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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Solving North Dakota's child-care crisis is taking another turn, with adoption of a new tax credit.

The incentive is geared for employers who make contributions toward their employee's child-care costs.

Gov. Kelly Armstrong has signed a bill that allows employers to claim a tax credit of 50%, for child-care stipends they might offer as part of a benefits package.

Bill supporters say it might convince more businesses to meet the needs of staff members with young kids.

Bill Bauman, CEO of the Missouri Valley Family YMCA in Bismarck, said he hopes it'll be effective in removing stress on the child-care system by keeping parents in the workforce.

"It's so vital to our economy," said Bauman, "our community, our workforce and our families."

The YMCAs are collectively the largest provider of child-care services in North Dakota, and Bauman said they've seen progress in closing gaps based on 2023 investments from the state.

Other organizations such as the Chamber of Commerce agree that previous steps have helped.

But officials note some solutions have limitations, pointing to age and income eligibility levels under the Working Parents Child Care Relief Program.

Bauman credited policymakers for continuing to monitor how these efforts are playing out, and whether they need to try something new.

He suggested it's going to take additional time to measure the effectiveness of new programs and incentives.

"Some are highly utilized and others maybe not as utilized," said Bauman, "so you have to be able to adjust."

According to a 2024 North Dakota business survey from the Chamber of Commerce, 69% of respondents indicated that child care was an issue for their organization.

A similar percentage indicated support for this type of incentive to help recruit and retain workers.



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Thousands are expected to rally in Harrisburg on Monday for a "Raise the Wage and Immigrant Rights Day of Action."

More than 47,000 Pennsylvania workers earn the minimum wage of $7.25 an hour or less.

Jarrett Smith, legislative director for the Service Employees International Union, said Pennsylvania hasn't raised its minimum wage in more than 15 years, while more than 30 other states and Washington, D.C., have all moved toward $15 an hour.

Smith said this makes it harder for the state to stay competitive.

"We are demanding that we raise the wage in Pennsylvania to $15 an hour," he said, and "that we include a cost-of-living adjustment so that we don't have to keep coming back, year after year."

Smith said the coalition Pennsylvania Stands Up is leading the protest, backed by labor and community groups and some lawmakers.

Two years ago, the House passed a bill to raise the state minimum wage to $15 by 2026, but the Senate hasn't acted. Smith said Gov. Josh Shapiro has pointed out it could bring in up to $60 million a year in tax revenue.

Smith said it's key to distinguish low-wage from minimum-wage workers. Nearly 1.2 million Pennsylvanians earn wages less than $15 an hour, and many are single moms. He added that these workers often support families, pushing the state to cover gaps with programs such as SNAP and Medicaid.

"When we talk about how do we actually lift workers out of poverty," he said, "one of the things that you can do is raise that floor and give families the financial independence to actually earn a wage that's going to allow them to not have to make decisions between paying a grocery bill or getting health care."

Smith noted that Pennsylvania is losing workers to neighboring states with higher minimum wages, making it hard to keep a strong workforce.

"We are one of the fastest-shrinking states in the Northeast," he said. "New Jersey, across the border, they have a $15 minimum wage to start, and they're already increasing it for certain workforces, like health care and education."

He added that SEIU represents around 80,000 service workers in the state, across industries such as government, health care and food service. The union is also negotiating its first national Starbucks contract.


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New national rankings out this week show South Dakota jumped a few spots higher in teacher pay for each state. However, there are questions about whether the shift will be temporary.

The National Education Association puts South Dakota at 46th in the U.S. for compensation offered to educators around the state. The current rank is the highest South Dakota has achieved since reporting began. Teachers in the state now earn an average salary of more than $56,000.

Loren Paul, president of the South Dakota Education Association, credits higher bumps in state aid the past few years.

"That extra effort from our state gets us out of the bottom rankings," Paul explained. "It also is supportive in recruiting teachers and also retaining teachers in the profession."

In this year's legislative session, education got a smaller funding increase of 1.25%, falling behind inflation. Paul cautioned it could mean South Dakota will slide back in future rankings. The smaller bump came as part of a "belt tightening" mood at the State Capitol this year, with uncertainty over federal funding and declines in sales tax revenue.

Educators said they understand the budget challenges facing South Dakota but Paul contended taking the foot off the accelerator only puts the state in a troubling pattern it has been trying to shake off.

"It has to be year after year," Paul stressed. "It's not a, 'Oh, we're going to address this for a year or two, and then we're going to fall back into very small increases,' or no increases, or actually going backwards."

He added when shrinking investments cause a state to tumble in rankings, public pressure goes back up because no state wants to be seen as holding the last spot.

The union noted when adjusted for inflation, teachers in many parts of the country still make less than they did a decade ago, and if they cannot afford to cover basic expenses, some will choose to leave the profession.