Due to nerve damage from multiple sclerosis, Lisa Sprague relies on state-funded assistance for 13 hours a day to help with essential tasks like getting out of bed and bathing at her Harmar home. While the program provides critical financial relief, Sprague says the quality of care has been alarmingly inconsistent.
She recounts caregivers who arrived smelling of marijuana, brought a pet rabbit to play with in the yard while leaving her unattended, and one who she felt pressured into paying $30 for gas money. However, her most persistent fear is that the home care agency will have no staff to send at all, leaving her stranded in bed until her son returns from work.
“You wake up and you’re thinking, ‘Is somebody going to show up today?’” said Sprague, 59.
Her experience reflects a statewide crisis. According to the Pennsylvania Homecare Association, approximately 112,000 personal-care shifts go unfilled every month. For each missed shift, an older adult or a person with disabilities may go without vital assistance, which is distinct from skilled nursing or hospice services but helps hundreds of thousands of Pennsylvanians avoid more costly nursing home facilities.
The trade group attributes the staffing shortage to inadequate state payments for home care and is urging lawmakers to address the issue in the stalled state budget negotiations. The funding currently being considered is a fraction of what the association claims is necessary and would not benefit the agencies that supply the vast majority of caregivers.
A February study from the Pennsylvania Department of Human Services estimated it would take an additional $800 million to raise the state’s average reimbursement rate from $20.63 an hour to over $25 an hour, which would allow agencies to offer more competitive wages and close the labor gap.
Agencies report they are already streamlining operations to maximize pay, but it isn’t enough. In a recent letter to state Senate leaders, a group of Pittsburgh-area agencies stated, “Agencies like ours want nothing more than to pay caregivers more.”
Ben Kondor, a division director at BAYADA Home Health Care, noted that starting wages of $12 to $14 an hour in Southwestern Pennsylvania make it difficult to compete. “You have the Sheetz of the world, the Amazon, the big box store — you name it — paying $15 an hour,” Kondor said. “We’re losing the workforce to competition outside of our industry.”
Neighboring states offer significantly higher reimbursement rates. West Virginia’s average is $25.44 per hour, Maryland’s is $25.58, and Ohio’s is $28.96—40% more than Pennsylvania’s.
“I just want the lawmakers to care and listen and do something about this,” Sprague said.
While budget talks continue, Governor Josh Shapiro’s proposed budget includes a $21 million increase for caregivers hired directly by patients, which would raise their hourly rate from an average of $13.51 to over $15. This would benefit about 8,500 workers, many represented by the Service Employees International Union (SEIU).
Silas Russell of SEIU Healthcare Pennsylvania called it a “small but very smart investment,” arguing that in this participant-directed model, the full reimbursement goes to the caregiver. The governor’s office said it prioritized these workers because agencies received more financial aid during the pandemic.
This proposal, however, excludes the estimated 140,000 caregivers employed by agencies. The Pennsylvania Homecare Association is requesting a $370 million increase for both care models, which would raise agency reimbursement rates by about 10% to just under $23 an hour. Neither the House nor Senate draft budgets have included this request as the state budget remains nearly three months overdue.
“We’re not looking at a potential crisis. We are in a workforce crisis right now,” said Cody Jones of the Pennsylvania Homecare Association.
For care recipients like Sprague, navigating the system can be a challenge. About a year ago, she switched to Caring Personal Touch, an agency run by Renee Carter. Sprague reports she now receives consistent, compassionate care and has formed a close friendship with Carter. But she acknowledges her situation is fortunate. “Not everyone has a Renee,” Sprague noted.
Carter faces the same industry-wide struggles. Of her 17 caregivers, only four have been with her for over a year, reflecting an industry turnover rate the Homecare Association puts at nearly 80%. After new hires complete background checks, health screenings, and training, many quit within weeks, citing difficult cases or long commutes. “It’s just that same spiral over and over again,” Carter said.
This instability directly impacts patients. For Sprague, who is still adapting to life after her husband’s death five years after her diagnosis, consistency is crucial. Each time a caregiver leaves, her sense of normalcy is disrupted.
“I make friends with them, I trust them, and then they find other jobs because this is not a livable wage,” Sprague said.
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