Modernize senior care in Pennsylvania

Those with too little money have too few choices

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The debate continues on how or if the Affordable Care Act will actually help Americans who need health care. The uncertainty for seniors becomes even more problematic with federal cutbacks under budget sequestration. What we can be certain about is the negative effect these changes are having on many of Pennsylvania's older and vulnerable citizens.

While it was designed to provide funding for all, the Affordable Care Act does not address severely underfunded senior care services needed by millions here in the commonwealth. In fact, it cuts Medicare funding for providers, which is a major source of support for senior programs and care settings.

Sequestration adds to the anxiety, as it will reduce federal funding for Pennsylvania's Medicare-supported nursing facilities by another $37 million or so.

Further compounding the problem is that finding Medicaid money -- the other major funding source for nursing facilities -- have never been more difficult. The strain is so bad that Pennsylvania's Medicaid-participating nursing facilities have received at least $1.5 billion less than state regulations have required since 2005.

The state Department of Public Welfare has complex and conservative formulas designed to determine the cost of the nursing facility services it covers. If a person is on Medicaid, the facility must accept the Medicaid reimbursement as payment in full. Yet Medicaid, which pays for 65 percent of nursing facility residents, covers only 85 percent of the cost as determined by DPW. This built-in loss on every Medicaid resident must be made up by either Medicare (which the Affordable Care Act has cut) or by charging a higher-than-equitable rate for privately paying residents. In other words, the government has indirectly taxed the elderly who pay for their own services.

Pennsylvania has to address these inequities now. The commonwealth's over-85 population has grown 10 times faster than its overall population, making it one of the grayest states in the nation. Yet Pennsylvania continues to operate under and devote billions of dollars to an outdated funding and regulatory model with little consideration for modern programs, such as assisted living, personal care and home- and community-based services.

Pennsylvania seniors and their families prefer these cost-effective, modern programs when they fit their needs. But when seniors have limited financial means, they must rely on state funding that does not support modern services. We're trying to meet 21st-century care and service needs with a 20th-century funding model.

Pennsylvania's seniors need their leaders to take on the challenge of creating a modern, centralized system in which need drives care and services, with the necessary funding to follow. Our current system prevents those with limited means from getting the choice of services that best meet their needs.

Ironically, if seniors had a choice, many times they would choose less-costly options. Band-aids no longer work. We need a systemic change in the way we provide and fund senior services, and the time to act is now. State lawmakers and the Corbett administration should build a truly integrated system of senior services that is open to all, not just a few with the ability to pay.


Ron Barth is president and CEO of LeadingAge PA, an association of not-for-profit senior service providers (


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