Long-Term Care in Pennsylvania: Home & Community-Based Services

Long-term care issues have high prominence among state officials in Pennsylvania as a result of its large elderly population and concern about the impact of long-term care costs on the state’s budget. Its population aged 65 and older is 15.6% of its total population, ranking second only to Florida. By 2025, 21% of its population will be 65 and older. Pennsylvania is federal and state Medicaid spending for long-term care in FY2001 was $5.1 billion – almost half of all Medicaid spending. Spending for nursing homes was more than one-third of Medicaid spending. While spending for home and community-based services has increased dramatically in recent years, these services represented less than one of every five dollars spent on long-term care in FY2001. Over the last two decades, Pennsylvania has documented issues it has confronted in providing long-term services. Among these issues are: an imbalance in financing favoring institutional care, rather than home and community-based care (which most people prefer); fragmentation in the management and delivery of services; difficult access to services, especially for low and moderate income persons who do not qualify for Medicaid; and disparities in service availability across the state and populations in need of care. According to state officials, Pennsylvania’s guiding principles in long-term care are to: control surplus growth of nursing home beds; support consumer choice; encourage expansion of home and community-based services; fund services rather than capital construction; and assure quality of care.