PA Legislators Ignore Own Studies on In-Home Care Crisis

Pennsylvania is already confronting an in-home care crisis. Every month, more than 112,500 in-home care shifts go unfilled across the state, meaning that seniors, children with complex medical needs, and adults with disabilities are being left at home without the care they need. This is unacceptable, and it’s a crisis caused by lawmakers on both sides of the aisle who have refused, for years, to pay Pennsylvania in-home caregivers a decent wage.

Here’s the worst part: none of this is a surprise to our elected officials.

Earlier this year, the Shapiro administration released an independent, taxpayer-funded study that laid out exactly how to fix this problem. Then, just last month, the Pennsylvania legislature received a second study, also paid for by taxpayers and conducted by the Legislative Budget and Finance Committee, that reached the same conclusion: Pennsylvania must increase reimbursement rates for caregivers by 23% to stop the workforce from collapsing.

Despite these two studies, each funded by the taxpayers, the governor and legislature have failed to act. They have the data. They have the solution. They just won’t follow it.

As someone who has spent decades working within Pennsylvania’s health-and-human services sector – most recently shaping systems that support older adults and people with disabilities –  I’ve witnessed the inaction that has caused this crisis to grow, year after year, and now, we’re at the boiling point

Make no mistake: in-home caregivers are an essential service that more than 400,000 Pennsylvanians rely on every day to get dressed, prepare meals, bathe, and more.

While this is a policy issue, it isn’t a partisan political issue, and it shouldn’t become one either. I’ve worked for Governors Ridge, Schweiker, Rendell, Corbett, Wolf, and Shapiro, and I can say that Pennsylvania’s home care crisis is the result of both parties ignoring this issue year after year.

Each state sets reimbursement rates for these services, but Pennsylvania has failed to raise those rates for years. Our reimbursement rate for Personal Assistance Services (PAS) is only $20.63 per hour, while every bordering state pays 25–75% more. West Virginia, for example, provides $25.44 per hour.

It’s no wonder, then, that home care workers are leaving the industry when our aging population needs them most. Many home care jobs in Pennsylvania pay less than fast-food restaurants, and those who live near a state line can earn significantly more by crossing it for work.

This represents a growing threat to Pennsylvanians’ ability to age with dignity, remain safely at home, and access consistent care. Home care is highly personalized: it depends on the same caregiver arriving on time, knowing the client, and being physically able to help. With unreliable staffing, providers often can’t reach everyone who needs care.

Gov. Shapiro and leaders in his administration such as Human Services Secretary Val Arkoosh have repeatedly highlighted their commitment to direct care workers and home-based services, and I believe them, but without financial resources to back that commitment, it becomes little more than rhetoric.

This crisis touches nearly everyone in our state. Caregivers are working full-time jobs for wages so low they can’t support their own families. The families of those they care for – seniors, adults with disabilities, and children with complex medical needs – are losing access to compassionate, reliable care as workers leave for better-paying jobs.

Taxpayers aren’t getting a fair deal either. The fewer in-home services available, the more people end up in institutional or emergency care – at far greater cost than home care would require.

This is not a new problem either. The first legislative study into home care reimbursement was commissioned back in 2007.

The Shapiro administration’s latest study provided clear analysis, benchmarks, and a roadmap to fix this: fund in-home caregivers at sustainable rates tied to living wages, with wage pass-through to workers and inflation-indexed adjustments. The legislature’s study reaffirmed that roadmap. Despite overwhelming evidence and cross-party acknowledgment of the crisis, neither branch has followed through. The governor’s proposed budget and the budget just passed by the House both essentially ignore the problem – adding $21 million in funding when more than $800 million is needed. In-home care industry leaders say that at least half of that is necessary to keep the system afloat.

That roadmap must become action. The 2025–26 state budget should include a reimbursement rate increase tied to wage benchmarks, and providers should be required to pass those funds on to caregivers with enforcement to ensure compliance.

Failing to act simply shifts costs, deepens the underlying problems, and breaks promises to our seniors and other vulnerable residents. The time for studies is over. The time for action is now.