Senior living industry advocates in Pennsylvania say they are encouraged by steps to support older adults evident in the recently passed state budget, but they say much more needs to be done to support providers and those they serve.

Gov. Josh Shapiro (D) on Saturday posted on X, the social media platform formerly known as Twitter, that the $47.6 billion bipartisan budget, passed July 11, includes $80 million “to better support our seniors by securing additional funding for caregivers, investing in our Commonwealth’s first 10-year plan to care for our seniors, and establishing the Alzheimer’s Disease Division in the Department of Aging.”

Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, told McKnight’s Senior Living Friday that the “[g]iven Pennsylvania’s aging demographic –– and the growing need to care for those living with Alzheimer’s disease and related disorders (ADRD) –– the establishment of a permanent ADRD division within the Department of Aging and an ADRD legislative advisory committee are positive steps to ensuring our commonwealth can meet the needs of our vulnerable family members and neighbors.”

PHCA, he added, “strongly” encourages lawmakers and the governor’s administration “to ensure participation and representation from the broader long-term care continuum, including providers from nursing homes, assisted living communities and personal care homes.” Such providers, Shamberg said, “serve our most vulnerable every day and can therefore help create and execute strategies, such as specialized training for caregivers, aimed at responding to these terrible diseases.”

Pennsylvania Assisted Living Association Executive Director Susan Saxinger told McKnight’s Senior Living on Friday that “the establishment of an Alzheimer’s Dementia and Related Disorders (ADRD) office is a pivotal step in advancing services and supports for those living with ADRD or caring for individuals with ADRD.”

But Saxinger also registered the association’s disappointment that the Keystone State budget did not contain even a modest increase in the Supplemental Security Income rate to help low-income older adults pay for their residences in personal care homes. An increase in the daily rate, which currently is “woefully inadequate” at $49, is “desperately needed” by operators, she said.

“The hard truth is that personal care homes are closing in Pennsylvania …These homes could not continue to operate because of the increased costs for operation and workforce shortages,” Saxinger said. “Several closed because they were unable to employ staff to provide the care or the owners were exhausted from working 24/7.”

When a personal care home closes, she said, older adults must move in with their families or move to a nursing home “at a dramatically increased cost to the state’s Medicaid funds,” or they become homeless.

As for the state’s 10-year master plan on aging, called Aging Our Way, PA, Saxinger said that to meet the plan’s goals, the state must apply to the Centers for Medicare & Medicaid Services for a Section 1915(c) home and community-based services waiver, a 1915(b) managed care waiver or Section 1115 waiver “to permit seniors residing in assisted living to utilize their Medicaid benefits.”

Currently, she noted, Pennsylvania is one of only three states that does not allow some form of Medicaid for assisted living services. “As a result, seniors are being forced to leave their homes and communities where they are aging comfortably with dignity, to avail themselves of their Medicaid benefits in a skilled nursing facility,” Saxinger said. “The result is less choice for our seniors, a negative impact on senior health, and tremendous savings to our state’s Medicaid budget that are not being realized by empowering our seniors to reside in less costly assisted living communities.”

PHCA’s Shamberg previously had said that the master plan’s omission of an initiative to allow assisted living communities to be Medicaid-eligible was one of several “missed opportunities.”

LeadingAge PA President and CEO Garry Pezzano said Friday that his group appreciates the state’s “efforts to support those living with Alzheimer’s and their caregivers, and we encourage the administration to involve all care settings, including assisted living and personal care, in these strategies.”

The association, he added, also was “encouraged that Gov. Shapiro prioritized seniors in the recent state budget through both Aging our Way, PA, and through Medicaid rate increases for both nursing homes and the LIFE/PACE program.” 

But LeadingAge PA, Pezzano said, was “disappointed to learn that the Long-Term Care Transformation Office did not receive funding as originally proposed, which means that personal care and skilled nursing communities will no longer have the opportunity to apply for Quality Improvement Grants this year.”

The association, he said, will “look forward to continuing to be a part of the conversation as various pieces of the master plan and other approaches are prioritized, adjusted, and implemented over the coming years.”