caring for a sick or aging loved one is a full time job with the pandemic Finding Help has only gotten harder.

Tonight PBS 39 proudly presents a community conversation the cost of caring.

community conversation.

The cost of caring is brought to you by capital.

Bluecross is a proud supporter of healthcare programming on PBS 39.

Medicare coverage backed by over 80 years of health care expertise serving 21 counties in central Pennsylvania and the Lehigh Valley capital BlueCross going the extra mile Additional support provided by BSI corporate benefits.

And by the generous support of viewers like you, thank you.

Now, here's your host, Whitney Smith.

Hello and welcome.

It might be a spouse or a parent or maybe you're thinking about yourself as you get older.

Finding Help and Resources and caring for aging loved ones can be a real challenge and an overwhelming source of stress and worry.

Tonight we'll explore all of that.

I'm Brittany Sweeney, PBS 39 and 91.3 W L VR are proud to bring you this community conversation the cost of caring live from the university Public Media Center in Bethlehem Pennsylvania.

The issues we'll discuss tonight didn't start with COVID but the pandemic has deep into crisis and exposed looming gaps in the health service industry while demand increases with a with a growing graying population.

We have a lot to get to tonight's will assess the situation for long term care and nursing homes will meet direct care workers and the dedicated army of Pennsylvanians who provide home based care enabling people to remain independently in their homes.

We'll hear how the wolf administration is planning to support and beef up these lifelines for families.

But is it enough?

First let's take a look at some of the numbers.

For nursing homes Pennsylvania's long term care workforce shrunk 18% In the first year and a half of the pandemic.

That's according to the Pennsylvania Health Care Association, a statewide advocacy group.

The reasons for staff departures vary but topping the list, low wages and burnout were most often cited in a survey also concerns about COVID.

Safety and contracting the virus were cited almost 40% of the time, and 1/3 of respondents said vaccine mandates on staffers were a factor that prompted them to leave their jobs.

This all comes as the Pennsylvania Department of Health has proposed new minimum staffing requirements for skilled nursing facilities.

In an effort to improve the quality of care new regulations would require a minimum of just over four hours of direct care for each resident per day.

That's up from a 2.7 hour staffing minimum now, a number that nearly one in three nursing home providers say they already are struggling to meet.

Underlying all of this, of course is the cost 73% of VA nursing home residents rely on Medicaid to pay for their care and the amount of Medicaid reimbursements is not keeping up with the cost.

The Health Care Association says nursing homes lose an average of $50 per day for each resident paying for Medicaid.

In his budget address.

Last month, Governor Tom Wolf laid out a plan for nursing home providers to receive $91 million more in Medicaid funding starting next year.

The Health Care Association says that's a drop in the bucket.

It is pushing for a $294 million investment in Medicaid reimbursement rates.

Now that's a lot to digest and the industry seems to be on the wrong side of many of those numbers.

Here to help sorted out and explain is the president and CEO of the Pennsylvania Health Care Association.

Zach schanberg, welcome to the show.

Zach, thanks so much for having me.

Thank you for focusing on this important topic.

It really is an important one.

Thank you so much for joining us.

I want to keep the focus on the caregivers for just a moment, more than two years into the pandemic.

What is it like today for the workers caring for people in nursing homes or skilled nursing facilities?

I mean, it's never been an easy task, but then you add a pandemic on top of that.

So if you could talk to us about that, that would be wonderful.

Yeah, that's exactly right.

You said it.

This is hard work.

And that was true prior to the COVID 19 pandemic.

Our frontline staff are caring for vulnerable senior citizens with underlying conditions, comorbidities.

Nursing homes are truly the hospital's of 15 to 20 years ago.

But the challenges of frontline care were really exacerbated throughout the past two years, and today, due to staffing shortages and the struggles of the pandemic.

Our frontline caregivers are tired, they're emotionally drained, they're burned out For those who are still working with us, they're left to wonder if this is the career they want to build upon.

During the height of the pandemic, our frontline caregivers were hailed as healthcare heroes.

We all remember that term.

But today, and certainly throughout the public debate of vaccine mandates, in many ways, they were cast as villains.

And it's interesting, Brittany, we heard held a summit earlier this week with providers.

And during a workforce seminar, our panelists asked if there were executive directors, leadership and communities who were forced to work the floor is caregivers and every single hand went up.

And then they asked, Who has cried recently, due to stress in their facilities.

And again, every single hand went up, that's unsustainable.

That's not right.

For this sector.

Our workers need more support.

Sure, so many issues.

And it's not like these people can take a day off.

Other people like their clients need them.

So what can happen right now, the number one thing to relieve some of that stress some of that pressure that the people providing care feeling right now, what's the number one thing that can happen?

At the end of the day, we have to properly fund senior care in Pennsylvania and PHCS.

Very proud to lead that charge for that funding.

And I would encourage your visitors or your viewers, bring me to visit who will care pa.com to learn more.

You said it at the top of the segment, our providers depend on the state's Medicaid program and Medicaid reimbursement for everything that they do.

More than 73% of all care provided in a nursing home is paid for by the state.

But when the state doesn't raise that reimbursement rate, and invest in providers, providers can't invest in their caregivers, or in the care that they provide.

So exactly saw the numbers almost one in five workers leaving the top reasons being wages and burnout.

So let's talk a little bit about that.

What is the average pay for a caregiver?

Yeah, when it comes to CNAs in Pennsylvania right now, it's 19 to $20.

For an LPN, it's $29 to $30.

And for an RN, it's $40.

But I think we all agree that those numbers need to go up in the months and years ahead.

And that's people who have medical backgrounds that's not including the people who provide non medical care.

That's exactly right, such as our housekeepers and other staff, and that's anywhere from 12 to $20.

Depending on the facility and depending on where that facility is located in Pennsylvania.

Let's talk policy.

The residents and quality of care are paramount in his budget plan.

Governor Wolf is proposing $91 million more in Medicaid funding to nursing homes and skilled nursing facilities.

That's a lot of money.

But is it enough money at this point?

It's not and you said it at the top of the segment pH.

Ca is advocating for a Medicaid rate increase that would enable providers to pay higher wages to their current workers to recruit more caregivers to the frontlines, and ultimately to meet the demands of higher operational costs and inflation.

In all, that would mean a $294 million increase in Medicaid reimbursement or Brittany, just $35 more per resident per day.

Now, the governor's proposal $91 million dollars in an increase in his budget is a start.

But every dollar is tied to an increase in that new staffing requirement, which would ultimately make Pennsylvania's minimum staffing level the highest in the entire country.

And the governor's proposal would not support current workers, not a single dollar would go to support wages for our workforce today, we want to help fill the Medicaid reimbursement gap.

Governor Wolf's proposal would actually expand that gap in short, okay, so of course going along with costs, you have the other side of the aisle, the quality of care, or lack thereof.

It's an issue with 1000s of PA families with loved ones in nursing homes, of course, they want to make sure their loved ones are treated well.

How is your organization addressing that issue?

They're making sure that these people are taking care of.

Yeah, and I'm one of those people.

I'm one of those family members with a loved one in long term care.

Quality Care is a priority for the Pennsylvania Health Care Association and we work with providers on improving quality and implementing higher standards every single day.

I think it's important to know that even during the pandemic, if you can believe it, Pennsylvania's nursing home showed improvement in nearly all 23 quality measures that are monitored and promoted by CMS or the Centers for Medicare and Medicaid service.

And that includes areas such as helping residents recover after hospitalization, reductions in anti psychotic medication, and a reduction of pressure ulcers.

But I also think that quality means ensuring that the right providers are operating in Pennsylvania.

And that can be done through a more robust Chow or change of ownership process, which the Department of Health is advocating for.

We're advocating with that as well.

Sure, because of course, people want to pay for the the caring, but they also want to make sure that their loved ones are cared for it.

Now, Zach, is the workforce crisis limiting nursing homes acceptance of new residents, you know, is there a decline in occupancy at this point?

And what does that mean for access to care for seniors and their families?

Well, that's the scary part of this story.

We actually just surveyed our members on this issue, because during the spike in cases this winter, we kept hearing that hospitals across the state were at capacity.

Well, that was because nursing homes didn't have the staff available to admit new residents.

And based on this survey, between December 2021, and just last month, on average, nursing homes were turning away 20 potential new residents each month.

And that's simply due to lack of available staff.

So you have to ask yourself, how can that happen in one of the oldest states in terms of population in the entire country, we have members who now have waitlists and they're accepting residents from further and further away.

So unfortunately, we've got to address the workforce shortage where we will exacerbate the access to care issue in Pennsylvania.

And what impact have vaccine mandates requiring workers to get vaccinated?

What has that and how has that played into these shifts staffing shortages at this point?

Well, and you flashed up the graphic at the beginning of the segment, we saw many workers leave the industry altogether for fear of the COVID-19 vaccine or hesitancy related to the COVID-19 vaccine.

Look, we've got to do everything we can to build a more robust workforce pipeline, rather than push frontline caregivers away from long term care.

And unfortunately, we saw that many vaccine mandates at the state and federal level it just that well, many nursing homes are, are using hiring agencies to staff these facilities.

Does that cost more?

And are there concerns of price gouging at this point?

They need people.

So are they going to pay big bucks to get them?

That's exactly what's happening right now.

All health care providers and long term care providers have relied on contract agency staff to help fill shifts and during the pandemic, in the midst of a workforce crisis.

We saw many of our providers become more reliant on their staffing agencies.

But unfortunately, some of those agencies saw the pandemic in the last few years as a prime opportunity to inflate their rates and to charge exorbitant fees to help fill shifts.

That's not sustainable again, for an industry that relies on government funding and payments from seniors who may be on fixed incomes.

And the price gouging in some cases that we're seeing is four to five times higher than an hourly rate a provider pays their own workers.

That's not only unsustainable, but it infuriates full time loyal staff.

So right now, pH.

Ca is actually advocating for legislation that would end price gouging by staffing agencies in long term care.

President Biden has proposed reforms that he says will improve staffing levels and make nursing home operators accountable for the billions that they receive in federal money.

You don't agree why is that?

Well, unfortunately, instead of supporting providers in their mission to provide quality care, the federal government, quite frankly decided to use our industry as a punching bag when it released new reforms without ever consulting a single expert on the frontlines.

Really, these reforms are a backwards attempt at trying to address concerns surrounding long term care.

And I'll give you a few examples.

The President hopes to implement higher staffing requirements at a time when nursing homes are grappling with a workforce shortage.

The administration is focused on funding inspectors and increasing penalties rather than funding care and Frontline caregivers.

And we continue to hear about private equity in long term care, but we can't define private equity.

And we're failing to address why outside sources CES are coming to long term care in the first place.

And that's because a lack of government support has driven many good providers away, and that needs to be addressed.

Okay, over the past two years, of course, what role have federal stimulus dollars played in long term care all of this brought on by the pandemic?

Is that money gone?

Is it just a short term fix?

What are your thoughts?

Well, it is a short term fix.

And I will say stimulus funds for long term care have been a lifeline.

It really allowed our providers to survive and keep the doors open.

Throughout the past two years by the Cares Act and the American rescue plan.

Ultimately, were one time short term fixes.

They're not going to provide sustainability to an industry that desperately needs.

Those funds were designated for COVID-19 expenses, your test your PPE, and your staff.

And we need sustainability.

We need a sustainable solution and ultimately, Brittany, that means Medicaid funding moving forward.

Some really great information.

There's X schanberg president and CEO of the PA Health Care Association.

Thank you so much for joining us.

Thank you for having me.

Well, chances are you've heard the term direct care worker.

These are the people who work with agencies to go into homes and provide home based care to seniors and people with disabilities.

In Pennsylvania direct care workers supply non medical care, helping folks to stay in their homes and out of settings like assisted living or nursing homes.

Look at this, there are about 220,000 direct care workers in Pennsylvania, the median salary just over $11 An hour according to the State Department of Human Services.

The last two years we've seen how low pay has led to an exodus of workers across all sorts of industries and the service sector.

To find out more about what direct care workers do and what they mean for their clients.

I visited a small apartments in Emmaus.

Hi.

Good morning, Valeria.

Good morning.

How are you?

Okay, a friendly greeting sleep.

Well.

Not too good.

A familiar face.

So what would you like for breakfast this morning?

I'd like an omelet for you.

I'll make it.

This is a typical day for a caregiver.

Though Kimball Morrison is donning her angels on call uniform.

She seems more like a friend to Valeria Hanzlik than an aide.

Hey, it looks good, though.

They look like a normal Yes.

Alrighty.

She is my friend.

And very close friends.

Thank you.

You're welcome.

I think we take for granted that we can get up in the morning and make breakfast for ourselves.

Now, because we can do that.

But then when we get to start me, you can do that.

It's like, I should be able to do that, you know, and then come in to help her do that is that's rewarding.

That's what I like to do.

Morrison works in direct care.

She found her calling for in home caring.

A few years ago, after her children were all in school, I was a stay at home mom for 17 years.

And this was something that was immediate.

Like I was like, I can't justify being at home anymore because the baby is going into the eighth grade.

So I was like, let me find something.

And I've always been corporate wasn't for me, even though I was in corporate.

But caregiving and taking care of people was something that I always wanted to do.

Okay, where this is your afternoon pool, we'll take it after lunch.

And then there's your bedtime and put them right up here.

Okay.

And her clients say she does it well.

Oh my god.

It's wonderful when I can get up or I can do things the way I like to do.

I really appreciate that when somebody can do it for me.

Hanzlik is 90 years old, and after COVID took its toll on her body.

She needed more help around her Emmaus apartment.

My back was not getting better, and it was getting worse.

When one thing led to another you know, and you start ever I've ever since I had COVID I have been really not myself.

I come in and I help and I know her conditions.

What can I do for you today?

You know, and that's what it is.

So breakfast and then go downstairs, do her laundry, clean her bathroom, make her bed, take her to her doctor's appointments if need be on that day, and then some days there's nothing when we sit here and we just talk all day, you know when we do puzzles and she'd be like, how many of you came in today you know, so it's pretty much a good day every day.

Valeria Morrison says it's important to know that caregivers are not made however, they do help with like cleaning depending on the condition of their clients, they can provide non medical home care, most of the duties include what she calls ADLs, which stands for activities of daily living.

Hello, pretty much they want to do things by themselves.

So they want you to help them, they don't want you to do it for them, you know what I mean?

Cuz they still want to be able to get around and be mobile.

So I like that I like helping them.

Although she enjoys doing it.

Morrison says the pay is minimal and the schedule can be demanding.

as caregivers, we don't get days off, we have to come.

Or else our client don't get what they need.

She says help is needed in her field.

But in addition to meeting the qualifications, all the red and I was going through them, I say you're gonna walk, it seems compassion is the key to success.

We need more characters, we definitely do.

But if you want to do this job, you have to want to help the elderly, you have to want to help the disabled.

If you don't want to do that, then don't pick this job.

All the red fi can depend on it.

That's the real big thing, depending on my caregiver, and what she can do, and she knows what she can do.

I know you've picked the Pennsylvania Home Care Association is an advocacy organization for direct care workers, including home health nurses who visit homes after hospital stays or surgery and hospice workers, more than 3 million people in the US receive home based care.

Joining us now is the President of the Pennsylvania Home Care Association, Terry Henning Terry, thank you so much for joining us.

Thanks for having me.

Brittany, thank you so much for being here.

Can you first tell us about the demand for these types of services?

What are you seeing right now?

Sure.

Well, demand for home based care has been on the rise for many years, people if they are able to be cared for in their home, that's where they want to be.

I'll add that it has the added benefit of better outcomes for patients and consumers at less than half the cost of some facility based care.

But demand has skyrocketed during COVID.

And and as we are continuing to live with it for obvious reasons.

Sure.

These are jobs that people still had to go to throughout COVID.

There was no break.

That's exactly right.

I think you know, we talk about it a lot at our work and with our caregivers and providers.

But home based care really in many ways were some of the unsung heroes of COVID-19.

They never got a break, they never stopped going into people's homes, often.

In times we can think back to years ago with great fear and uncertainty about what they were encountering what they would encounter.

When you go into a home based setting.

It's very different than going into a facility a more controlled environment of a facility where of course, there were many issues and concerns as well.

But they never stopped going into the home for the first time.

Some of these caregivers had to deal with personal protective equipment.

greater concern over infection control.

Some of them had never handled an n 95.

Before, let alone get a medical test to see if they can wear one fit tested to make sure that they're wearing it properly learning the donning and doffing I mean just a lot of increased stress.

In addition to of course, all the challenges that we all faced surrounding COVID Or I'm sure Kimbo was one of those people.

She's a non medical direct care worker.

So we saw some of the things that she does light laundry, helping that with the cooking, even just socializing, doing something as simple as a puzzle to help stay busy and focused.

What are some of the other things that these direct care workers do?

Whether it be medical or non medical?

Sure, and just focusing on what Kimble does.

You know, she expressed it very well, it's very intimate care, very personal care.

Sometimes it's the difference between helping someone get out of bed in the morning, helping them transfer in and out of chairs, helping them in the bathroom, helping them shower.

I mean, that's the kind of non medical care that when people are going into help with activities of daily living that she said it better than I it's not for everyone.

It requires a very special person, a very special caregiver.

And then when you combine that with the low pay, which unfortunately is a reality, you cited the statistics that you got from the Department of Human Services.

It's just more challenging than ever as demand skyrockets.

The need continues to grow.

We know there are going to be 10s of 1000s of new job openings and needs in coming years.

And we just don't have the funds to support it.

Sure, Valeria said to me when I was there, that just having Kimble there while she showers just knowing someone's there in case something should happen gave her that peace of mind.

So who are these people that are dedicating themselves to go into these homes and help people it takes a special person like I mentioned, it really does.

It takes a caregiver, a caretaker, someone who has it in their heart who really wants to do this kind of help to keep people safely comfortably in their homes, and sometimes it's not.

It's wonderful that she can shower on her own.

There are many people who cannot.

So the caregiver is in the bathroom with them, helping them, you know, do their really daily living tasks.

So you hit the nail on the head, it's really challenging work.

And it needs to be compensated at a level commensurate with how difficult it is and how important it is.

Sure, we mentioned the pay the benefits a lot to be desired there.

So put that into perspective for us.

What are these people working for?

Yeah, well, the median indirect care work, the state had an $11 an hour fee, I believe that is accurate in some communities, other communities that might be 1240, still far, far below what you're going to get at a Sheetz or an Amazon or McDonald's.

And we simply cannot keep the number of caregivers, we cannot keep the people who we are who we have now, we cannot get applicants in the numbers that we need to add or to fill the, you know, up, some say 70,000 vacancies or openings are going to be additional jobs are going to be needed in the next, you know, five years.

Are there plans to fix that or address that in the next few years?

You know, there have been some efforts made.

It's just not enough.

The Federal there's been some federal funding and I know Deputy Secretary Buckner will talk to speak to this.

There's been some American rescue plan funding that has made some improvement in the wages, but you're still not getting close to $15 an hour, which you really need to be competitive in the marketplace.

Because not only can people go get easier jobs for more pay, you're really only starting with a smaller pool of people who have it in their heart to provide this kind of care.

Sure.

So what is the governor proposing in way of funding for these types of jobs to support these people in these workers?

Yeah, unfortunately, that the current proposal only includes the federal funding that we've already been promised.

We are of course advocating for an additional amount of money to get the the level of pay at around $15 an hour, which is really just to begin to make this this work competitive.

A lot of people watching may not know that these services exist, that there's funds out there for them for help.

What are some of the resources where can they go?

Where do they start?

If they're starting out?

You know, you certainly go to the Department of Human Services website.

The Pennsylvania homecare Association has a website with a lot of resources and links on it that's PA Home Care dot o RG Medicaid has has website medicare.gov has websites, there are a lot of federal state, and of course private agency websites where they can get a lot of information about how to seek access to care, do you have to be on Medicaid to get some of these resources?

A lot of what we are talking about in terms of the low wages are are controlled by or affected by I should say Medicaid funding, because that's where those rates are initially set.

There are opportunities and certainly some people in Pennsylvania use private pay, but that's just out of pocket.

So that's not federally supported in any way to our not everybody can afford a lot of people cannot the basic level.

Okay, caregiving agencies, this is the other part of this, this goes hand in hand with the equation.

Are they taking referrals?

Are they taking people in?

Okay, you get all of these resources lined up?

But is there a place to send your Yeah, right now, it's a real challenge.

We surveyed our members very recently a 98%.

We're turning people away not accepting cases or starting waitlists.

That's obviously huge.

I mean, you know, before COVID, there were about 234,000 caregivers in Pennsylvania, non medical caregivers in Pennsylvania, we've heard that that those numbers have been decreased by up to 25%.

applicant pools are down 50%, demand is up, you know, even more than they're down.

So, you know, what's the end here?

Right?

It's not it's not so much can we afford to pay this extra money?

It's how can we afford not to short Terry without effects without extra funds without some help here?

What happens?

Well, the concern is that the system collapses, that there's just not adequate care or caregivers to provide quality care to keep people safe in their homes.

If they cannot stay safe in their homes, they will have to go to facilities that told you about the challenges that facilities are facing, but they're also a much more expensive alternative.

So if somebody is able to be cared for in their home and community first, that's where they want to be.

We all want to be there.

Right?

I mean, it doesn't take too much imagination to think where you'd want to be cared for, if you could, and of course, the whole continuum of care is important, certainly not suggesting otherwise.

But if you if you cannot receive safe care in your home, you have no alternative but to try to get into a facility and then you know, it goes from there.

And when we talk about safe care that goes hand in hand with training.

So how do these people get training?

Are they trained, they are the agents there are certain competencies that are required under state law for homecare, direct care workers, and the agencies handle and pay for the training to make sure that they are providing quality care.

You talked about the future how many more in home or just caregivers do you need for the next 10 years?

Yeah.

What do you need?

What's the need?

Like?

What are we going to see over the next 10 years is this a growing industry it is the demand is again, skyrocketing.

And that is COVID has exacerbated that, you know, made it even larger.

But it has been growing steadily for a number of years as people realize that they are able to if they can find care, stay safe in their home for a longer period of time.

We've heard vacancies or openings for new positions will be over $70,000.

By 20.

I mean, sorry, 70,000 openings by 2028.

And that's not even accounting for turnover, which is at 62%.

Right now in Pennsylvania, that's brutal.

And you know, people just leaving leaving the industry because because of burnout because of low wages, some some because of COVID-19.

Terry, before we let you go if there is someone watching who this piques their interest that they may want a job in this their caregiver, where's the best place to start for them, there are so many resources out there.

But I would say start on our website, call us email us, we will connect you with quality, really wonderful, wonderful agencies across the state, I just sort of want to start and end with the same thing, which is this is all about the people who are getting care and the importance of them getting care that keeps them safe and comfortable in the setting where they want to be as long as they can possibly be there.

And that really sort of begins and ends these conversations for every one of us involved in this field.

Sure.

Hopefully some of these resources can connect some people.

Terry Henning, the president of PA Home Care Association.

Thank you so much for joining us for having me.

Absolutely.

We continue this community conversation, the cost of caring on PBS 39.

It's streaming on our Facebook page and on the web at PBS 30 nine.org.

A little later in the show, we'll meet a professor whose experiences experiences caring for his aging parents, they turned into a book and then he turned it into a film.

He wants others to know the lessons he learned along the way.

But first COVID-19 placed unprecedented pressure on Pennsylvania's health care system.

As we've discussed, many of these issues weren't caused by the pandemic, but they were certainly made worse by it.

Our next guest is Deputy Secretary for the Office of long term living in the Pennsylvania Department of Human Services.

The Office of long term living serves more than 400,000 Pennsylvanians.

It oversees services and programs covered through Medicaid.

joining us remotely is Jamie book an hour.

Thank you so much for joining us, Jamie.

Thank you for having me.

Glad to be with you.

We're glad to have you the idea that Pennsylvania could be leaving its seniors behind with a funding and staffing crisis.

How does that sit with the state?

And what is the state doing in response?

Yeah, we have heard, obviously, from stakeholders, and we've heard from our provider communities.

And so we have got, we have been fortunate to receive a lot of federal funds, American rescue plan Act funds, which we in turn, were able to send out to both nursing facilities and home and community based providers, really to support their workforce and to make sure that they had the resources that they needed to deal with COVID.

Well, several forces at play here improving the quality of care and then paying for it from a policy perspective.

How do you balance or manage all of that?

Yeah, that's a really good question, you know, so in 2018, the Office of long term living really changed the way that they provided services for many of our recipients, we switch to a managed care system, we call it community health choices.

And it's actually gives us the flexibility to pay pay our providers based on the quality of services that they're providing.

So previous to that we had a fee for service system, fee for service means if you, you provide a service, you're paid a rate established by the Department of Human Services.

And so there's no opportunity to really pay for the quality of services that our recipients are receiving.

With the switch to manage care.

We're starting to institute value based payment arrangements.

And so we're requiring our community health choices, managed care organizations, to start to establish value based payment arrangements with providers so they can measure the quality of services that are being provided and pay according to those quality services and pay for the outcomes of the services that they're getting.

Jamie, what can you tell us about the number of beds available for people who rely on medical assistance at this time?

So right now, we have 82,000 Medical Assistance beds in Pennsylvania, actually over 82,000 Medical Assistance beds in Pennsylvania, among the 618 Medicaid and facilities, you know, that talked a lot about the occupancy and in the staffing availability and so the overall occupancy rate for our medical assistants population or our medical systems beds is at 71.63%.

So we do have a very high occupancy rate, or I'm sorry, very low occupancy rate, we have a pretty high vacancy rate at about 28.37%.

And Zach did talk a little bit about why that vacancy rate may be higher.

But I, because of staffing issues on facilities having trouble recruiting staff to fill those beds.

The other issue really is, there has been a real switch in Pennsylvania because of the institution of managed care.

And really our focus on providing services in home and community based settings, giving individuals choice on where they want to receive their services.

So we know in Pennsylvania, prior to the switch to community health choices we were serving about, I want to say 50% of individuals in their home and community based setting 50% in a facility based setting.

Now after the institution of community health choices, and honestly due to COVID, we're serving over 70% of individuals in home and community based setting.

So you did mention availability has tightened.

So are being are people being turned away?

Are they being waitlisted.

So we are not here.

So let me just say that we are aware during the height of COVID.

And especially in December and January of December of 2021, January of 2022, we were hearing from hospitals who wanted to discharge patients, and I want to say free up those beds for more COVID patients.

And so there was issues and we did hear from hospitals and obviously worked through many of those issues.

We're not hearing those problems as much today.

We know that if a patient requires extra care, and it's usually extra staffing, that is going to be a much harder person to discharge from the hospital into a nursing facility.

Jamie, I want to talk about direct care workers Pennsylvania received enhanced Medicaid funding through the American rescue plan, how much and what is that money being used for at this point, if you could break that down for us?

Absolutely.

So act 24 of 2021 provided $282 million in American rescue plan Act funds for long term living programs.

nursing facilities were allocated 198 million based on their medical assistance days and another 49 million based on their licensed beds, our personal care home and assisted livings facilities were allocated a total of $30 million in in those funds, we then got to another, I want to say separate allocation of funding, we were able to get a 10% enhanced F map from the federal government.

So more federal dollars for all home and community based services provided and the federal government said you can have these extra federal dollars, but you have to you have to spend them on things that would improve or enhance your home and community based services.

So Pennsylvania got these funds.

And so we allocated $418 million, and in in these enhanced, and they were American rescue plan Act funds, again, for an 8% increase for personal assistance services.

And it's really for the services that were shown in your in your video.

And that Terry hunting was talking about.

So are you allocate?

I'm sorry, I'm sorry, you saying there is still money left for direct care workers like Kimball, who we met a little bit earlier.

We just provided an 8% rate increase through our Medicaid program for those types of services?

Yes, because we knew that in some parts of the state workers were making nine $10 an hour.

And obviously, your video just showed it.

I mean, there is it's so important the work that they do, they have to show up every day.

They mean so much to the people they serve, and they are the backbone of our programs.

And so obviously an 8% rate increase for those workers was first and foremost.

We also got another 46 are allocated another $46.5 million to some of those types of services, as well.

And they were going to homecare agencies and direct care workers do strengthen their workforces.

And so those funds have actually they're in the process of going out to home care agents.

sees, and they have to use them on their workforce.

So that would be bonuses retention payments, payments of benefits.

The funding has to be used for something that they weren't already used getting funds for.

Are there any delays in getting that money where it needs to be in?

Are you seeing it being distributed in the places where it is most needed?

So we allocated the funds based on medical assistance services provided over a prior period of time.

And we sent letters to the providers telling them that they were eligible for these funds.

And so the providers had to sign an attestation that yes, they were going to use these funds for their workforce.

As, as soon as we got there at test station, then we generated the payments to providers.

So if a provider did not return an attestation, they have not received a payment, because they really haven't told us that they're going to use it on their workforce.

I know you touched upon this just a little bit, but when will that money be gone?

And do you think Pennsylvania will get any more and what happens after that funding sources no longer available?

So we'll continue to call contact providers and let them know about the funding that we have available.

We do have another grant program in the pipeline.

And it's really to be used to it's for quality improvement in home and community based services.

And so we hope to put that opportunity out to providers in early April.

You know, I'm really not sure if additional funding is coming from the federal government.

I know that the General Assembly has access to additional American rescue plan Act funds, and we would encourage them obviously to to allocate them to our workforces in both home and community based services and nursing facilities.

I think you heard a lot tonight about the need in both places.

And the Department of Human Services would not argue with that.

Back to nursing homes.

The facility inspections were suspended at one point during the pandemic have they resumed Is there any backlog because of that?

So the Department of Human Services doesn't do the licensing inspections for nursing facilities, but we do license and inspect personal care homes and assisted living residences are on site licensing inspections resumed in October of 2020.

We did take a small break from March 2020 to October 20 of 2024.

Obviously COVID.

We wanted to make sure if our licensing inspectors were going into a facility that everybody was safe.

So we did go back in October of 2020.

We did have a backlog of licensing inspections to conduct we're about 94% of our way through that backlog.

Jamie Bouken.

Our thank you so much for joining us tonight.

Thanks.

Thanks for having me.

Absolutely.

And today more than one in five Americans act as a family caregiver.

Being a caregiver can place a heavy financial and psychological burden on families.

It can consume time interfere with work and strain personal relationships, even within the family.

Our next guest wrote a book called The lessons of caring, and he's turning that into a short film.

Here's a clip from the film The caregiver.

Huge.

You're just jealous.

Oh, no dad, no.

Maybe a little man that he's never around to see or even call.

He's very busy.

I'm busy too, dad.

I work here so I can help take care of you.

You could stay home.

And then you'll get most of my money on the house.

Talking about Todd sold the house and the money's in a savings account.

It's all their horses.

That's why you didn't put me in a nursing home.

So you'll get the money and not joking.

It's it's better for you to be here.

You didn't want to be in a nursing home.

You wanted to be here with me.

What is your day?

We'll find that.

I'll call the lawyer on Monday.

Santo mera Bella is a reading native and Professor of Management at Moravian University here in Bethlehem.

Thank you so much for joining us.

Thanks for having a really intense scene.

They're really intense.

So I get a sense that you kind of lived through this tell us how this book and short film came about.

I grew up with parents that I observed them taking care of their parents as they aged.

And I kind of knew that that would be what I was going to be doing.

It really seemed like the right thing to do.

But it also seemed like the thing that you do for family.

And so as they aged, we were very fortunate they were they were in their 80s and it did.

We determined that it was really they wanted to be in their home and some of this, this scene that you see is, you know, some of the things that people really deal with a lot, they hold the dismiss trust or the concerns or the, the anxiety from on both sides.

And so I was fortunate enough to have an employer, like Moravian.

That was really very, very understanding empathetic about this.

But no, that's not the case for a lot of people.

Sure.

So you watched this firsthand and based your book, and then this short film, on some of your experiences, was that something that was really close to home for you, those intense kind of conversation?

It could be well move over Italians.

Yeah, it can't be.

But I think it I think, you know, storytelling on film, or in a book is a wonderful way to, to make points, but also to engage people in ways that you might not talk about these things otherwise.

And so yeah, there were some of these things like that, that my mom could be, you know, pretty strong willed.

And I think that was what kept her.

So vivacious.

And so vital.

Sure, is this kind of her story, did you talk to other people who had to care for family members?

Did you collect this, this is kind of a compilation of what I've observed, what I've experienced, in the book, the lessons of caring, we we actually talk to other caregivers, that I knew of, and you know, it's really encouraging.

And it's really helpful for people to know that there are other people who are going through the similar thing, that you're not the only person that is listening to this or being told that you don't care about me, or you're going to put me away or, or take my name off the will, things like that it's so devastating to hear because this is not your parent, this is not the person that you knew, growing up, or even for that matter five years ago.

So it gets really intense and challenging.

So that was part of the reason, you know, telling stories can often be a less threatening way to get these issues out.

But also, I think, I really hope that people benefit from knowing that other people were there and knowing some of these ways, maybe tips that I've learned and other people have learned, it's not the be all end all to to this issue.

But I think, from my experience, I like to write in ways that are real accessible, you know, I'm an academic, but I also get it that like, I didn't want to spend time if I was a caregiver, reading a heavy literature book on the science of caregiving, I just needed steps, I needed help.

Sure, let's hold that backups of folks can see, like the lessons of caring since you brought it today.

And so this is a book for who who did you write this to?

Who did you write this for?

Who should be reading it family caregiver, really, and truly who's in it, or who's about to get into it, or both?

It you know, the sandwich proverbial sandwich generation is, is I've seen it so much with people taking care of kids or taking care of parents.

This is the book that I want to to read, when I was going through this, I just wanted to know that I was doing okay, you know, I you know, we can tell we can tend to dwell on all the things we're not doing.

Instead of acknowledging that we're there for the for our family, we're there for that person.

And let's So let's kind of acknowledge and celebrate that, because we're really hard on ourselves.

I've seen a lot of caregivers who just beat themselves up.

So this is this is kind of a you know, help you kind of get some inspiration and support, but also some resources, some some tips, some strategies and tactics.

And I think that, you know, as you said, one out of five, and about 60% of those are women who are caring for a loved one.

So maybe they're also playing the role of danger parent, you know, in taking care of kids as well.

Sure.

So through your research for this book, there may be people out there watching who may be thinking about the future, and may be wanting to care for a loved one or needing to care for a loved one, or they may be on their caregiving journey.

Now, what would be your advice after collecting some of these anecdotes I've learned is that the biggest cost to the caregiver is regrets.

You don't want regrets.

And I am so fortunate and blessed that I don't have regrets.

And the second thing is you want to choose it.

You know, being having it thrown upon you might be the reality.

But then you still have the freedom to choose it.

You can say I'm doing this because I am choosing to do that doesn't make things get all better and easy.

But it does give you that freedom to know that you're not a victim here, that, that it's nobody's fault, that this is what you're choosing to do to be helpful.

And I think the other piece of this is you got to reach out and take care.

However, you can do it, you've got to take care of yourself.

You are, you know, if you're not good for them.

I mean, if you're not good for yourself, you're not gonna be good for them.

And I think that's the hardest thing.

We feel guilty for taking time away.

I mean, I'm talking about taking a coffee break.

I'm not talking about going on vacation for two weeks, right?

It's just but simple.

people it's just so hard because we should be doing this I should be doing that.

They're, you know, they're gonna need me to be home the caregiver has to I was fortunate to, to have caregiving helpers, too, because my parents were really fortunate and smart about their, their finances and all these things.

But there's a lot of people that don't have we heard from from folks in earlier in the program, how many people really need this kind of help and support and maybe they have family members, maybe they maybe they don't.

But you have to take care of yourself and reach out and just even to talk to people, whether it's that Zoom, you know, quick zoom, call the checking with a friend or taking a coffee break, but you deserve that.

And you need that chore center, what are some of the real life things caregivers go through?

From your experience?

Yeah.

One of the lessons I talked about in the book is advocacy.

So I went from being booted out of the emergency room, department of the hospital, to be appointed to the family, and Patient Family Care Council.

Because, you know, if you're going to be an advocate, you got to do your homework, you got to know what you're talking about.

But if you're, if you're taking care of my parents, my loved one, um, right there, and you're gonna, you're gonna know if it's something that I'm not thrilled about what you're doing.

And I was pretty respectful about it.

But I was really adamant that you can't do that.

This is not it was I think it was something about getting blood and a stick.

My mom was a hard stick.

Which means her veins are really small.

And I said to the nurse, you have one shot, and then we call the team and she called but she called security.

Oh, yeah.

So you're their advocate.

Yeah, their boy, I do it again, I do it again.

And it was funny because I spent five hours in the care in the ER, waiting room until shifts changed.

And then they let me in again.

And then about a month later, after I expressed my concern about how this was handled, I was asked to serve on this Council, where I and others who were wonderful family caregivers, and we learned from each other.

But I think the hospital really cared about being better about doing better.

Sure.

So almost the moral there is knowing your rights and knowing what you can and cannot do and where you can be with that person you're taking care of.

How do you stop it from taking over your life and consuming you?

That's a really good question.

I am also blessed to have a good tribe, you know, that village to raise a kid well, it takes a village to get through a get a caregiver to get through this.

And not only me, but for my parents, they were surrounded by people, I think you have to get through it by just acknowledging that you're human, and that you're doing your best.

As I said, don't, don't beat up yourself.

The other thing that really helped me is humor.

I mean, it's not always fun.

And it's not always easy.

But there's, there's a way to find something that's lighter about it, because that, for me, that really gets me through that and friends of mine over the years have taught me about, you know, using that humor.

But I think the other part of it is that you have to understand what they're going through, it's about them.

It's about what the changes are the losses they're experiencing, you know, you kind of lose them gradually, if you're lucky, sometimes, if you had an accident, and that made you unable to walk that's very dramatic, but in many cases family caregivers deal with is very gradual loss, and the loss is produced anger, and if but really, it's about being sad about the losses.

So if we kind of can be sad about the losses, then there's not so much anger.

And there can be a lot of anger and frustration from this.

So I think it's really helpful if we can understand what's going on.

And then the final thing that I think of for is this gift, this, this is really a gift that I got to give my parents and I got back a lot like just being able to, you know, I wasn't a sports guy, and my dad is in was and so I'd be watching games, I'm like, which team is which I don't even like oh, yeah, they won a great, but that time, you don't get that again.

And, you know, I got from him and from my mom and that opportunity to kind of be with them in a different way, a different way that I probably wouldn't have before.

And I know, I know that I gave them a gift and they wanted to be in their home and they wanted to be in their surroundings and have people win and so that that was really important.

But you know, that's hard to think of while you're going through it.

Sure.

I think that's a really good perspective for people to keep in mind.

Try to keep in the back of your head that this is a gift.

It's only a limited amount of time if you're lucky.

How do you navigate the family situation?

If there is a large family how do you navigate who takes care of mom and dad and who gets to make those decisions once they take on caregiver role?

Yeah, it's the, you know, in some ways being an only child is a good thing, because there was no one to argue with.

I have seen so many situations and some of my caregivers that talk in the book, talk about, you know, there's one, there's three siblings, one of them is always the one that takes care.

And it may be convenient, because there are local, but it becomes convenient because others just choosing not to like the film is really about that bad also, because in this case, he does have a sibling, but he's out of out of town, and really out of the picture, because it's kind of too hard.

Caregiving is too much.

You know, so what, what usually happens if somebody does take the lead by default or by choice, and I think, you know, the things I've seen, fortunately, I see sometimes, well, you know, I'll give you a break.

I'll come down this weekend.

And you can get a day or two off, and that helps people out.

A lot of times, though, they don't see that.

Yeah, yeah.

So make sure that you're trying to spread out the responsibilities throughout Family Center.

We don't have that much time.

But if folks want to read this book, absolutely.

How can they read the book online?

There are many sources, you know, the usual suspects on Amazon, Barnes and Noble, etc, about the film and this is also an e book to film um, we're gonna be circulating that in festivals and things.

But I think we're gonna have a little premiere coming up.

So we'll keep you folks aware that yes, so folks can get a copy of the book online if they like the lessons of carrying carrying just paperback as well as wonderful and then look for the film this what do we think this spring's bring?

Yeah, definitely bring it here.

So May or June, check back in with you.

All right, Santo.

Maria mera Bella, the author of the lessons of Karen, thank you so much ruining us.

And that'll do it for this community conversation, the cost of caring.

We want to thank our guests for joining us tonight.

From all of us here at PBS 39 and 91.3 W L VR.

Thank you for watching and listening.

I'm Brittany Sweeney Have a good night.

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