Adam Marles (Website).jpg

MECHANICSBURG, Pa. - LNP | LancasterOnline (Jan. 18, 2020) - A recent LNP | LancasterOnline editorial headline, "Everyone must ensure that safety comes first at our nursing homes," underscores the need for Pennsylvania to approach this type of care as a community effort.

We agree. Expectations are high for nursing home care -- as they should be. Assuring that everyone is working together is far more complex and requires some explanation. While the editorial falls short in that regard, it does provide an important opportunity to discuss the challenges faced by senior care providers and efforts to improve care.

First, let's be clear: LeadingAge PA has zero tolerance for any nursing home facility that doesn't make resident safety its top priority. We have publicly stated that poorly run facilities should close. But sometimes the problem isn't a bad facility, or even a bad actor. Sometimes it's a good employee at a good facility -- like Mennonite Home Communities -- who makes a mistake.

Mennonite Home Communities consistently ranks as one of the top performing facilities in a county with a strong reputation for long-term care. Thousands of dedicated staff and administrators across Lancaster County work hard to provide the very best in care. All are dedicated to increasing efforts to improve the safety and care of their residents through technology, training and supervision. It's a process that good facilities aggressively do every day.

If LNP | LancasterOnline and others are serious that everyone must work to ensure safety at nursing homes, it's important to understand the challenges -- and that starts with resources. For example, every year nonprofits use benevolent funds to help those who cannot afford care. Too many assume those funding sources are never-ending, but as Medicaid reimbursements continue to fall further and further behind the coast of care, even the best facilities struggle to make ends meet and retain their best staff. 

This is how bad it has become. Medicaid has been flat-funded by state government four times in five years. In fact, Pennsylvania has averaged increasing Medicaid rates by barely 1% per year over the last 15 years. Meanwhile, the cost of providing care has increased 33%. Pennsylvania's shortage has meant that nursing homes lost a staggering $631 million in 2017-18 alone, according to a 2019 RKL report. You can find the report at

That means the costs for health care, medications, medical devices, salaries and benefits are all increasing at a rate beyond the control of most facilities. Staff at these facilities are some of the most dedicated and hardworking professionals anywhere. Their jobs are stressful and physically taxing. They bathe and feed residents, help them with their walking, provide medication and, in many cases, offer the humanity we all desire when we reach an advanced age. They deserve salary increases and a living wage as much as anyone, but as resources dwindle, facilities cannot keep up. That's when employees typically leave for a better paying job.

We also understand increased regulation from the commonwealth, but we don't agree that all facilities should be treated the same. Allow good-performing ones to keep doing what they do best, and focus more strongly on those that are failing. Citations for serious infractions are necessary, but over-aggressiveness also can hurt care and deplete resources.

For example, a Lancaster County facility was cited for having water temperature in one public area above state requirements. The only problem was that the area wasn't part of the nursing home facility. The facility was eventually successful in having the citation overturned, but it cost $13,000 in legal fees that it can never recover. Those fees could have been used to provide higher wages and purchase desperately needed technology to minimize care mistakes.

This is why we've been telling whoever will listen for years that Pennsylvania is in a Medicaid funding crisis, and it's impacting patient care. We are heavily regulated, reimbursement for care is flat, and no one is listening.

This conversation begun by LNP | LancasterOnline is an important one. As nonprofits, we want to keep our good employees and hire more. We want to make critical technology investments. Editorial boards and Pennsylvania communities should advocate for responsible regulation and the need for proper Medicaid funding. In turn, state lawmakers should heed that call and better invest to ensure one of the grayest states in the nation properly serves its older residents.

When that happens, Pennsylvania will truly have everyone working together.


Adam Marles is president and CEO of LeadingAge PA, a trade association representing nonprofit senior housing, health care and community services across the commonwealth.