Spotlight PA is an independent, bipartisan newsroom operated by The Philadelphia Inquirer in association with PennLive / The Patriot-News, TribLIVE / Pittsburgh Tribune-Review, and WITF Public Media. Sign up for our free newsletter.
HARRISBURG – Democratic Governor Tom Wolf said this week he was backing major investments to address a growing dementia crisis in one of the fastest aging states in the country, including millions to support controversial reforms to the troubled elderly care industry in Pennsylvania.
However, the governor did not offer any specific figures for the total investment required or an outline of the political path through the GOP-led General Assembly. For their part, the leaders of the legislature declined to comment on what, if anything, needs to be done.
Wolf’s comments come in response to a recent investigation by Spotlight PA and PublicSource that found the state pathetically unprepared to meet the growing need for dementia services and the toll that is being demanded from providers and caregivers alike.
The investigation showed, among other things, that only a few state-licensed care facilities have dementia-specific accommodations, nursing homes are scarce and the care costs are exceptionally high.
Key action points in a state-commissioned preparedness plan are incomplete or not yet started seven years later, while a task force set up by Wolf in 2018 to lead the work has no money, which slows progress with increasing urgency.
Task Force Chair Jennifer Holcomb said that urgent action was needed.
“The problem is now,” said Holcomb. “It’s today. It’s not coming, it’s here.”
The Pennsylvania Department of Aging – which oversees the task force – attributes slow progress to a lack of resources, although its funding requests to lawmakers for dementia-related initiatives have remained unchanged.
Wolf’s office told Spotlight PA that the governor welcomed funding to support the task force’s “critical work” but noted that it would need to be approved by the General Assembly as part of the budgetary process.
Although older voters are in high demand from both parties, legislative support was not a guarantee. In 2012, a bill that would have set the state’s preparedness plan in motion failed to find a majority, in part because it did not include related regulations on the indoor tanning industry that met opposition. Then-Gov. Tom Corbett started the planning process months later, single-handedly by order of the executive.
Overall, proponents say that meaningful dementia-related laws are still a rarity in Pennsylvania, with offerings traditionally geared more towards raising public awareness than public policy failure.
A bill to create a public awareness and education campaign for the early detection of Alzheimer’s and dementias was passed with just one no vote in the US state in June, pending Senate review.
However, experts said that while awareness is important, the problem requires tangible resources.
This includes investing more in frontline work that is done outside of nursing homes and community care facilities, places that are usually viewed as a last resort.
“The only reason I have a job and the other social workers we just hired is because of philanthropy,” said Alison Lynn of the Penn Memory Center in Philadelphia.
“Our jobs are completely financed by donations because we cannot bill [insurers] for the types of services we broadly offer. “
President Joe Biden plans to pour $ 400 billion into home care programs that help dementia patients and others nationwide, but efforts remain pending.
In Pennsylvania, Democratic lawmakers said efforts to deal with the state’s looming dementia crisis could also be funded by a rare state budget surplus, borne by a godsend of federal COVID-19 aid funds, largely siphoned off by Republican leaders.
“Ignoring the lack of support for people with dementia and the facilities that provide their treatment and care while we are making these referrals is unreasonable,” said State Senator Maria Collett (D., Montgomery), a former long-term caregiver and minority leader of the age and youth committee of the regional senate.
Other heads of the State House’s Aging & Youth Committee and Aging & Older Adult Services Committee did not respond to requests for comment.
About $ 315 million was earmarked for nursing homes, assisted living communities, and personal nursing homes in this year’s budget – $ 282 million from the state’s $ 7.29 billion portion of the US rescue plan.
Both Collett and Wolf – who signed the budget – said the amount was nowhere near enough.
Across the aisle, House GOP spokesman Jason Gottesman said the Republicans’ “prudent” approach to issuing stimulus funding from Pennsylvania is a bulwark against future economic turmoil.
While dementia patients with severe symptoms in nursing homes are more likely to need specialized care in safe memory stations, many will have more mild symptoms and live in traditional units with less protection – at least until their symptoms progress.
Wolf’s office said the regulations proposed in June would have a dramatic impact on the quality of care people receive in government-licensed homes.
The regulations would increase the time workers in these facilities must spend with patients to the federally recommended minimum of 4.1 hours per day. Pennsylvania currently requires nursing homes to provide residents with 2.7 hours of “direct care” per day.
To achieve the higher rate, retirement homes would have to spend significantly more on staffing, which has led to a rejection from some in the industry.
Zach Shamberg, CEO of the Pennsylvania Health Care Association, which represents for-profit elderly care organizations, called the proposed benchmark “unreachable.”
LeadingAge PA, an advocacy group for nonprofits, questioned timing, citing technological advances and other innovations that are enabling nursing homes to do more with less.
Wolf spokeswoman Lyndsay Kensinger defended the plan, telling Spotlight PA in an email that the administration would offset hundreds of millions of dollars in compliance costs by collecting Medicaid reimbursements, a major financier of dementia services in nursing homes across the state .
“If this ordinance is approved through the regulatory process, it will be funded,” Kensinger said, adding that the administration will use both state and federal funds. “The total estimated cost of the increase is $ 385.7 million, of which $ 182.5 million is government funding.”
Shamberg of the PHCA is unsold, saying that Medicaid reimbursements to nursing homes are already close to $ 50 per resident per day, adding, “That underfunding needs to be corrected first.”
Jason Thompson, a spokesman for Senate President Pro Tempore Jake Corman (right, center), agreed with the criticism. He said institutions “need the flexibility to deal with these difficult and unique financial circumstances – and not with unfinanced government mandates.”
Kim Jackson, a Service Employees International Union-affiliated nurse at a nursing home in Pennsylvania, supports the Wolf government’s proposal, but doubts that it will work without a pay rise – which Wolf is pushing for.
“It’s not feasible because they don’t pay enough wages for people to live and not live in poverty,” Jackson said.
Learn more about Spotlight PA.