Pennsylvania budget omits home health nurse funding increase

Pennsylvania’s latest budget did not include a funding increase for home health nurses. For families who rely on skilled nursing at home, the question is whether a provider can find someone to cover the hours. Scarlotte Sell, a 6-year-old in Adams County with a rare genetic disorder, requires round-the-clock care to check a gastrostomy tube and catheter. Her father, Brandon Sell, said medically trained caretakers have been hard to find when he is away from home.

Mia Haney, CEO of the Pennsylvania Homecare Association, said low rates are tied to stagnant worker entry in Pennsylvania. She said Medicaid reimbursement rates in every neighboring state, from New York to West Virginia, are higher than in Pennsylvania, where the average hourly wage for personal assistance services is $20.63. As of 2024, Haney said, direct care workers cared for nearly 21,000 children and roughly 155,000 adults in the state.

That is different from the staffing question inside a nursing home. A nationwide study of long-stay nursing homes found that, when total nursing hours were held constant, a higher share of those hours provided by registered nurses was associated with lower hospitalization and outpatient emergency-department visit rates. The study was observational, so it does not show that more RN time caused those outcomes. Pennsylvania reporting concerns Medicaid reimbursement for home health and personal assistance services, while the study examines nursing-home staffing data. The sources do not offer one staffing fix. They show different workforce questions: whether skilled care is available at home and whether the share of RN time is associated with acute-care use in a nursing home.