In 2024, Pennsylvania’s long-term care continuum, including nearly 700 nursing homes across the state, finds itself at a true crossroads of accountability and care outcomes.

We’re two years removed from a 17.5% Medicaid reimbursement increase for nursing home providers — the largest in the history of our payment structure. Almost one year into the implementation of new, higher staffing minimums and ratios. And just a few months shy of seeing those ratios increase for CNAs, specifically, on July 1.

The work we’ve done at PHCA — alongside administration officials, regulators, legislators, other stakeholders and the workers’ unions — has yielded significant reform and progress. And we’ve been proud to see Pennsylvania lead the way in advocating for more support and accountability — two terms that have not necessarily been synonymous with one another in the long-term care space.    

So then, why does it feel like our sector is facing more challenges than ever before?

In Pennsylvania, we’ve seen more and more facilities up for sale. There has been a dramatic increase in changes of ownership. And we’ve experienced a number of facility closures, especially since the start of the pandemic. 

In October, our commonwealth’s Independent Fiscal Office (IFO) published a report, Pennsylvania’s Strained Nursing Homes, which outlined two alarming problems facing our rapidly aging population: there has been a dramatic contraction in nursing home capacity in Pennsylvania since 2019, which means we’re quickly arriving at the point where demand will outpace supply. And there is an overwhelming reliance on Medicaid reimbursement, which falls woefully short of covering provider costs.

Something, clearly, has to be done.

For as long as I’ve been here at PHCA, our advocacy within the halls of the Pennsylvania Capitol has concentrated solely on Medicaid rates. While the facts and figures may change, the overall message remains the same: long-term care is overwhelmed by various challenges, costs are increasing exponentially, and reimbursement is inadequate. That message is accompanied by a request for increased funding, typically a COLA, to meet rising costs.

But that script simply won’t cut it in Pennsylvania anymore. And throughout the last few years, we’ve taken note of states across the country that faced a similar dilemma.

With rough fiscal years ahead for Pennsylvania, lawmakers and state leaders are making it clear: higher reimbursement for increased costs is not a sustainable model. Our legislators are asking for results, and they’re adamant about transparency and accountability.  

So, as the state budget season officially gets underway in Harrisburg, we’ve introduced a new, innovative proposal that should be the cornerstone of any new spending plan.

Here in Pennsylvania, we want to implement a payment program that will improve outcomes and improve accountability for the funds providers receive. We want to reward operators for what they are already doing: achieving results and meeting quality metrics. And the program we’ve introduced will incentivize providers for boosting total occupancy and for Medicaid reliance — so that those facilities caring for our most vulnerable with little to no resources are supported.

We want to be good stewards of Medicaid dollars — taxpayer funds — and deliver real results for our communities and state leaders.

We have asked our governor to invest in senior citizens and adults with disabilities, as well as their providers of care, by Enhancing Care With Incentivized Payments — or ECWIP. More simply, we want the state to “equip” providers with the tools they need to further enhance care and join more than twenty other states in this type of innovative approach. 

In Pennsylvania, we’re reframing the argument — and the question — regarding how to support long-term care. We’re offering real solutions and forging an innovative path forward. And we’re addressing our challenges head-on as we fight for sustainability and success for our sector.

ECWIP is a big step forward to enhancing quality care in a state with one of the oldest populations. And we’re excited to get started.

Zach Shamberg is the president and CEO of the Pennsylvania Health Care Association (PHCA), a statewide advocacy organization for Pennsylvania’s most vulnerable residents in long-term care and their providers of care.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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