Pennsylvania has approximately 278,000 direct care workers (DCW), the vast majority of whom work in Long-term Services & Supports funded via the state’s Medicaid program – either directly or through their employment with a home care agency or nursing facility. Direct care work is one of the fastest-growing job sectors in our Commonwealth, and demand continues to increase. By 2030, 1 in 5 Americans are projected to be age 65 or older, and many Pennsylvania counties are aging at a far faster rate. Yet direct care is among the lowest paid workforces in our commonwealth, with a median wage of $14.41 per hour across all DCW positions. These wages are so low that a significant number of home care workers and personal care aides in Pennsylvania receive public assistance, like Medicaid and SNAP benefits, to meet their basic needs. 
 
Direct care work is also physically and emotionally demanding, and the structure of the job means workers have limited access to support or guidance from coworkers. Their work is solitary, with no common space to connect with peers, and many DCWs face language barriers that exacerbate the feeling of isolation. The challenging conditions combined with low compensation for direct care jobs have together caused a crisis of high turnover and chronic workforce shortages. 
 
The demand for direct care is far outpacing the number of people able and willing to fulfill open roles. According to the Paraprofessional Healthcare Institute, Pennsylvania is expected to hire an additional 32,000 DCWs by 2023, but, despite that hiring bump, 120,000 more workers would still be needed to ensure all Pennsylvanians can receive care. Without a pathway to meet staffing needs in the direct care sector, we can expect even higher rates of turnover, decreased quality of care, and increased costs for elders and their families. 
 
To ameliorate this problem, I will be introducing legislation that will direct the state’s Secretary of Human Services to create a long-term care standards board as part of the state’s Medicaid rate setting process. This board will meet every three years to ensure that the wages being paid to DCWs are sufficient to maintain a strong workforce that can deliver the highest quality of care. 
 
The Board will: 

• Advise the Secretary on rate setting in long-term care support services, 

• Have the power to set pay rates for DCWs, and 

• Create a public process whereby recipients of care, DCWs, private home care and long-term care employers, and the Medicaid program could work together to determine the best pay rates. 
    

To ensure that DCWs have a strong voice in the Board process, they would have the option of choosing a Workers Organization to represent their interests at the Board. The Medicaid program would support a robust Workers Organization via the following: 
  

• The state would require all Managed Long-Term Services and Supports (MLTSS) funded employers to allow DCWs to receive information about the Wage Board process and decisions from a certified Workers Organization at new employee orientations and continued trainings. 

• Require all employers of DCWs funded through Medicaid resources to allow their direct care employees to elect to deduct a portion of their paycheck to support the work of the Workers Organization. 

 

Please consider signing onto this legislation to support our direct care workers.