A lack of access to in-home care in Pennsylvania has reached a crisis point, according to professionals in the field, leaving thousands of residents without essential services.

More than 400,000 Pennsylvanians rely on in-home care for daily support.

Mia Haney, CEO of the Pennsylvania Homecare Association, said Gov. Shapiro's budget puts seniors at risk, as it only includes $21 million for direct care workers and only for what's known as the directed model, which employs just 6% of them, leaving 94% without funding.

"We do not have enough workers to meet the need for folks who are looking for services and every single month, 112,000-plus shifts go unfilled," Haney pointed out. "That could be an eight-hour shift, it could be a six-hour shift, but a caregiver is not coming and someone is waiting for services."

Haney emphasized legislators control budget priorities and insisted they must support the direct care workforce this year. Without funding increases, she argued, many will go without care, leading to harm and unnecessary nursing facility placements for those who could receive services at home.

The General Assembly must vote on the budget by June 30.

Haney notes by 2030, one in three Pennsylvania residents will be over 65, increasing the demand for caregivers. Meanwhile, the number of potential caregivers remains steady, creating a growing shortage as the elderly population rises.

"We just this year had a study released that showed that the rates here in Pennsylvania are insufficient, meaning that you cannot possibly recruit and retain quality workers with the Medicaid reimbursement rate that we have today," Haney reported. "In fact, (it) indicated that we are 23% below where we should be."

Pennsylvania's average reimbursement rate for in-home care is just $20.63 cents per hour, which some feel is insufficient to maintain a stable workforce.

In comparison, neighboring states -- such as Delaware, Maryland, New Jersey and West Virginia -- offer rates that are 25% to 75% higher for the same services.


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A Montana legislative committee this week heard a bill to revise workers' compensation laws. Among opponents were workers who have navigated the system themselves. If a Montana worker were to get hurt on the job today, law requires insurance providers defer to the person's "treating physician." But Senate Bill 345 would remove that policy.

Sen. Greg Hertz, R-Polson, says that helps insurers get the "best available evidence."

Amanda Frickle, political director of Montana AFL- CIO, a state federation of unions, said workers' compensation claims and cases are "meant to be deliberative."

"This bill is fundamentally tipping the scales against the injured worker and in favor of the insurance company when it comes to these workers' compensation claims," she said.

The bill would allow insurers to require an independent medical examination from a provider of the company's choosing, even if that means someone out-of-state. In that case, the insurer would cover expenses such as travel, lodging and child care. But opponents say travel is not conducive to healing.

Niki Zupanic, owner of the Montana Trial Lawyers Association, says that adds to workers' up-front costs.

"Many of these costs, whether or not they will eventually be reimbursed, are likely to be coming out of pocket ahead of time from the injured worker, while they're also working most likely reduced hours and trying to juggle other expenses with their families," she explained.

According to the Montana Department of Labor and Industry, of all Montanans covered by a workers' comp policy, about 4% report an injury in a given year, or 23,000 people.

South Dakota's new governor is making an active pitch regarding economic opportunities for the state. The renewable-energy sector said it continues to build a strong case, including manufacturing jobs.

Gov. Larry Rhoden spent much of March crisscrossing South Dakota on his "Open for Opportunity" tour to hear about promising development, workforce needs and trade issues. It has not received a visit yet but officials with the Marmen Energy plant in Brandon said they are keeping busy. Nearly 300 people there construct towers to hold turbines for wind energy.

Dan Lueders, plant manager for Marmen Energy, called it the very definition of "American-made" products.

"It's fully American made with American steel," Lueders explained. "We're contributing to the American independence on energy and also providing good-paying manufacturing jobs."

The Clean Grid Alliance said the plant produces roughly 1,000 tower sections each year for shipment throughout the upper Midwest. Lueders noted with data centers and other factors driving up electricity demand, he sees more opportunities for his operation. Nationally, enthusiasm has been somewhat dampened by the Trump administration's push to roll back renewable-energy funding, with a stated desire to focus more on fossil fuels.

But utilities are increasingly turning to renewables to diversify their output as demand spikes.

Waylon Brown, president of Rushmore State Renewables and regional policy manager for Clean Grid Alliance, said if South Dakota keeps the welcome mat out for wind and solar development, other industries will want to set up shop here.

"They're looking for nearby energy generation when deciding what states to do business in," Brown pointed out.

In addition to the manufacturing upside, the Energy Information Administration said South Dakota ranks second nationally for wind energy generation. Brown said, for example, having a healthy power supply could be attractive to the health care sector, noting advancement in medical technology is one of the many other things requiring more energy use.

More jobs could be coming to Arkansas as companies interested in bringing manufacturing jobs back to the U.S. consider the Natural State, according to a study by the Reshoring Institute.

Rosemary Coates, executive director of the nonprofit, said the state's low minimum wage is cost-effective for companies requiring a large labor force.

"What we generally encourage our clients to do is look at the major metropolitan areas and set up manufacturing just outside of that area so you can pull from the labor pool there," Coates explained. "Or to look at the metropolitan areas in places like Arkansas."

She noted although manufacturing remains cheaper in other countries, supply-chain problems experienced during the pandemic are making U.S. companies explore options for reshoring. The study did not address the financial effects of possible Trump administration tariffs on materials manufactured abroad.

Twenty states across the country, mainly in the South, pay the federal minimum wage of $7.25 an hour. If labor is a high percentage of a company's costs, it could be less expensive to reshore operations. Coates added some companies opt to have plants in multiple countries.

"Bringing some manufacturing to Mexico and some to the U.S. and keeping some in Asia," Coates outlined. "Companies are really rethinking the whole idea and strategy about where in the world they're manufacturing."

She stressed labor rates vary between rural areas and major cities in every state. Other costs associated with reshoring include local and state taxes, training, tax credits and logistics.


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