On a recent Friday morning in a South Philadelphia rowhome, Tamara Baptiste helped her 71-year-old mother, Jacqueline Percell, down the steps from the second floor and into the living room.
Baptiste became a paid home caregiver for her mother a couple years ago through TruCare Home Care Services, a local agency.
Percell was resistant to help at first, even though she deals with diabetes and physical limitations requiring hip and knee replacements. Now she recognizes that having these services is making her life easier.
“I’m getting the care and I’m getting my medications and she makes sure that I’m taking my medications on time,” Percell said. “And I like her driving me around, because I have a car and everything, but her or my son don’t trust me, you know, with what’s going on in the world right now. Some people are targeting senior citizens.”
Percell is among an estimated 400,000 children and adults in Pennsylvania who get support with daily tasks of living from paid home care workers. A large majority of clients are people 65 and older and part of the state’s rapidly aging population.
An increasing demand for services that is outpacing the availability of home care workers has swelled to crisis levels, industry leaders say.
An additional $800 million in state funding is needed to help raise reimbursement rates to home care agencies and improve pay for workers, advocates say. They want to see some of that money reflected in the next annual budget, which currently does not include any increases for agencies.
However, Pennsylvania department heads said they are bracing for significant financial shortfalls early next year as federal funding cuts to safety net programs like Medicaid take effect, which will limit how far they can stretch state dollars for a range of services.
“It is a costly undertaking and there are so many pressures under our budget right now that I think it’s an area where we really need a lot of agreement across aisles and across chambers that this is a priority,” Valerie Arkoosh, secretary of Pennsylvania’s Department of Human Services, said during a legislative budget hearing earlier this month.
But she added that state leaders would welcome proposals to increase funding for the industry in the next budget.
Lawmakers acknowledged the impending federal cuts, but Democratic state Rep. Jordan Harris, who serves as House Majority Appropriations chairman, said the state will face greater costs by not making investments in home care now.
“The truth is, we can’t afford not to have these types of programs in our community,” he said, “because a lot of these folks would either just whittle away in their homes by themselves or they would be in a facility in a bed that’s going to cost us much more as a government.”
Home care for aging parents, adults with disabilities in Philadelphia
Leaders at the Pennsylvania Homecare Association, which represents about 700 home care, home health and hospice agencies, say the industry’s workforce, about 290,000 people, is not growing at the same pace as the client population.
Low pay, moderate benefits and high burnout are making it increasingly hard to attract and retain workers, said association leaders, who estimate more than 112,000 direct care shifts go unfilled every month because of shortages.
“When you already can’t find somebody to do the work and then you’re not paying those folks well, those folks can go somewhere else and make more money,” Harris said. “Then you have more people who should be getting services, who need those services, who aren’t.”
Harris, who represents parts of South and West Philadelphia, recently met with families who depend on home care services, like the Walker family.
A home care worker comes by a couple times a week to support Barbara Walker’s adult son, Anthony, who has an intellectual and developmental disability.
In the past, Walker said she would often have to take off from work to stay home if Anthony was having a bad day or needed specialized services.
“It was hard. It was really hard,” she said. “It took a whole lot of time and patience.”
Walker is 75 and retired now, but said the home care support for Anthony is vital, especially as she herself gets older.
“I’m grateful that we have so many things they have now that they never had before,” she said.
As they sat in the family’s living room, Harris explained that Pennsylvania’s current Medicaid reimbursement rates to home care agencies often fall short of what they need to better support staff.
“It’s far too low, and lower than all of our neighbors,” he said. “So, we’re raising awareness around, one, we need to pay our home care workers more … and, the work they do is vitally important.”
The Pennsylvania Legislature faces a June 30 deadline to pass a new fiscal budget. Last year’s budget included some additional money for home care, but only for a minority of consumer-directed workers. Advocates hope lawmakers this year will include increases for the rest of the workforce, even as the state faces federal cuts for services across the board.