Auditor General: Pa. unprepared to care for aging population

Pennsylvania is ill-prepared to serve a fast growing-population of older adults, according to state Auditor General Eugene DePasquale.

DePasquale released a special report on July 23 that followed up on his 2016 audit of oversight of nursing homes by the state Department of Health.

DePasquale’s 2016 audit cited issues with inadequate review of nurse-staffing levels, complaint handling and sanctions imposed against poor-performing facilities.

His new report, “Who will care for Mom and Dad?” was developed to see how the department has implemented the audit’s recommendations.

“My team and I spoke with more than 50 experts for this report, and we heard from more than 20 nursing home residents, families and staff members about their experiences,” DePasquale said. “While much of what we heard was encouraging, we also heard about serious challenges such as staffing, equipment and supply shortages.”

The report suggests the department of must adopt thorough, clearly outlined policies for investigating nursing-home operators.

“We found at least one case where lax vetting processes resulted in granting a license to a financially unstable operator who had a poor quality track record in another jurisdiction,” DePasquale said.

The report also urges the DOH to produce better data to offer a clearer picture of which homes are truly improving.

In addition, the report calls for a stronger collaboration between state agencies to prepare for a large wave of aging baby boomers, some of whom may not have spouses or children to help them as they age.

“By 2040, nearly a quarter of Pennsylvania’s population will be 65 or older,” DePasquale said. “That’s over 3 million Pennsylvanians who will likely need some kind of care, many of whom may lack personal financial resources or family support and end up relying on taxpayer-funded programs like Medicaid.”

The Department of Health responded to the Auditor General’s report with a statement maintaining that the DOH’s objective is improved care for seniors in aging-care services, not increased fines for aging-care institutions.

“We want our civil penalties to be meaningful but not punitive,” said Rachel Levine, secretary of health. “The priority is not the fine, the priority is to make sure the problem is corrected. The department regularly reviews all sanctions and as a team establishes progressive discipline sanctions, as needed if the facilities fail to make improvements to the quality of life and care for residents.”

In addition to a lack of effective disciplinary measures for poor facilities, DePasquale said shortages of registered nurses and direct-care workers will worsen the aging care crisis.

“By 2030, there will be 38 older adult dependents for every working-age resident,” DePasquale said. “At about the same time, Pennsylvania is projected to be short by thousands of registered nurses and tens of thousands of direct-care workers, creating a looming workforce crisis that must be addressed.”

He called on colleges and universities to help develop solutions.

“Pennsylvania’s State System of Higher Education and community colleges across the state should view this healthcare workforce crisis as an opportunity to grow,” he added. “The public and private sectors, along with labor organizations and educators, must work together to recruit and prepare more professionals to enter the field and nurture the next generation of healthcare workers.”

However, some organizations are placing part of the blame for the aging care crisis in Pennsylvania on a lack of adequate Medicaid funding.

“Some of the best facilities in Pennsylvania are struggling to remain open,” said Adam Marles, president and CEO of LeadingAge PA, a trade association representing aging services providers in the state. “Others are forced to sell to out-of-state, low-quality operators. It is our hope that state lawmakers will begin addressing this funding crisis in next year’s state budget. We’re running out of time.”

Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, also believes that more Medicaid funding should be part of the solution to the crisis.

“The Pennsylvania Health Care Association has continually fought for higher Medicaid reimbursement, a more favorable legal and regulatory environment and workforce training programs,” he said. “Without each of these key components, the next few years will only result in more and more long-term care providers selling their facilities, changing ownership or closing their doors altogether.”