November 13, 2023 • 28 mins
“Lack of funding for Pennsylvania Nursing Homes leaves many residents on the streets and desperately looking for a place to live." www.phca.org
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(00:00):
Hi, I am Sylvia Mausin thisis Insight. A few months ago,
I did a program about a veryfew serious issues that impact our seniors and
their families, and what I foundout really concerned me that I decided to
run that Chilgren last week. Andjust in case you're warn't aware, that's
what's going on. Currently, Pennsylvaniais the fifth oldest population in the country,
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and the number of people in thisstate are eighty five and older is
expected to double within the next coupleof years. Solutions to major issues such
as the ones we're going to addresstoday don't come quickly and certainly not easily,
but because of the insight and dedicationof my returning guests, things are
truly looking so much better for ourseniors. With us is Zach Schamberg,
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President and CEO of the Pennsylvania HealthcareAssociation. I just found odd by something's
going on. I'm so excited aboutit, and I just think it's awesome.
I want to really want to getto it quickly. But Jack,
I'm so glad you're here. Well, thank you for having me back.
Here's the deal. First of all, for people who don't know what the
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Pennsylvania Healthcare Association does, Can youtell us about it? Yeah, of
course. We're a statewide advocacy organizationlocated in Harrisburg, two blocks away from
the Capitol, And at the endof the day, our mission is to
fight. It's to fight for longterm care providers and operators across the state.
It's our mission and our job tofight for workers on the front lines,
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and it's our job to fight forthe residents they serve, whether it's
in a nursing home, personal carehome, or assisted living community. And
as I think I said the lasttime we were here and we work together,
our job has never been more importantthan it is today. And it's
never been more important than it's beenfor the last three years or so,
at the beginning of the COVID nineteenpandemic, at the height of the pandemic,
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and now as we're attempting to emergefrom that time. There are a
lot of issues within our sector andwe've got to fix them. Well.
One of the things that we hadtalked about is the fact that they're not
only in Pennsylvania, but across thecountry there nursing home's long care homes that
are closing for a number of reasons. And one of the reasons is because
since COVID, I think, youtell me that they've lost over two hundred
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thousand employees at these nursing homes.Is that still the status and has it
gotten any worse? How bad isit? Well, the workforce crisis is
just that it's a crisis. It'sbeen really the lingering issue that occurred during
the pandemic and it still continues today. And it's the number one whole hurdle
that we have to get over.And to your point, Soviet, it's
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not just in Pennsylvania, but it'sacross the entire country. We are seeing
nursing homes close. But I thinkeven more alarmingly, we're seeing nursing home
shut their doors to new residents orpotential patients simply because they don't have enough
staff. So rooms sit empty,bed sit empty. Nursing home providers are
forced if they can't find full timeemployees, they're forced to rely on costly
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agency staff or contract agency staff,which doesn't really lend itself to continuity of
care for our residents. So whenwe talk about provide care and providing high
quality care, the workforce crisis isthe number one issue affecting long term care
providers across the entire country. Whydo people believe while they left at the
height of the pandemic for a numberof reasons. One, it's not easy
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work. And then before the pandemicwe could say that too, right,
this is not easy work given reimbursementchallenges. Folks are leaving and their going
to sheets or wah wah because theycan make as much or more and it's
a much easier job. And duringthe pandemic, we saw a lot of
folks on the front lines who werenearing retirement who decided, you know what,
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this is just not for me.I'm going to leave now, whether
I'm going to go to a differentindustry or I'm going to retire at the
end of the day. That's createda really perfect storm for our sector.
And it's not just nursing homes,but personal care and assisted living as well.
Now, it's our job to replenishthe labor pool, and it's our
job to make sure that our workforcepipeline is up and running so that we
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can care for our older population.Well, you know what, when I
saw the press release from Eric,your communications director, I could hardly wait
to talk to you again because somethingwe had talked about again before has come
to fruition. It's all about inan awesome partnership you have with Harrisburg University.
It's going to really put a dentinto the situation. Yeah, I
think that's right. And again,when we talk about shoring up our workforce
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pipeline, and when we talk aboutensuring that we have enough workers, it's
making sure that we're able to provideenough incentive for folks to either come to
long term care in the first placeor to come back to long term care.
So we've been working with our friendsat Harrisburg University to offer incentives and
tuition assistants for our workforce so thatthey can go, they can take classes,
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they can get twenty five percent offtheir tuition. As long as they're
a PHCA member, they can furthertheir career. And not only that,
and I think this is a realhidden jam of this proposal and this program.
Family members of long term care workersare eligible for up to fifteen percent.
So it's not just you, butit's your significant other, it's your
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loved ones, it's your family membersthat are able to take advantage of that.
And again it's just ensuring that wecan incentivize our workforce to stay or
to come back to long term care. When does that kick in. It's
already kicked in. So if you'rea PHCA member, you can reach out
to us, you can contact ourteam, or you can go right to
Harrisburg University and you can sign upfor courses and you can begin today.
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And Harrisburg University has campuses in Harrisburgand Philly. Right, that's exactly right.
So it's stretching across this part ofthe state. And also it's just
not certifications. You can go asfar as getting what your bachelor's and nursing.
That's exactly right. So do youbeat that? You can't beat it.
And what we aim to do atthe end of the day is we
work with partners like Harrisburg University.We work with others to make sure that
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we're investing back and we're giving backto our workforce. That is so important
when we have to compare with anywith other service industries with wah wah,
with sheets, with anyone. We'vegot to entice folks to stay in long
term care. Are you anticipating apartner with other universities? Would we would
love to. And that's something that'salways on the table, and it shouldn't
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just be universities, by the way, but we talked about it last time.
Investing in K through twelve education,that's another thing that I was going
to talk to that. Excuse mea second. Yeah, I've been a
proponent of that for years and yearsand years. If you want to build
a caring society, you start withthe kids when they're little, as you
call them compassionate workers, right,careers of compassion and college in some ways
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might be too late. It's startingin high school. It's starting even in
middle school. Whether we ask studentsto spend a day at a nursing home
or we ask students to come toread to the residents, we really expose
them to these types of careers becausethey're going to be around, given our
aging population the next ten to twentyto thirty years, and enticing folks to
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say, don't look here or there, don't look at other parts of the
healthcare continuum, look at long termcare because it is a career of compassion.
Oh, I'm so excited about this. I'm telling everybody about it.
I think it's wonderful. Are yougoing to do any advertising. What people
know about this. I mean,you're sending all this information out to your
member. You have four hundred members, right, we have over four hundred
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and fifty members. We're putting itout on all of our social channels,
so whether it's Facebook, Twitter,LinkedIn, if you're not following PHCA cares
you should, we're putting it outthat way in any way we can get
the word out. We're also workingwith Harrisburg University to get the word out
anyway we can do that to makesure that folks know about it. Again,
you've got to be a PHCA member. So if you're not a PHCA
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member, the question is what areyou waiting for? Come talk to us.
What gift you're giving your members?I mean, come on, this
is an no brainer. Well,and it's really it's been. It's come
to fruition because we've asked our memberswhat are you you need? What do
you need to be able to offeryour employees or what do you need to
be able to recruit new employees tothe front lines. Tuition assistance comes up
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time and time again, So whynot from an association standpoint, why not
take the lead on that. Ithink that's incredible. You know. I
think was in May that governor announcedwhat was it, It was an executive
order that he had a ten yearplan. Yep, Okay, talk to
us about that and how do youfeel about that? Yeah, So it's
the Pennsylvania Plan on Aging. Andagain it's a ten year plan. I
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am proud to say that PHCA wasthe first association to bring in the Department
of Aging and the folks leading thisten year plan to talk to our members,
to hold what it was essentially alistening session in June and to ask
the question, what do you need, what do we need to be prepared
for in the next ten years,and what do you long term care providers
and workers need to ensure that you'regoing to be successful. Well, tell
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us about that conversation. Where'd youfind out? Well, what we found
out again we need reimbursement. Weneed toquate or sufficient reimbursement. How's that
going? Because the last time Iwas pretty frustrating. Last time you were
here, it was very frustrated,and it's never not been a very frustrating
issue to talk about. I mean, for years, Pennsylvania unfortunately underfunded Medicaid
reimbursement for nursing homes. If seventyfive percent of residents rely on Medicaid for
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their care, but the reimbursement ratedoesn't increase for eight years, that handicaps
providers in terms of providing quality care, investing in the care that they're turning
on the light, turning on thelights, investing in their workforce. If
Medicaid is the number one payer source, then we have no choice but to
rely on legislators and governors and administrationsthat that reimbursement rate is going to be
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sufficient. So that's an ongoing fight. We do said, the governor's pretty
supportive of senior citizens in Pennsylvania.Yeah, governorship heir has been very supportive
of senior citizens. I mean hedid start the ten year plan. We
did receive a two percent Medicaid reimbursementincrease for nursing homes that will start next
year. That was contained in thegovernor's proposal. So the governor has taken
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steps as well as the legislature.They both sides have taken steps to support
our seniors. But I want tobe clear, more has to be done
because we're not only dealing with challengesat the state level. But right now
we're dealing with challenges at the federallevel. And well, and there is
an impending proposal at the federal level, and what is that tell us about
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that? Yeah, CMS, theCenters for Medicare and Medicaid Services two months
ago proposed a federal staffing minimum fornursing homes. We did this work last
year in Pennsylvania. PHCA was proudto work with the workers' unions, then
Governor Tom Wolfe, members of thelegislature, the Department of Health to increase
staffing minimums in nursing homes in Pennsylvaniafor the first time in twenty years.
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And what do you know, ayear later, the federal government says,
we've got a better idea. We'regoing to raise staffing even higher, but
we're going to do it throughout thecountry. It doesn't make sense for the
country, it doesn't make sense forPennsylvania. It's not funded, the workers
aren't there, and we're working todefeat it. That's a that's a good
we you know, we haven't calledit that, but you can use it.
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But at this point, it presentsa lot of challenges to providers.
And we started this conversation talking aboutthe access to care crisis that will only
be exacerbated through if this federal mandategoes into a FILI. Oh my gosh,
so we're better off take care ofour own in our own state.
Well, that's exactly right. Leavethat decision up to the states to know
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what's best for their providers and mostimportantly, the residents that they serve.
Bureaucrats in Washington, d C.Don't know how Pennsylvania works. They don't
know how Louisiana work, Louisiana works, how California works. Let the states
do this on their own. Whatis their benefit to offering this across the
country? Just is it a likesort of like a PR move, Well
we did this for you, oris what do they is it going back
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to everybody's on the same page.Well, I think it's it's a PR
move because they can say in theBiden administration can say that they're working on
it. I also think it's fairto say that it's probably a handout to
a lot of the workers' unions whohave helped craft this proposal. But again,
at the end of the day,if it's not going to be funded
and if the workers aren't there itjust doesn't make sense. It will only
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harm patient care, which is theexact opposite point of the proposal in the
minds of CMS. You had senta letter I believe it was in When
was it to We send a lotof letters to which letter was this?
Okay, let's talk about the oneI think we were talking about. It
was I think here was it toBernie Sanders. Yes, we sent a
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letter to Senator Bernie A. Somebodyever get back to you, And that's
what I like that. Well,you know, Senator Bernie Sanders chair the
Help Committee, and to his creditand to the Help Committee's credit, they
reached out and said, tell usabout the workforce challenges in long term care
and if you have something to say, say it. And we did.
We sent a letter to the committee, We sent a letter to members of
Congress, and we said, hereare the challenges, here's what we need.
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We don't need as mandate, wedon't need the Biden administration telling Pennsylvania
what to do. Let us handleit, but we could use some help,
whether it's immigration reform, whether it'spassing legislation at the federal level to
get rid of some of our archaiclaws, or some of the regulatory burdens.
Okay, let's take those one.Time you talked about the archaic laws,
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can you talk about something, Yeah, we're going We see that all
the time unfortunately in Pennsylvania, andsome of the things that we're doing at
the state level right now will ultimatelyand hopefully counteract some of those archaic laws.
It shouldn't take six weeks or sixmonths for a prospective nurse to get
their license. Let's put that outright there. At the height of the
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pandemic, we cut through a lotof the red tape and a lot of
the bureaucracy and said, if thereare nurses in Pennsylvania, or if there
are nurses in other states, theycan come here and they can work right
away. But now we flip thatand we're back to the long way times.
We've got to get rid of that. We've got to get rid of
some of the requirements that make itsuch a inefficient process to work in a
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long term care facility. We're nottalking about lowering the bar of care or
the bar to get in, butwe're just saying it shouldn't take weeks or
months to start a career. Wewill lose people if that happened. Was
it always that way? Zacher?Is it just something that just keeps I
think it's it's build up. Ithink it's built up over the years,
and I think there have been layersof regulatory challenges or bureaucracy added to the
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process year after year after year andagain. If we learned anything at the
height of the pandemic, it's thatwe cannot afford to wait on government.
Providers have to be able to act, They have to be able to care
for their residents, and they needto ensure that there are people at the
bedside to care for their residence.So we're looking to change some of those
rules and make it a more efficientprocess. That's just one example. Immigration.
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Talk to me about immigration, Howabout the impact that has Yeah,
So again, at the federal level, we're talking about a new date that
would raise the threshold specifically for ourends registered nurses and nurse aides or CNAs
to be caring for residents in anursing home. If we can't find folks
in the state of Pennsylvania, andif we can't find folks within the borders
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of the United States, we haveto look elsewhere. And we need immigration
reform or comprehensive immigration reform to bringfolks in from other countries. We have
providers who are working with African countries, with the Philippines to bring nurses over.
The problem is, at the sametime the Biden administration introduced this staffing
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mandate proposal, they basically cut theability or they stop the ability for nurses
from overseas to come to the UnitedStates and work. That is stopped,
that is backlogged, and there arenot nurses coming over anymore. So you
tell me how that makes sense.We need more nurses, but we're not
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gonna let nurses come from overseas towork in Pennsylvania or the United States.
None of it makes sense. Weneed that to change exactly. That's a
big problem. Okay. I wantedto ask you a couple of other things
about that too. You have alwaysI've told a lot of people, you're
the kind of person. This isn'tsome guy that got a job because he
has great degrees. You've had it. I mean, this is part of
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your family, part of your life. This is more of a calling for
you than it is a career foryou. Yeah, and my degrees are
okay, but you're right that mypassion from this really comes from growing up
in the business and growing up withinlong term care. My mom started as
a nurse, my aunt started asa nurse. They've both been in long
term care for twenty plus years.My stepfather has been in long term care
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for twenty plus years. But really, at the end of the day,
it's because of my grandfather, mymom's father. He was diagnosed with dementia
ten years ago, and even duringthe height of the pandemic, he was
in a nursing home, he wasin personal care, he was in a
secure dementia unit at one point.I may have mentioned this last time we
said goodbye to him, because hecontracted COVID nineteen and we had to say
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goodbye to him over FaceTime. Thatwas extremely hard. Now he survived that,
and unfortunately he passed earlier this yearin January. But I really saw
it firsthand. I saw what myfamily had to go through firsthand. But
I also saw the dedicated caregivers whowere at his side, and it really
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reignited my passion and our team's passionfor doing this and for achieving positive outcomes
to make sure that folks like mygrandfather would be cared for. And that
their family members could rest well knowingthat they were getting the right type of
care and high quality care. Youknow, I've always burned me up the
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way we are, especially over thelast twenty thirty years. Wait other societies,
other countries like Japan, how theyhave such respect for their elders and
we've lost that in this country.Well, I think we don't address the
problem until it's almost too late.Yeah, we saw that in twenty twenty
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two. I mean, the membersof our legislature, our state legislature as
well as the governor really made longterm care and nursing homes the priority in
the state budget. It can bedone. We just can't afford to wait
another eight to ten years to dosomething about it, or it will be
too late. So we've got toensure, just like we do education,
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every single year. If our fastestgrowing demographic is age eighty five and older
in this state, then we needto make sure that that demographic is supported
each and every year, whether it'sin the state budget or in the state
House or the state Senate. Well, our older population is what got us
all here, where it took usall here. They are responsible for life
without the politics that we have today, all the good things that we have
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today not only because of their hardwork, but because of their wisdom.
And it always frustrated me about whatwe had just spoken about that the respect
that they honoring someone just for thefact of what they've gone through life isn't
there. But you really don't addressthose type of issues with your organization,
do you? Oh, we do, and we see it. We go
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and visit our members, whether it'sa nursing home, personal care home.
You do, I know, Zach, you do well. And we see
that dedication. We see it inthe workforce. We see those dedicated individuals
who do care about our oldest populationand our greatest generation. But we need
more of that. At the endof the day, We need the help
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and support of our policymakers, bothin Harrisburg and in Washington, d C.
So we need to make sure thatthose workers and ultimately those residents are
the priority. And you know what, as I may have mentioned last time
we met, that I believe thatgrassroots efforts are the most effective things that
elections are won on a local level. That's why I truly believe in get
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in touch with these hammer these guys, your legislators. If you don't know,
there's an easy way to find outwho represents you on a national or
statewide level. Call them and callthem, and call them and call them
because you know they listen, right, they do. And I think there
is a recognition there certainly was lastyear and there has been this year.
There's a recognition by state representative,state senators, members of Congress that this
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is a growing issue and the seniorhomelessness population can you imagine, it is
skyrocketing. And if we can't puta stop to this, if we can't
stop the crisis, if we can'tstop nursing homes from closing their doors,
we will see more senior homelessness inthis state. That's the exact wrong route
that we need to go. Sothere is a recognition, whether it's in
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Harrisberg or DC. We just needto act on it. And yes,
our number one goal is to ensurethat our members can be good advocates,
strong advocates and tell their legislators exactlywhat they need. Call them on it,
Call them on and call them onit, and you know, if
they're not impacted by the fact thatthey make care, make care. Getting
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re elected is first and I meanI had somebody in my family that worked
as an intern in the in Congress, and when somebody was elected, first
thing they said it when somebody youknow a lot of people go to DC
with the whole intention of I'm goingto do good things. First thing they're
told on both sides of the aislesis shut your mouth. If you want
the money to get reelected. Thisis what's what you're going to have to
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do. Right Well, I thinkwhat we're seeing is again our members speaking
out. We're seeing a recognition oflawmakers that this needs to be prioritized or
that this is a growing issue.And what I would say to your listeners
if you're in the state of Pennsylvania, or if you're anywhere around the country
that vote for long term care andvote on long term care issues, So
if you're a worker, if you'rea frontline nurse, if you're a family
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member of a resident, if you'rea resident in a long term care facility,
this can be an issue that youvote on and vote for. So
make sure your lawmaker knows that thatwe're watching. We're watching their support of
long term care. I would imaginethat the Pennsylvania nurses Association really supports what
you're doing, don't they. Wework in tandem with the Nurses Association.
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We've reached out again and worked withSCIU and the workers' unions. I mean,
we're looking to work across the aislewith anybody to make sure that this
sector is supported. What now,You've been doing this for quite a while,
and it's a part of who,as I said, who you are
other than these issues we've talked aboutover the last couple of times you were
here. Is there anything else thatyou're thinking about or things that we need
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to address. I mean, you'rewith the primarily you're looking out for these
places where people live, where seniorslive. Yeah, at the end of
the day, I think if weI think, if we're looking at the
next five to ten years, weneed to be innovative. And it's one
of the reasons we did what wedid with Harrisburg University. We need to
look for more solutions. We needto look at bringing, for instance,
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Medicaid into assisted living in Pennsylvania.If we're not going to fund the Medicaid
program for nursing homes, let's findalternatives and other solutions. Again, at
the end of the day, wecan't keep doing things that we've been doing
for the last ten to fifteen years. It's insane. It's a changing environment.
We need to be innovative. Andmy message to the Shapiro administration as
well as the General Assembly is justlisten and let us work with you.
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Let us bring you ideas, becauseI do think we can be innovative together.
I would imagine they've been pretty supportiveof you. They've been fantastic,
and we've enjoyed a very good relationshipagain with Republicans and Democrats in the House
and Senator, as well as thegovernor. I think we're on the right
track. There's a lot to do, but we're on the right track.
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Is there anything pending as far aslegislation right now that you can support from
our listeners. Yeah. In fact, about a week ago, there was
a bill that came out of theSenate Health Committee that would create, for
the first time in Pennsylvania a CertifiedMedication Aid or a CMA. Thirty states
across the country have this position,Pennsylvania does not. We're working to make
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sure that nursing homes can utilize thisposition. It's on second consideration in the
Senate Hopefully it will move through theSenate this year and then we need the
House to send it to the governorearly next year, if not before.
That would be a fantastic innovative solutionsto solving the workforce crisis. I don't
know if this is something you address, but we've heard on the news over
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the last couple of weeks that numberedthe pharmacies, especially the pharmacists, are
thinking about striking. Oh my god, I think about all the older people
they need their meds. Yeah,we see it. We've unfortunately, I
have seen it with the pharmacists nowthis week. We've saw it with the
hospital workers last week. We sawit with nursing home workers last year.
Last week unfortunately Lancaster when they shoutedthat if we don't get this fixed,
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if we don't get our wage raises, we should shut this down. We
should shut this sector down. That'sthe wrong message, first and foremost to
be talking about in Pennsylvania. Againgiving our aging population. But what we
learned during the pandemic Soviet is thateverything of every part of the health care
continuum affects the other parts of thehealthcare continuum. So if the hospital strike,
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if the pharmacist strike, that willaffect us, that will affect seniors.
We've got to be a strong continuumto make sure that we can care
for our seniors. We're running ontime quickly, and I could talk to
you for days, seriously, becauseif you're not a senior citizen you're going
to be hopefully, or you havesomebody in your family right now that you
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love who is a senior sin it'sgoing to impact unless you're a millionaire.
Long term healthcare insurance is extremely expensive. Should be started when you're young,
and when you're young, you're raisingyour kids. So I don't know how
effective that is. But over theyears, you've done so much to move
this ahead. Don't you get tired? Never, neverver, No, Because
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again, we see the dedication fromour workforce, We see the dedication from
our frontline caregivers, and that keepsus going. What can we find on
your website? You can find informationon what we're doing, upcoming events,
advocacy initiatives. I would encourage yourlisteners again follow us, whether it's on
Facebook, Twitter, LinkedIn PHCA cares. We are constantly putting out information and
(26:27):
important updates regarding long term care inPennsylvania and if we want to find out.
Of course it's open to your membersand their families if you want to
find out more about that. Andperhaps someone hasn't told their members yet about
it. Are their employees about itand they're listening and they want to get
in touch with them. Where dothey get the information from? Is it
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through your website? Yeah, itcan be on our website, It can
be it from Harrisburg University. ButI would encourage if you're a member of
ours, come to us. ComeTOPHCA dot org again, go to our
social media sites, reach out tous. We can get you all the
information that you need. Are youcoming back again? If you'll have me?
I mean I'll stand outside every dayas long as you have me here
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and you want to talk. Thankyou that we owe our senior systems so
much respective warmth for them, wewouldn't be here. And as I said
to Zach, I'd have you inevery day because not only because you've got
such passion and you are sincere aboutthis. This comes from the bottom of
your heart, so you don't can'timagine how much this means to me.
My guest again, Boy, thatwent fast, isn't it? Zach Shamberg,
(27:33):
Presidency of the Pennsylvania Healthcare Association.As I said, this is going
to impact you. If it's notnow, it'll happen down the line,
or right now, it's impacting someoneyou love. For more information, go
to the Pennsylvania Healthcare Association website PHCAdot org. My listeners. As always,
if you miss Insight when it airson our ten iHeart stations, catch
it any time in on your iHeartpodcast stapp or your favorite podcast s app
(27:57):
and I hope it is the iHeartup. I'm Sylvia Moss. This has
been Insight. Thank you so muchfor listening to you next week.
Hi, I am Sylvia Mausin thisis Insight. A few months ago,
I did a program about a veryfew serious issues that impact our seniors and
their families, and what I foundout really concerned me that I decided to
run that Chilgren last week. Andjust in case you're warn't aware, that's
what's going on. Currently, Pennsylvaniais the fifth oldest population in the country,
(00:21):
and the number of people in thisstate are eighty five and older is
expected to double within the next coupleof years. Solutions to major issues such
as the ones we're going to addresstoday don't come quickly and certainly not easily,
but because of the insight and dedicationof my returning guests, things are
truly looking so much better for ourseniors. With us is Zach Schamberg,
(00:42):
President and CEO of the Pennsylvania HealthcareAssociation. I just found odd by something's
going on. I'm so excited aboutit, and I just think it's awesome.
I want to really want to getto it quickly. But Jack,
I'm so glad you're here. Well, thank you for having me back.
Here's the deal. First of all, for people who don't know what the
(01:03):
Pennsylvania Healthcare Association does, Can youtell us about it? Yeah, of
course. We're a statewide advocacy organizationlocated in Harrisburg, two blocks away from
the Capitol, And at the endof the day, our mission is to
fight. It's to fight for longterm care providers and operators across the state.
It's our mission and our job tofight for workers on the front lines,
(01:23):
and it's our job to fight forthe residents they serve, whether it's
in a nursing home, personal carehome, or assisted living community. And
as I think I said the lasttime we were here and we work together,
our job has never been more importantthan it is today. And it's
never been more important than it's beenfor the last three years or so,
at the beginning of the COVID nineteenpandemic, at the height of the pandemic,
(01:45):
and now as we're attempting to emergefrom that time. There are a
lot of issues within our sector andwe've got to fix them. Well.
One of the things that we hadtalked about is the fact that they're not
only in Pennsylvania, but across thecountry there nursing home's long care homes that
are closing for a number of reasons. And one of the reasons is because
since COVID, I think, youtell me that they've lost over two hundred
(02:07):
thousand employees at these nursing homes.Is that still the status and has it
gotten any worse? How bad isit? Well, the workforce crisis is
just that it's a crisis. It'sbeen really the lingering issue that occurred during
the pandemic and it still continues today. And it's the number one whole hurdle
that we have to get over.And to your point, Soviet, it's
(02:29):
not just in Pennsylvania, but it'sacross the entire country. We are seeing
nursing homes close. But I thinkeven more alarmingly, we're seeing nursing home
shut their doors to new residents orpotential patients simply because they don't have enough
staff. So rooms sit empty,bed sit empty. Nursing home providers are
forced if they can't find full timeemployees, they're forced to rely on costly
(02:52):
agency staff or contract agency staff,which doesn't really lend itself to continuity of
care for our residents. So whenwe talk about provide care and providing high
quality care, the workforce crisis isthe number one issue affecting long term care
providers across the entire country. Whydo people believe while they left at the
height of the pandemic for a numberof reasons. One, it's not easy
(03:14):
work. And then before the pandemicwe could say that too, right,
this is not easy work given reimbursementchallenges. Folks are leaving and their going
to sheets or wah wah because theycan make as much or more and it's
a much easier job. And duringthe pandemic, we saw a lot of
folks on the front lines who werenearing retirement who decided, you know what,
(03:34):
this is just not for me.I'm going to leave now, whether
I'm going to go to a differentindustry or I'm going to retire at the
end of the day. That's createda really perfect storm for our sector.
And it's not just nursing homes,but personal care and assisted living as well.
Now, it's our job to replenishthe labor pool, and it's our
job to make sure that our workforcepipeline is up and running so that we
(03:57):
can care for our older population.Well, you know what, when I
saw the press release from Eric,your communications director, I could hardly wait
to talk to you again because somethingwe had talked about again before has come
to fruition. It's all about inan awesome partnership you have with Harrisburg University.
It's going to really put a dentinto the situation. Yeah, I
think that's right. And again,when we talk about shoring up our workforce
(04:23):
pipeline, and when we talk aboutensuring that we have enough workers, it's
making sure that we're able to provideenough incentive for folks to either come to
long term care in the first placeor to come back to long term care.
So we've been working with our friendsat Harrisburg University to offer incentives and
tuition assistants for our workforce so thatthey can go, they can take classes,
(04:48):
they can get twenty five percent offtheir tuition. As long as they're
a PHCA member, they can furthertheir career. And not only that,
and I think this is a realhidden jam of this proposal and this program.
Family members of long term care workersare eligible for up to fifteen percent.
So it's not just you, butit's your significant other, it's your
(05:08):
loved ones, it's your family membersthat are able to take advantage of that.
And again it's just ensuring that wecan incentivize our workforce to stay or
to come back to long term care. When does that kick in. It's
already kicked in. So if you'rea PHCA member, you can reach out
to us, you can contact ourteam, or you can go right to
Harrisburg University and you can sign upfor courses and you can begin today.
(05:29):
And Harrisburg University has campuses in Harrisburgand Philly. Right, that's exactly right.
So it's stretching across this part ofthe state. And also it's just
not certifications. You can go asfar as getting what your bachelor's and nursing.
That's exactly right. So do youbeat that? You can't beat it.
And what we aim to do atthe end of the day is we
work with partners like Harrisburg University.We work with others to make sure that
(05:53):
we're investing back and we're giving backto our workforce. That is so important
when we have to compare with anywith other service industries with wah wah,
with sheets, with anyone. We'vegot to entice folks to stay in long
term care. Are you anticipating apartner with other universities? Would we would
love to. And that's something that'salways on the table, and it shouldn't
(06:15):
just be universities, by the way, but we talked about it last time.
Investing in K through twelve education,that's another thing that I was going
to talk to that. Excuse mea second. Yeah, I've been a
proponent of that for years and yearsand years. If you want to build
a caring society, you start withthe kids when they're little, as you
call them compassionate workers, right,careers of compassion and college in some ways
(06:41):
might be too late. It's startingin high school. It's starting even in
middle school. Whether we ask studentsto spend a day at a nursing home
or we ask students to come toread to the residents, we really expose
them to these types of careers becausethey're going to be around, given our
aging population the next ten to twentyto thirty years, and enticing folks to
(07:03):
say, don't look here or there, don't look at other parts of the
healthcare continuum, look at long termcare because it is a career of compassion.
Oh, I'm so excited about this. I'm telling everybody about it.
I think it's wonderful. Are yougoing to do any advertising. What people
know about this. I mean,you're sending all this information out to your
member. You have four hundred members, right, we have over four hundred
(07:24):
and fifty members. We're putting itout on all of our social channels,
so whether it's Facebook, Twitter,LinkedIn, if you're not following PHCA cares
you should, we're putting it outthat way in any way we can get
the word out. We're also workingwith Harrisburg University to get the word out
anyway we can do that to makesure that folks know about it. Again,
you've got to be a PHCA member. So if you're not a PHCA
(07:46):
member, the question is what areyou waiting for? Come talk to us.
What gift you're giving your members?I mean, come on, this
is an no brainer. Well,and it's really it's been. It's come
to fruition because we've asked our memberswhat are you you need? What do
you need to be able to offeryour employees or what do you need to
be able to recruit new employees tothe front lines. Tuition assistance comes up
(08:09):
time and time again, So whynot from an association standpoint, why not
take the lead on that. Ithink that's incredible. You know. I
think was in May that governor announcedwhat was it, It was an executive
order that he had a ten yearplan. Yep, Okay, talk to
us about that and how do youfeel about that? Yeah, So it's
the Pennsylvania Plan on Aging. Andagain it's a ten year plan. I
(08:31):
am proud to say that PHCA wasthe first association to bring in the Department
of Aging and the folks leading thisten year plan to talk to our members,
to hold what it was essentially alistening session in June and to ask
the question, what do you need, what do we need to be prepared
for in the next ten years,and what do you long term care providers
and workers need to ensure that you'regoing to be successful. Well, tell
(08:54):
us about that conversation. Where'd youfind out? Well, what we found
out again we need reimbursement. Weneed toquate or sufficient reimbursement. How's that
going? Because the last time Iwas pretty frustrating. Last time you were
here, it was very frustrated,and it's never not been a very frustrating
issue to talk about. I mean, for years, Pennsylvania unfortunately underfunded Medicaid
reimbursement for nursing homes. If seventyfive percent of residents rely on Medicaid for
(09:18):
their care, but the reimbursement ratedoesn't increase for eight years, that handicaps
providers in terms of providing quality care, investing in the care that they're turning
on the light, turning on thelights, investing in their workforce. If
Medicaid is the number one payer source, then we have no choice but to
rely on legislators and governors and administrationsthat that reimbursement rate is going to be
(09:43):
sufficient. So that's an ongoing fight. We do said, the governor's pretty
supportive of senior citizens in Pennsylvania.Yeah, governorship heir has been very supportive
of senior citizens. I mean hedid start the ten year plan. We
did receive a two percent Medicaid reimbursementincrease for nursing homes that will start next
year. That was contained in thegovernor's proposal. So the governor has taken
(10:03):
steps as well as the legislature.They both sides have taken steps to support
our seniors. But I want tobe clear, more has to be done
because we're not only dealing with challengesat the state level. But right now
we're dealing with challenges at the federallevel. And well, and there is
an impending proposal at the federal level, and what is that tell us about
(10:24):
that? Yeah, CMS, theCenters for Medicare and Medicaid Services two months
ago proposed a federal staffing minimum fornursing homes. We did this work last
year in Pennsylvania. PHCA was proudto work with the workers' unions, then
Governor Tom Wolfe, members of thelegislature, the Department of Health to increase
staffing minimums in nursing homes in Pennsylvaniafor the first time in twenty years.
(10:48):
And what do you know, ayear later, the federal government says,
we've got a better idea. We'regoing to raise staffing even higher, but
we're going to do it throughout thecountry. It doesn't make sense for the
country, it doesn't make sense forPennsylvania. It's not funded, the workers
aren't there, and we're working todefeat it. That's a that's a good
we you know, we haven't calledit that, but you can use it.
(11:09):
But at this point, it presentsa lot of challenges to providers.
And we started this conversation talking aboutthe access to care crisis that will only
be exacerbated through if this federal mandategoes into a FILI. Oh my gosh,
so we're better off take care ofour own in our own state.
Well, that's exactly right. Leavethat decision up to the states to know
(11:30):
what's best for their providers and mostimportantly, the residents that they serve.
Bureaucrats in Washington, d C.Don't know how Pennsylvania works. They don't
know how Louisiana work, Louisiana works, how California works. Let the states
do this on their own. Whatis their benefit to offering this across the
country? Just is it a likesort of like a PR move, Well
we did this for you, oris what do they is it going back
(11:54):
to everybody's on the same page.Well, I think it's it's a PR
move because they can say in theBiden administration can say that they're working on
it. I also think it's fairto say that it's probably a handout to
a lot of the workers' unions whohave helped craft this proposal. But again,
at the end of the day,if it's not going to be funded
and if the workers aren't there itjust doesn't make sense. It will only
(12:15):
harm patient care, which is theexact opposite point of the proposal in the
minds of CMS. You had senta letter I believe it was in When
was it to We send a lotof letters to which letter was this?
Okay, let's talk about the oneI think we were talking about. It
was I think here was it toBernie Sanders. Yes, we sent a
(12:37):
letter to Senator Bernie A. Somebodyever get back to you, And that's
what I like that. Well,you know, Senator Bernie Sanders chair the
Help Committee, and to his creditand to the Help Committee's credit, they
reached out and said, tell usabout the workforce challenges in long term care
and if you have something to say, say it. And we did.
We sent a letter to the committee, We sent a letter to members of
Congress, and we said, hereare the challenges, here's what we need.
(12:58):
We don't need as mandate, wedon't need the Biden administration telling Pennsylvania
what to do. Let us handleit, but we could use some help,
whether it's immigration reform, whether it'spassing legislation at the federal level to
get rid of some of our archaiclaws, or some of the regulatory burdens.
Okay, let's take those one.Time you talked about the archaic laws,
(13:22):
can you talk about something, Yeah, we're going We see that all
the time unfortunately in Pennsylvania, andsome of the things that we're doing at
the state level right now will ultimatelyand hopefully counteract some of those archaic laws.
It shouldn't take six weeks or sixmonths for a prospective nurse to get
their license. Let's put that outright there. At the height of the
(13:43):
pandemic, we cut through a lotof the red tape and a lot of
the bureaucracy and said, if thereare nurses in Pennsylvania, or if there
are nurses in other states, theycan come here and they can work right
away. But now we flip thatand we're back to the long way times.
We've got to get rid of that. We've got to get rid of
some of the requirements that make itsuch a inefficient process to work in a
(14:03):
long term care facility. We're nottalking about lowering the bar of care or
the bar to get in, butwe're just saying it shouldn't take weeks or
months to start a career. Wewill lose people if that happened. Was
it always that way? Zacher?Is it just something that just keeps I
think it's it's build up. Ithink it's built up over the years,
and I think there have been layersof regulatory challenges or bureaucracy added to the
(14:30):
process year after year after year andagain. If we learned anything at the
height of the pandemic, it's thatwe cannot afford to wait on government.
Providers have to be able to act, They have to be able to care
for their residents, and they needto ensure that there are people at the
bedside to care for their residence.So we're looking to change some of those
rules and make it a more efficientprocess. That's just one example. Immigration.
(14:54):
Talk to me about immigration, Howabout the impact that has Yeah,
So again, at the federal level, we're talking about a new date that
would raise the threshold specifically for ourends registered nurses and nurse aides or CNAs
to be caring for residents in anursing home. If we can't find folks
in the state of Pennsylvania, andif we can't find folks within the borders
(15:20):
of the United States, we haveto look elsewhere. And we need immigration
reform or comprehensive immigration reform to bringfolks in from other countries. We have
providers who are working with African countries, with the Philippines to bring nurses over.
The problem is, at the sametime the Biden administration introduced this staffing
(15:43):
mandate proposal, they basically cut theability or they stop the ability for nurses
from overseas to come to the UnitedStates and work. That is stopped,
that is backlogged, and there arenot nurses coming over anymore. So you
tell me how that makes sense.We need more nurses, but we're not
(16:03):
gonna let nurses come from overseas towork in Pennsylvania or the United States.
None of it makes sense. Weneed that to change exactly. That's a
big problem. Okay. I wantedto ask you a couple of other things
about that too. You have alwaysI've told a lot of people, you're
the kind of person. This isn'tsome guy that got a job because he
has great degrees. You've had it. I mean, this is part of
(16:25):
your family, part of your life. This is more of a calling for
you than it is a career foryou. Yeah, and my degrees are
okay, but you're right that mypassion from this really comes from growing up
in the business and growing up withinlong term care. My mom started as
a nurse, my aunt started asa nurse. They've both been in long
term care for twenty plus years.My stepfather has been in long term care
(16:48):
for twenty plus years. But really, at the end of the day,
it's because of my grandfather, mymom's father. He was diagnosed with dementia
ten years ago, and even duringthe height of the pandemic, he was
in a nursing home, he wasin personal care, he was in a
secure dementia unit at one point.I may have mentioned this last time we
said goodbye to him, because hecontracted COVID nineteen and we had to say
(17:14):
goodbye to him over FaceTime. Thatwas extremely hard. Now he survived that,
and unfortunately he passed earlier this yearin January. But I really saw
it firsthand. I saw what myfamily had to go through firsthand. But
I also saw the dedicated caregivers whowere at his side, and it really
(17:36):
reignited my passion and our team's passionfor doing this and for achieving positive outcomes
to make sure that folks like mygrandfather would be cared for. And that
their family members could rest well knowingthat they were getting the right type of
care and high quality care. Youknow, I've always burned me up the
(17:56):
way we are, especially over thelast twenty thirty years. Wait other societies,
other countries like Japan, how theyhave such respect for their elders and
we've lost that in this country.Well, I think we don't address the
problem until it's almost too late.Yeah, we saw that in twenty twenty
(18:18):
two. I mean, the membersof our legislature, our state legislature as
well as the governor really made longterm care and nursing homes the priority in
the state budget. It can bedone. We just can't afford to wait
another eight to ten years to dosomething about it, or it will be
too late. So we've got toensure, just like we do education,
(18:40):
every single year. If our fastestgrowing demographic is age eighty five and older
in this state, then we needto make sure that that demographic is supported
each and every year, whether it'sin the state budget or in the state
House or the state Senate. Well, our older population is what got us
all here, where it took usall here. They are responsible for life
without the politics that we have today, all the good things that we have
(19:03):
today not only because of their hardwork, but because of their wisdom.
And it always frustrated me about whatwe had just spoken about that the respect
that they honoring someone just for thefact of what they've gone through life isn't
there. But you really don't addressthose type of issues with your organization,
do you? Oh, we do, and we see it. We go
(19:25):
and visit our members, whether it'sa nursing home, personal care home.
You do, I know, Zach, you do well. And we see
that dedication. We see it inthe workforce. We see those dedicated individuals
who do care about our oldest populationand our greatest generation. But we need
more of that. At the endof the day, We need the help
(19:47):
and support of our policymakers, bothin Harrisburg and in Washington, d C.
So we need to make sure thatthose workers and ultimately those residents are
the priority. And you know what, as I may have mentioned last time
we met, that I believe thatgrassroots efforts are the most effective things that
elections are won on a local level. That's why I truly believe in get
(20:10):
in touch with these hammer these guys, your legislators. If you don't know,
there's an easy way to find outwho represents you on a national or
statewide level. Call them and callthem, and call them and call them
because you know they listen, right, they do. And I think there
is a recognition there certainly was lastyear and there has been this year.
There's a recognition by state representative,state senators, members of Congress that this
(20:32):
is a growing issue and the seniorhomelessness population can you imagine, it is
skyrocketing. And if we can't puta stop to this, if we can't
stop the crisis, if we can'tstop nursing homes from closing their doors,
we will see more senior homelessness inthis state. That's the exact wrong route
that we need to go. Sothere is a recognition, whether it's in
(20:53):
Harrisberg or DC. We just needto act on it. And yes,
our number one goal is to ensurethat our members can be good advocates,
strong advocates and tell their legislators exactlywhat they need. Call them on it,
Call them on and call them onit, and you know, if
they're not impacted by the fact thatthey make care, make care. Getting
(21:15):
re elected is first and I meanI had somebody in my family that worked
as an intern in the in Congress, and when somebody was elected, first
thing they said it when somebody youknow a lot of people go to DC
with the whole intention of I'm goingto do good things. First thing they're
told on both sides of the aislesis shut your mouth. If you want
the money to get reelected. Thisis what's what you're going to have to
(21:37):
do. Right Well, I thinkwhat we're seeing is again our members speaking
out. We're seeing a recognition oflawmakers that this needs to be prioritized or
that this is a growing issue.And what I would say to your listeners
if you're in the state of Pennsylvania, or if you're anywhere around the country
that vote for long term care andvote on long term care issues, So
if you're a worker, if you'rea frontline nurse, if you're a family
(22:00):
member of a resident, if you'rea resident in a long term care facility,
this can be an issue that youvote on and vote for. So
make sure your lawmaker knows that thatwe're watching. We're watching their support of
long term care. I would imaginethat the Pennsylvania nurses Association really supports what
you're doing, don't they. Wework in tandem with the Nurses Association.
(22:22):
We've reached out again and worked withSCIU and the workers' unions. I mean,
we're looking to work across the aislewith anybody to make sure that this
sector is supported. What now,You've been doing this for quite a while,
and it's a part of who,as I said, who you are
other than these issues we've talked aboutover the last couple of times you were
here. Is there anything else thatyou're thinking about or things that we need
(22:45):
to address. I mean, you'rewith the primarily you're looking out for these
places where people live, where seniorslive. Yeah, at the end of
the day, I think if weI think, if we're looking at the
next five to ten years, weneed to be innovative. And it's one
of the reasons we did what wedid with Harrisburg University. We need to
look for more solutions. We needto look at bringing, for instance,
(23:07):
Medicaid into assisted living in Pennsylvania.If we're not going to fund the Medicaid
program for nursing homes, let's findalternatives and other solutions. Again, at
the end of the day, wecan't keep doing things that we've been doing
for the last ten to fifteen years. It's insane. It's a changing environment.
We need to be innovative. Andmy message to the Shapiro administration as
well as the General Assembly is justlisten and let us work with you.
(23:33):
Let us bring you ideas, becauseI do think we can be innovative together.
I would imagine they've been pretty supportiveof you. They've been fantastic,
and we've enjoyed a very good relationshipagain with Republicans and Democrats in the House
and Senator, as well as thegovernor. I think we're on the right
track. There's a lot to do, but we're on the right track.
(23:53):
Is there anything pending as far aslegislation right now that you can support from
our listeners. Yeah. In fact, about a week ago, there was
a bill that came out of theSenate Health Committee that would create, for
the first time in Pennsylvania a CertifiedMedication Aid or a CMA. Thirty states
across the country have this position,Pennsylvania does not. We're working to make
(24:15):
sure that nursing homes can utilize thisposition. It's on second consideration in the
Senate Hopefully it will move through theSenate this year and then we need the
House to send it to the governorearly next year, if not before.
That would be a fantastic innovative solutionsto solving the workforce crisis. I don't
know if this is something you address, but we've heard on the news over
(24:37):
the last couple of weeks that numberedthe pharmacies, especially the pharmacists, are
thinking about striking. Oh my god, I think about all the older people
they need their meds. Yeah,we see it. We've unfortunately, I
have seen it with the pharmacists nowthis week. We've saw it with the
hospital workers last week. We sawit with nursing home workers last year.
Last week unfortunately Lancaster when they shoutedthat if we don't get this fixed,
(25:03):
if we don't get our wage raises, we should shut this down. We
should shut this sector down. That'sthe wrong message, first and foremost to
be talking about in Pennsylvania. Againgiving our aging population. But what we
learned during the pandemic Soviet is thateverything of every part of the health care
continuum affects the other parts of thehealthcare continuum. So if the hospital strike,
(25:23):
if the pharmacist strike, that willaffect us, that will affect seniors.
We've got to be a strong continuumto make sure that we can care
for our seniors. We're running ontime quickly, and I could talk to
you for days, seriously, becauseif you're not a senior citizen you're going
to be hopefully, or you havesomebody in your family right now that you
(25:44):
love who is a senior sin it'sgoing to impact unless you're a millionaire.
Long term healthcare insurance is extremely expensive. Should be started when you're young,
and when you're young, you're raisingyour kids. So I don't know how
effective that is. But over theyears, you've done so much to move
this ahead. Don't you get tired? Never, neverver, No, Because
(26:04):
again, we see the dedication fromour workforce, We see the dedication from
our frontline caregivers, and that keepsus going. What can we find on
your website? You can find informationon what we're doing, upcoming events,
advocacy initiatives. I would encourage yourlisteners again follow us, whether it's on
Facebook, Twitter, LinkedIn PHCA cares. We are constantly putting out information and
(26:27):
important updates regarding long term care inPennsylvania and if we want to find out.
Of course it's open to your membersand their families if you want to
find out more about that. Andperhaps someone hasn't told their members yet about
it. Are their employees about itand they're listening and they want to get
in touch with them. Where dothey get the information from? Is it
(26:48):
through your website? Yeah, itcan be on our website, It can
be it from Harrisburg University. ButI would encourage if you're a member of
ours, come to us. ComeTOPHCA dot org again, go to our
social media sites, reach out tous. We can get you all the
information that you need. Are youcoming back again? If you'll have me?
I mean I'll stand outside every dayas long as you have me here
(27:11):
and you want to talk. Thankyou that we owe our senior systems so
much respective warmth for them, wewouldn't be here. And as I said
to Zach, I'd have you inevery day because not only because you've got
such passion and you are sincere aboutthis. This comes from the bottom of
your heart, so you don't can'timagine how much this means to me.
My guest again, Boy, thatwent fast, isn't it? Zach Shamberg,
(27:33):
Presidency of the Pennsylvania Healthcare Association.As I said, this is going
to impact you. If it's notnow, it'll happen down the line,
or right now, it's impacting someoneyou love. For more information, go
to the Pennsylvania Healthcare Association website PHCAdot org. My listeners. As always,
if you miss Insight when it airson our ten iHeart stations, catch
it any time in on your iHeartpodcast stapp or your favorite podcast s app
(27:57):
and I hope it is the iHeartup. I'm Sylvia Moss. This has
been Insight. Thank you so muchfor listening to you next week.
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