SWPPA’s Policy Committee and the Western PA LGBTQ+ Older Adult Advocacy Team identified four (4) areas of importance in relation to issues, policy, service and supports for those who are aging or disabled in Pennsylvania. To assure our members are making informed voting decisions this year, we asked the candidates to review each area below and respond to the questions presented.
The candidates’ responses are linked to their names. The Forum questions are below.
Candidate Forum Questions:
In 1972 the Legislature established the Pennsylvania Lottery to provide a restricted fund outside of the General Fund to assist low-income elderly residents to be able to remain in their own homes and to avoid institutionalization. The first program was property tax and rent assistance. As the Lottery grew the Legislature authorized additional programs to include off-peak transportation, pharmaceuticals, and other services through an Options program, administered by Area Agencies on Aging. These services are part of the general term Home and Community Based Services (HCBS) and include such things as home care and adult day services, all of which are designed to assist low-income elderly who do not qualify for similar Medicaid services. Adult protective services, senior community centers and the operation of the Department of Aging also are funded through the Lottery.
Several years ago the Legislature began transferring Lottery funds to the General Fund to support Medicaid programs and institutionalization, creating an ongoing waiting list for Options services described above.
Please explain your position on the preservation and use of Lottery revenues to fund services for older Pennsylvanians.
What are your thoughts about the practice of shifting lottery funds from HCBS to support institutionalization and what position would you take in that regard?
2. OLDER ADULT PROTECTIVE SERVICES ACT/ADULT PROTECTIVE SERVICES
Older Adult Protective Services (OAPS) have been the long-standing responsibility of several areas of government. This law provides a means to protect vulnerable older adults. The Area Agencies on Aging (AAAs) are responsible for assuring their areas have trained, functioning workers and processes who investigate suspected abuse, neglect, and exploitation. Their first goal is always to help the older adult and family to assure safety and meet needs. Police` departments and attorney generals/prosecutors may also become involved if the circumstances meet the threshold for being a crime and to protect citizens. Pennsylvania’s law outlines who must report suspected abuse, neglect and exploitation (mandatory reporting). It also limited who is eligible to work with vulnerable older adults in certain care facilities and for certain care providers, such as nursing homes and home health care, based upon criminal history. People with many types of conviction had lifetime bans on employment in the field. This aspect of the law was challenged in Commonwealth Court and a December 2015 decision struck down the ban necessitating reconsideration of this law to balance the safety needs of older adults and the rights of citizens to work in aging services. The law created barriers to finding workers in a field that needs to increase its workforce. Additionally, many advocates in the field recognize that the law could better address financial exploitation. Legislation has been introduced by Rep. Tim Hennessy and Sen. Bob Mensch to amend this act. It is not clear that it will pass this legislative cycle and may come up in the next general assembly.
What are your thoughts about balancing the need to protect vulnerable older adults and to assure the rights of Pennsylvania workers?
Do you have a position on expanding efforts to recognize and address financial exploitation, which will mean including the banking and financial services industries in ways they have not been involved up to this point, including allowing them to freeze assets prior to an investigation by state and AAA authorities?
3. DIRECT CARE WORKFORCE ISSUES
Nationally, we are in the midst of a direct care workforce crisis: As demand for direct care workers in a variety of long-term care settings continues to rise rapidly, the ability for Agencies to attract and hire at an equal pace is decreasing.
The U.S. Bureau of Labor Statistics estimates an additional 1.1 million direct care workers will be needed by 2024 — a 26 percent increase over 2014. Yet, the population of potential workers who tend to fill these jobs, overwhelmingly women ages 25 to 64, will increase at a much slower rate. Other factors also impact this potential workforce – a robust economy offers workers more options with greater pay in less physically demanding settings; low Medicaid reimbursement rates (Medicaid funds a large portion of long-term services) make it impossible for direct care employers to adequately compete for these workers.
In Pennsylvania, the reality is just as startling. Our senior population is growing 20 times faster than Pennsylvania’s overall population. By 2025, 1 in 5 Pennsylvanians will be older than age 65, with those younger than 65 steadily decreasing (based on US Census and PA State Data Center statistics). And so the challenge is, who is going to care for our aging seniors?
The most cost-effective type of care is care provided in settings of least restriction – most commonly home. Medicaid dollars can provide more care to more consumers over a longer period of time in less expensive settings. Unfortunately, without an adequate workforce to support care in this setting, we will never fully realize the impact of this cost saving approach. The primary obstacle in building a strong direct care workforce is low wages and unstable work conditions, driven largely by low Medicaid reimbursement rates.
In Southwestern PA, Medicaid funded personal assistance services reimburses at a rate of $19.32/hour. The average hourly wage of a personal care aide is just over $10/hour. The additional costs for benefits, insurance, training and supervision can easily add another $5 to $7/hour to the hourly cost to provide care. To remain operational, agencies who provide Medicaid funded services must struggle to keep costs under $19.32/hour, which means keeping wages low, reducing the benefits offered and limiting quality and oversight activities, which are costly. The daily reimbursement rate for adult day services has not been increased in twelve years. This reality further challenges providers in their effort to attract and retain a viable workforce.
Given Pennsylvania’s aging demographics, the increasing demand for Medicaid waiver funded services and the current direct care workforce crisis, what recommendations might you make to assure Pennsylvania can create a robust and ready workforce, supported by living wages, able to meet the demand for care?
What measures would you advocate for in changing this and improving our reimbursement rates in Southwest PA?
4. LGBTQ+ EQUALITY FOR OLDER PENNSYLVANIANS
Pennsylvania’s lack of a comprehensive anti-discrimination law allows a Pennsylvanian identified as LGBTQ+ to be denied housing, employment, and access to public accommodations simply because of their sexuality. PA HB 300, commonly called the Fairness Act, seeks to amend the Pennsylvania Human Relations Act, the state’s non-discrimination law, to include “sexual orientation” and “gender identity or expression” as protected classes. Also, PA SB 437 is titled “LGBTQ Senior Community Grant Program Act” was introduced to award grants to non-profit organizations and local governments for health care, cultural competency, computer training, job placement, social activities, and other programs that specifically help the LGBTQ+ senior community.
Please state your position about legislation that ensures justice and equality for LGBTQ+ older Pennsylvanians.