Insight With Sylvia Maus 080623 PA Health Care

“Lack of funding for Pennsylvania Nursing Homes leaves many residents on the streets and desperately looking for a place to live." www.phca.org

Episode Transcript

(00:00):
Hi, I'm Sylvia Moss, andthis is Insight, a presentation of iHeartMedia
where we really do care about ourlocal communities and all our listeners who live
here. You know, the issuethat we're going to discuss today is so
serious. The only way to beginthis program is to bluntly ask you,
how would you feel if you,your parents or even your grandparents were in

(00:20):
a nursing home and all of asudden you were suddenly out in the streets.
That's what's going on right now herein Pennsylvania and across the country as
well. And if you're young andyou think it's not going to happen,
do you think again, because eventuallyit affects all of this way before we
know it. Currently here in Pennsylvania, we are the fifth oldest population in
the country, and this year thenumber of people in state are that are

(00:43):
eighty five years old and older isexpected to double. And the critical situation
is that more than seventy percent andI listen to this, seventy percent of
all care at nursing homes in Pennsylvaniais paid for by Medicaid. Because this
is such an urgent and complicated issue, I've invited Zach Schamberg. Zach is
the president and CEO of the PennsylvaniaHealthcare Association. I ask them to come

(01:07):
in here and help us understand theissue and sort it all out for us.
Zach, honest to God and say, I said to you this before
we started tagging. This is areally serious crisis in Pennsylvania. First of
all, tell us about the PennsylvaniaHealthcare Association. Who do you represent?
What do you do? Yeah?Of course, and Sylvia, thank you
for the opportunity solutely. The PennsylvaniaHealthcare Association is a statewide advocacy organization and

(01:30):
we represent long term care in Pennsylvania. We've represent the providers, we represent
the frontline caregivers, our healthcare heroes, and most importantly, we represent the
residents who they care for, ourmost vulnerable, our seniors, our adults
with disabilities. Specifically, we representnursing homes, personal care homes, and
assisted living communities. And at theend of the day, it's pretty simple.

(01:52):
Our job is to fight for them. Our job is to fight for
more resources, more support, morefunding in many cases, and we've been
very proud to do that, especiallysince the beginning of the COVID nineteen pandemic
where when our job has been moreimportant than it's ever been before. Tell
me about your background. You comefrom a health care background. I do.

(02:12):
My mom has been in long termcare for more than thirty years,
My stepfather has been in long termcare for more than thirty years. My
aunt is a nurse, my cousinis a nurse. You know I couldn't
do that frontline job. So thisis what I've chosen to do to advocate
on behalf of those providers, thoseworkers, and those residents. And I
think, for me, what's mostimportant for your listeners to understand. I'm

(02:37):
also a consumer and my grandfather,who passed away earlier this year, spent
the last five years between personal carehomes, assisted living communities, and nursing
homes. He was diagnosed with dementiaten years ago. So we saw it
up close. And the hypothetical thatyou laid out where there are some family
members who don't know where to turnfor care, that was us, That

(03:00):
was my family. I saw itup close and personal. So I know
what these issues can or how theycan affect Pennsylvania's across the state. And
I can guarantee I Zach as thekind of person. And I've said this
a couple times before. I know, when somebody comes on in the studio,
one of the executive directors or CEOs, whatever, I know who's there

(03:22):
until they move on to their nextjob, and who's there because they're committed
to what's going on in that particularwith that particular issue. And I'm so
glad that you've had I don't wantto say I'm glad you had those experiences.
I went through them myself. Butyou've been there, done that.
You've walked the walk and talked thetalk. So that's exactly right. And
it's beneficial for me and for usas an association. When we're at the

(03:44):
capital and we're talking to legislators,we're talking to the governor's administration, we're
talking to those policy makers and decisionmakers who are ultimately going to decide the
fate of this industry and whether thisindustry can be sustainable, not just today
tomorrow, but in the next fiveto ten years. It's helpful to have
that experience in that background. Well, for those who may not understand,

(04:06):
let's start with the basics. Whenyou go to a nursing home, there's
a couple different ways you can payfor it, and this is what we're
pushing a lot of times. SoI see a lot of push as far
as long term healthcare insurance. It'sreal expensive and you got to start it
when you're young, and when you'reyoung, you're having babies, So how
can you afford it? So,as I said at the top of the

(04:28):
program, with seventy are relying onmedicaid, what's the difference between Medicare and
medicaire. So Medicare is a federalprogram and it'll pay in most cases for
the first one hundred days. Now, it's interesting, my wife and I
just had two babies. We havetwo young daughters, and long term care
insurance is not an option for us. It's far too expensive, and it's
far too expensive for the majority ofPennsylvanians and even folks around the country.

(04:53):
So we don't really utilize a longterm care insurance products. So we have
many seniors who are relying on Medicare. Very few, especially today, are
using or utilizing private pay. They'repaying out a pocket for services. So
where do we turn. We turnto Medicaid, and that's a state insurance
program requires state funding, and thatpays for the majority of care. You

(05:15):
said it, more than seventy percentof nursing home days are paid for by
the state's Medicaid program. Yet,and this is the real challenge. Funding
in that Medicaid program has not keptpace with rising costs. That's a disgrace.
I mean, come on, theseare the people that most of them
are middle classies, are the peoplethat build America. And this is where

(05:39):
we're getting all the money to supportall the programs, all the programs in
this country company the taxes that theypay. Now we're leaving them behind.
Well, it's a safety net atthe end of the day, to your
point, and we've made a promisein Pennsylvania that if you don't have enough
personal funds, if you can't secureMedicare funding, then Medicaid will be there

(06:02):
for you. It will pay foryour care. And we are on the
cusp of allowing hundreds, if notthousands of senior citizens to fall out of
that safety net, and that's alreadyhappened. They've had to close nursing homes.
Then you talk about that a littlebit. Yes, across the state.
Now we've got six hundred and seventyfour nursing homes, which may sound

(06:23):
like a lot, but prior tothe COVID nineteen pandemic, there were seven
hundred nursing homes. That means we'veseen, to your point, nursing home
closures, and more important than that, or more urgent than that. If
facilities aren't closing, they're closing bedsbecause there aren't enough staff or there's not
enough Medicaid funding to support the admissionof new residents. So we have nursing

(06:46):
home providers all across the state whohave essentially closed their doors to new residents,
new admissions, and new patients.And you ask the question, where
can people go? Yeah, mygod, we've seen senior citizens needing care,
ventilator care, even go out ofstate. We've seen them travel hundreds
of miles away. In a statelike Pennsylvania with our aging population, we

(07:11):
shouldn't allow. That's what happened.That's absolutely right. And you talked about
the issue of having a big enoughstaff. How bad is it, Well,
we're in the midst of a workforcecrisis and that really started at the
heart or at the height of theCOVID nineteen pandemic. Workforce has always been
an issue in long term care,but when the pandemics started, we saw

(07:33):
many frontline caregivers leave the profession.We saw many who were close to retirement
retire. So now we've seen manynursing home providers and many long term care
providers lose their full time employees andhave to rely on expensive contract staff or
agency staff. Oh my god,well do they pay them off? Because

(07:53):
you know, I remember having thisconversation with Centator Casey years ago when he
was I believe what was the AuditorGeneral, and one of his issues was
howard taking care of our older citizens, and he was a big proponent of
keeping him at home as long asyou can, because that's what most people
want. They want to stay athome. But that I would have thought

(08:13):
by now, that was years ago, somebody would have thought about getting a
plan to straighten as that was somany what's going on? Well, And
honestly, I agree with Senator Caseythat if you can stay at home,
you should, And nine of thesenior citizens out there in Pennsylvania and across
the country would like to stay athome. But again we talk about safety

(08:37):
nets. Yes, nursing homes area safety net for those who can't be
cared for at home, and Mygrandfather is a great example. After being
diagnosed with dementia, he would wanderand he would leave the stove on,
and even with my grandmother there,we could no longer safely take care of
him at home. And it breaksyour heart, and it does break it
does. I went through the similarthing with my dad. It's like,

(08:58):
and you look at this very vitalhe was a community leader, businessman and
everything, and all of a sudden, he's like a little kid. That
what that does to you inside?And as much as you want to leave
them in the home, you can't, No, you can't. And it's
the hardest decision that we've ever hadto make as a family together. But

(09:20):
you ask why this system isn't sustainable? Why can't we pay full time employees
more? Why can't we support that? Exactly, at the end of the
day, it comes back to Medicaidreimbursement and how does that work? Tell
us how that works? Sure,nursing home providers are so reliant on state
funding and Medicaid funding that it allowsthem to invest in everything throughout their facilities,

(09:46):
whether it's the facility itself with upgrades, whether it's the care that they
provide, and whether it's the directstaff who come in each and every day
to fulfill their mission of caring forothers. If Medicaid reimburse doesn't keep pace,
it doesn't allow providers to invest intheir workers, invest in their rest,

(10:07):
invest in their facilities. Usually fromwhat I understand because they used to
work at the Capital as a reporter. The budget. Okay, so what
you get and what they say you'regoing to get into twenty what they are
proving twenty twenty two is your budgetfor twenty twenty three, right, So
where are you right now with that? So there has been and we're in
the midst of a budget impass,so it's tough to say exactly where we

(10:31):
are. But there's been about aone percent Medicaid reimbursement increase allotted to nursing
home providers. However, we arein the midst of new staffing minimums and
new staffing ratios that took effect thirtydays ago on July first. That is
not a one percent increase. Thatis not sufficient for providers to meet new

(10:54):
staffing requirements. It's not sufficient forproviders to invest in their frontline caregivers,
and it's not sufficient for providers tokeep up with increased operating expenses like the
cost of care, the cost ofmedical supplies, caring for their residents.
So it doesn't do the job thatwe need it to do. What do
we do to get people? Imean, I don't know what the average

(11:16):
theory is for someone who works ina nursing home now, but there's got
to be some sort of incentive becausethat I mean, you're leaving at their
disposal of the most precious people inyour lives. It's interesting that you ask
about that. Right now, statewide, the current average salary or hourly wage
for a CNA or certified nurse agientsabout seventeen dollars and fifty cents. Okay,

(11:41):
we can certainly invest more in thewage. Yes, we can certainly
invest more in incentives and benefits andbonuses. That's all important from an advocacy
standpoint. What we can do isbuild a better career ladder, and right
now we're working with members of thelegislature, both the House and Senate Republicans
and Democrats, as well as thegovernor and his administration to build that ladder

(12:03):
for prospective employees. So you startday one as a CNA, but then
you go up and you move upto become an LPN and RN and soon
maybe a nursing home administrator. We'vegot to allow for more caregivers to be
able to climb that career ladder,and right now we make it too difficult

(12:24):
for folks to move on and tomove up. Well, I remember years
ago, like I think it was, Hack had a partnership with one of
the hospitals in town where they wouldas long as you've committed to so many
years working for one of these hospitals, they would pay for it. I
know you have a lot of partnershipswithin your organizations or anything like that that
you might consider. We do.We're actually working with Harrisburg University and we

(12:46):
just signed a new agreement to offerdiscounts on tuition for prospective nurses. We
have many providers who are doing tuitionassistance. We have many providers who are
doing assistance with daycare, student loanforgiveness, all these sorts of things.
Again to incentivize that workers will cometo long term care. We've also got
to look at education and the educationalsystem in this state. We emphasize STEM

(13:13):
the STEM jobs so much, butwhen we look at Pennsylvania, we look
at our population. Our fastest growingdemographic is age eighty five and older.
That population is going to double bythe year twenty thirty. And right now
we're in the midst of and Idon't mean to scare, but we're in
the midst of the baby boomers whohave aged into the demographic most in need

(13:35):
or who will be in most inneed of long term care. So we've
got to ensure that these jobs andthese professions are available not just today but
in the next five to ten years. We've got to be talking to our
students now that's right in high school. In high school, we're in the
middle school. Eggs, eggs,Oh, thank you for that, because
they've people. I've had people comein here and talk about AI and technology.

(14:01):
But nobody is doing well. Ican't say nobody. There are few
and far between schools that are doingexactly what you're saying, making it cool,
making it because that's when impresses kids. That's exactly right. And it's
tough because right now, if you'rea prospective nurse, you're probably going to
be pushed towards a hospital and you'regoing to go work at that hospital.
But we've got to be talking toour students, whether it's in high school

(14:24):
or middle school now, about whatcareers will be available in the future,
ten to fifteen years down the road, and really finding those younger Pennsylvanians who
respond to this mission and who havea compassion for caring for our most vulnerable.
You know, I can remember yearsago as I said, my dad

(14:45):
had four dealership and shmoking, andhim showing me letters that he used to
get from the guy singer that isthere any do you know any nurses?
We desperately need nurses. Then Ihad the pends I think was a Pennsylvania
Nurses Association came in, but thesame song. They said, we can't
get nurses, and I said,we know what I would do. I
would do billboards because there are certaintimes when you can get billboards for free

(15:07):
you're a nonprofit, and put apicture of a big, healthy young guy
in there, because as nurses getolder, they can't be lifting patients up,
and what they're going to be paidis pretty darn good, especially to
start out. I mean, Zachkind of understand why they said things are
so complicated, they don't have tobe What do we do, I mean,

(15:28):
what kind of support to people.And there's still more I want to
talk to you about. But peoplethat are listening out there and they're paying
attention to the fact that this isso serious, what can they do to
help? I mean contact like whosupports you in state House? Sure?
Well, first of all, contactPHCA and you can go to our website
PHCA dot org. You can followus on Twitter, Facebook and LinkedIn PHCA

(15:52):
Cares. You can also go toa brand new website that we set up
Pacare for the Aging dot org andthat and help providers connect with prospective workers.
So if there are listeners out therewho say, you know what,
maybe a career in long term careis for me, PA Care for the
Aging dot org can help you connectwith some of our PHCA members and you

(16:15):
can connect with us as well.I think it's important for the listeners to
understand that if you don't have afamily member who is in need of long
term care, it's probably safe tosay that you will one day. And
so now is the time to starttalking to your local representatives, your state
rep your state senator, your memberof Congress. Set up a meeting,

(16:37):
send them an email, give thema call at work. Grassroots Work Oh
my gosh, I'm seeing that happenover and over and over again, and
at the end of the day,again, we're an advocacy organization and that
is our message. Let's make surewe're supporting long term care providers, that
we're supporting workers, and most importantly, that we're supporting residents. Those conversations
can happen now. Talk to usabout people that are leading these nursing homes.

(17:02):
They're actually a lot of homeless.We're seeing that is more awful.
Yeah, and we actually just sawa report last week that a personal care
home in Johnstown, the Atrium,is going to be closing down fifty residents
more than sixty workers. The questionis where do they go? In twenty
twenty two, we stood in frontof a ventilator unit, a nursing home

(17:26):
specific to ventilator patients that was closingdown fifty residents, hundred workers. Where
do they go? That's the question. Some are going out of state,
Some are hopefully finding care in afacility that maybe dozens, if not hundreds
of miles away. But we're seeinga rise in senior homelessness, and that

(17:47):
is a very scary idea, avery scary proposition. I keep saying it,
but that's a disgrace in a countrylike this, again, especially in
Pennsylvania, given our aging population,that we're not owing a robust safety net
to care for them. And thatis our message to members of the legislature,
and it's our message to Governor Shapiro. We need to ensure that long

(18:08):
term care is sustainable, not justtoday or tomorrow, but in the next
five to ten years, or wewill see an explosion of a senior homeless
population. We can't allow that tohappen. Oh my god, that is
so upsetting. Oh my goodness.Well, let me ask you this too.
Should people be calling them say Ihave parents in a nursing home?
Should I be can say are youguys in gored shape financial way or what

(18:30):
do you do? From a nursinghome standpoint, when folks are reaching out
to their nursing homes, we thinkit's important and I saw this with my
family and we did this to alwaysmaintain that line of communication with a nursing
home, personal care home, orassisted living community, asking what you can
do to help, asking what theneeds are and what the challenges are.
I think that's very important to keepthat line of communication open. You wrote

(18:53):
a letter I think it was inMarch. Was it to the US Senate.
Tell us about that and what youexpected to come from them and what
the response was. Yeah. Youknow, if you had told me that
I would be sending a letter fromPHCA to Senator Bernie Sanders three years ago,
I would have told you you werecrazy. But here we are,
because these are crazy times, andthese are very interesting times. We sent
a letter to the Federal Help Committeeessentially asking for assistance with our caregiver crisis,

(19:22):
whether that is help at the federallevel with funding, whether it's comprehensive
immigration reform, which we've called forsince the beginning of the pandemic, and
even before that, we asked ourmembers of Congress, you've got to do
something to help us alleviate our workforceconcerns, because we can certainly act at
the state level, but Washington DCand members of Congress have a stake in

(19:45):
this as well. What's really interestingis that we are facing an impending federal
staffing mandate in nursing homes, yetat the same time, the Biden administration
State Department has stopped access for Greencards or worker visas for prospective nurses from
out of the country. Does thatmake any sense, whether we're facing an

(20:10):
impending staffing mandate or not. Givenour workforce challenges, if we can't find
folks in Pennsylvania, let's look toother states. And if we can't find
folks in the United States, thenwe need to look around the world.
But to shut off access to thatat the height of a workforce crisis is
inexcusable. And we asked for help. We asked for support. Have they

(20:33):
been in touch with you since thathappened. Not yet, but we anticipate,
hopefully that they'll get back to us, but not even get back to
us. I don't care if theyrespond to us. I want them to
act in Washington, DC, andI want them to do something about this.
Well, with a lot of thefun you said, you're trying to
do the best to get money formore money for medicating that comes from the

(20:55):
state. Correct, that's correct.Well, I thought we had billions of
dollars in the general General We do, and there's funding in the Rainy Day
Fund let me come in. Thestate has built up. At the end
of the day, it's about priorities. What do we prioritize Now, the
current budget impass has really been abouteducation, and that's fine. I have

(21:15):
two young daughters and we want tomake sure that education is supported. But
what about our fastest growing demographic.What about the other side of our population,
our aging population. We can't supportschools year after year and forget about
our seniors. And that's our messageto the governor, that's our message to

(21:36):
members of the legislature, legislative leaders. We need to prioritize our seniors.
Well, talk to me about thegovernor. How receptive does he get this?
And what about the legislature. Yeah, I think everybody gets it.
And certainly last year we saw ahistoric investment in Medicaid funding for nursing homes.
But that also came with higher costsdue to staffing, and it came

(21:57):
with accountability provision to ensure by lawthat providers are sending dollars and total costs
to where it's needed most, andthat's the frontline caregivers and that's to the
resident bedside. So we need toensure again that this is a sustainable system.

(22:18):
We can't make a historic investment andthen walk away. We need continued
support for sustainability. Well, that'slousy. I mean, year to year,
you have to hold your breath tofind out what's going to happen.
And that uncertainty causes lots of issuesfor providers who are wondering, can I
accept that new resident? Can Ipay for that new caregiver? And again,

(22:42):
given our population, we shouldn't haveto be faced with that uncertainty that
day after day. I know yougo through this, but we tell me
something good about your job. Imean, you have a lot of headache.
You didn't prepare me for that inthe prescreen. I mean, when
something happens, I'm sure you think, oh, thank God. But it's

(23:02):
a fight day after day, isn'tit. Well we saw it during the
pandemic. We saw that the silverlining of the COVID nineteen pandemic was a
recognition of what our caregivers do eachand every day. It was a recognition
of what our providers do each andevery day. And we saw members of

(23:23):
the legislature and the governor step upfor us, whether it was advancing legislation,
whether it was Cares Act funding,American Rescue Plan funding, or Medicaid
funding. We saw for the firsttime in Pennsylvania, long term care be
prioritized. So we've seen that typeof support. We just need that continued

(23:48):
support again to ensure that we cansustain our mission. So what you're doing
is you're cleaning up all the messthat somebody let go for years and years
and years. That's what you're doing, aren't you. At the end of
the day, we're trying to bringlong term care to a place of sustainability.
You know, I know Dauphin Countya loan got fifty one million bucks.
All these all these counties got lotsand lots of money. Was there

(24:11):
any money that you got from thator is that doesn't have to come from
the state. Well, I thinkwhat you're referring to is the American Rescue
Plan or the cares out funding,the one time funding. And yes,
again during the pandemic, long termcare was a priority. Long term care
received cares Act funding. Providers,workers, residents received Cares Act or American

(24:32):
Rescue Plan funding, So that prioritizationwas there. Again, we just need
to continue continue. Yeah, andhow big of a how what are we
talking here in terms of like awhat is a budget for nursing homes?
A typical budget, well, atypical budget for nursing homes on the size
of Yeah, it really depends onthe number of residents, the number of

(24:53):
beds, the number of workers,so that really varies. At the end
of the day, we need toensure medicated keeps pace with rising costs,
and we're seeing rising costs all throughall the state. Everybody is, everybody
is, tell me, what isthere any legislation that is pending that it
is soon to become law that wecan be happy about it at least.
Well, I don't know about soonto become law, because again, we

(25:15):
need to see what happens with theHouse and the Senate and the Governor as
it relates to the budget and passand when they're going to return to Harrisburg.
But there's two pieces of legislation thatwe're working on and I think are
really important and we're looking to thefuture. First, I talked about that
career ladder. Yes, that's excellent. We want to make the CMA or
a Certified med Aid a new positionin Pennsylvania. This would go between a

(25:38):
CNA and an LPN and it wouldadd one more important rung to that career
ladder. That's one two. We'refighting to reform our system, and we're
fighting to bring medicaid to assisted livingin Pennsylvania. Believe it or not,
we're one of just a handful ofstates that doesn't allow assisted living to be

(25:59):
a Medicaid provider. So what happensthis is strictly private pay. So if
a senior citizen or a resident ofan assisted living community runs out of money,
right they need to find another placeto go, whether that's a nursing
home, whether that's back home,whether that's to the hospital, or you
talked about the homeless population growing,it may be that. So if we

(26:25):
don't provide that safety net for assistedliving residents in Pennsylvania, we're going to
continue to see more and more seniorcitizens be faced with that issue, where
do I go next? So we'refighting to reform the system to bring medicaid
into assisted living. It's a longtime coming. We need to get it
done. It must be very frustratedwith this. How do you go home?

(26:47):
I know you've got two great littlekids in our wonderful wife and you're
so passionate about it. How doyou go home and forget about this?
But that's the point. We don'tand like so many of our caregivers who
spend every day working with their residentstrying to improve the health of their residence.
We feel that too, and weutilize that that feeling, that passion

(27:08):
to work with our legislators and ourstate leaders. I want you to come
back. I wanted to follow upwith this also. When you get some
sort of a program in place withthis where the CIENNA and you move up
their they've got it. I'm surethere's partner people out there that would want
to partner with you. I wantto hear about that, because that's that's
a big part of this. Doyou think the public knows it about this

(27:30):
what's going on? I don't.And most of the public either doesn't know
or refuses to face this fact untilthey're faced with it themselves. And again,
I saw it with my grandfather,I saw it with my mom.
I've seen it with members of myfamily. Until you are faced with this

(27:51):
reality, you really don't know exactlywhat's happening. So if you're not seeing
it now up close, chances areyou made you. And that's why we're
asking folks to get and bought andit may be you, and it may
be you because time fly, stressexactly that. Again your website, the
two websites you provided, ye,So, first PHCA dot org is our

(28:12):
website for the Pennsylvania Healthcare Association.And then we also have Pacare for the
Aging dot org. And again,if you're a perspective healthcare worker, or
if you work in healthcare and yousay I want to get involved in long
term care, Pacare for the Agingdot org is a great resource and a
great place to turn. We're goingto check that or I hopefully get some
more information out there. Zach,keep going, buddy, keep going.

(28:36):
I'm glad you're young, because thisis a lot to take on. I
have so much faith in you.I'm so grateful that you came. Zach
Shamberg is a president and CEO ofthe Pennsylvania Healthcare Association. Thank you so
much for making us aware and givingus all the information that's going on with
our elder citizens and nursing homes.And as always, if you miss Insight
when it airs on our iheartstation,catch it anytime on several podcasts up including

(29:00):
your iHeart podcast app. I'm SylviaMoss. This has been Insight. Thank
you so much for listening. Tosee you next week.