direct care workers in the Office of Long-Term Living Home and Community Based Services programs, regardless of whether they are employed through participant-directed or agency-based models of care.  

“We understand that this is a challenging budget year, but Pennsylvania simply cannot afford to ignore this home care crisis any longer.  The heartbreaking reality is that more than 112,500 caregiver shifts and 27% of allocated nursing hours in Pennsylvania are already missed every single month, and that number is only going to increase,” said PHA CEO Mia Haney. “Every state bordering Pennsylvania has invested in their direct care workforce while we’ve failed to meaningfully address our workforce needs. Inaction is no longer an option – the health and safety of our communities is hanging in the crosshairs of these budget decisions.  If our legislators don’t act, the results will be devastating – medically complex children sent back to hospitals, families torn apart, wheelchair-bound adults left in bed all day, seniors laying alone on the floor after a fall, or worse…”  

“While this is first and foremost a health and workforce issue, it’s also important to recognize that in-home care is also cost-effective. It costs 127% more to care for an adult in a nursing home. For children, the cost of facility care is staggering – a recent study showed that moving just 70 children from hospital to home offsets the cost of a $9/hour increase in reimbursement across the entire system.” Haney added. “Pennsylvania has to invest now in our health care workforce to prevent an even larger, more expensive crisis in the years to come.”  

More information on Pennsylvania’s home care crisis:  

More than 400,000 seniors and medically fragile Pennsylvanians rely on in-home care, but caregivers and nurses are rapidly departing the industry to work in surrounding states or alternate settings that pay more competitive wages. As a result, more than 112,500 home care shifts go unfilled every month in Pennsylvania. For children, 27% of total authorized hours are missed, largely due to the lack of staff.  

The reason for this crisis is simple: Pennsylvania’s Medicaid reimbursement rates have failed to keep pace with inflation and the changing competitive landscape.  In the last decade, rates for Personal Assistance Services have changed only $1.91/hour, bringing the total reimbursement to only $20.63 per hour.  All neighboring states have rates 25 – 75% higher, including West Virginia which is at $25.44 per hour. Nursing rates tell a similar story – the ability to compete for workers has been stymied by government set rates. That is why PHA is urging Governor Shapiro and legislators in Harrisburg to make desperately needed investments in our home care workforce in this year’s budget.  

Earlier this year, the Shapiro Administration released its own study of reimbursement rates for home- and community-based service (HCBS), including Personal Assistance Services (PAS). The study overwhelmingly validates what advocates have been cautioning for years: Stagnant rates over more than a decade have resulted in a need for significant investment in programs to protect the health and safety of 400,000+ Pennsylvanians.  The study specifically calls for a 23% increase for Personal Assistance Services within the Office of Long-Term Living to support direct care worker wages and cost of care oversight and delivery.   

Similarly, an independent 2024 study conducted by the Menges Group shows that an investment of $9/hour in nursing rates for home-based care can be almost entirely offset by decreased use of hospitals and facility-based care for children.  An investment in pediatric and adult shift nursing, is an investment in keeping Pennsylvania families together and at home.   

About the Pennsylvania Homecare Association 

The Pennsylvania Homecare Association is a statewide membership organization of more than 700 homecare, home health, and hospice providers. PHA members provide quality care and serve as advocates for their patients and clients on a variety of healthcare-related issues. PHA and its members work to improve professional standards and ensure access to quality home care throughout the Commonwealth. For more information about PHA and its initiatives, visit http://www.pahomecare.org. For media inquiries, please contact [email protected].      

  

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