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2017-01-27 / News

Aging Pennsylvanians will need home-based care, but paying for it could be challenging

By r. brock pronko
Regional Business Analyst

Pennsylvania’s 65 and older and 85 and older age populations both rank 4th among all states.

Nationwide,thecostofuncompensated elder care provided by patients and their families has reached nearly $275 billion annually. About 23 percent is paid out-of-pocket by patients and their families, 47 percent is paid by Medicaid, 23 percent by Medicare, less than four percent by veterans/state programs and only three percent by private long- term care insurance.

Home-based care is divided into three different sectors. The first is home health where a healthcare professional, most often a nurse or physical therapist, comes to the patient’s house to provide in-home services. For seniors, the cost is paid by Medicare. The second is non- medical homecare, where homecare aids help the elderly or disabled perform daily tasks such as preparing meals, showering and getting dressed. That care is paid by Medicaid for those who qualify, but most homecare is either paid out of pocket or by long-term care insurance. The third sector is hospice, which is end-of-life care, and that’s paid by Medicare.

Pennsylvania residents pay an average hourly rate of $21.50 for homecare. Areas of East Stroudsburg and Gettysburg have more affordable costs of assisted living than the state average. These areas, however, have higher than state average costs per hour for homecare – an average of $22 to $23. Costs for homecare in State College, Pittsburgh and Philadelphia are about the same.

More affordable homecare can be found in Altoona, Reading, Bloomsburg, Chambersburg and Johnstown, where the hourly rate can be as low as $20 per. Home health care costs about $1 per hour more than non-medical homecare.

According to the U.S. Dept. of Labor Statistics, the third fastest growing profession in the U.S. is homecare aids, but in rural Pennsylvania the demand for homecare aids exceeds supply.

“We have many meetings with representatives from homecare and home health agencies, and they all say the biggest challenge they face is finding nurses for home health but especially finding homecare aids to do non- medical care,” said Vicki Hoak, CEO of the Pennsylvania Homecare Association in Lemoyne, Pa.

“Although it’s one of the fastest growing professions, the pay for homecare aids is not as good as it needs to be, so we have huge vacancies to fill and a high turnover rate.”

While homecare costs can average between $18 to $21 an hour, that’s what the agencies get, not the homecare aids, who earn anywhere from minimum wage to $11 or $12 an hour.

“Since Medicaid pays for homecare service, the reimbursement is fairly low, which doesn’t help the agency when it comes to elevating their workers’ salaries,” said Hoak.

“As more baby boomers turn 65, we’re seeing an increase in homecare needs, because most people don’t want to go into nursing homes. They want to be cared for at home, which means home- based care is going to become more and more important.

“Not only is the home where people want to live in old age, but homecare is also cheaper for Medicaid to pay than nursing home care.”

Despite being cheaper, Medicare places limits in Pennsylvania on the number of seniors receiving homecare to a maximum of 29,000 residents, which is a tiny fraction of the senior population.

“If Republicans are looking for a less costly healthcare program than Obamacare, increasing the cap on home-based care for Medicaid would be a good place to start,” said Hoak. .

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