Looser education rules floated as fix to Pennsylvania's troubled home care workforce
This story first appeared in How We Care, a weekly newsletter by Spotlight PA featuring original reporting and perspectives on how we care for one another at all stages of life. Sign up for free here.
HARRISBURG — Workers who help older adults with daily activities would no longer need a high school diploma or GED under a bill designed to boost employment in an industry that faces high turnover and rising demand.
The bill, introduced by state Sen. Dave Argall (R., Schuylkill), would instead require potential employees to pass a competency exam.
'It's very evident that there just aren't enough people working there,' Argall said of the workforce.
Advocates for nurses, caregivers, and older adults largely support the bill's intent, but argue that a more direct solution would be to increase wages.
There are more than 213,000 direct care workers in the state, according to the latest Bureau of Labor Statistics data. They help over 400,000 Pennsylvanians with tasks such as eating, getting dressed, and bathing, according to the Pennsylvania Homecare Association, which represents the agencies most of those caregivers work for.
Austin Cawley, director of legislative affairs at LeadingAge PA, which advocates for companies that provide services to older adults, supports the change to the educational requirement. But higher pay, he told Spotlight PA, would better address the problems facing the industry. Pay depends on the kind of direct care work, but averages to a little less than $15 an hour, according to federal data.
Agencies pay direct care workers through the state's Medicaid program, which reimburses them. They take a portion of the reimbursement for administrative and training costs, and pay employees the rest.
Pennsylvania caps the hourly reimbursement rate at $20.63, around $5 lower than those of its neighbors. Nursing homes and agencies have pushed for years for the state to raise the rate and in turn worker pay.
Direct care workers are mostly employed by home care agencies and provide a range of nonmedical services to older adults. This support can help older people maintain independence and comfort as they age, which can keep them out of costly nursing facilities.
Under Pennsylvania law, direct care work requires a high school diploma or equivalent GED certificate, or completion of a nurse's aide program, which teaches basic nursing assistant skills.
State law also mandates that workers must be over 18 and free from certain medical conditions, including drug or alcohol addiction. (Some 16- and 17-year-olds are permitted to provide direct care, but restrictions apply to their work.)
Argall's bill would direct the Department of Human Services to administer the test, but doesn't specify how, nor does it say who would write it or what exactly would be examined. According to the bill language, the exam would assess interpersonal communication skills, basic writing and reading comprehension, understanding of cultural and diverse communities, and awareness of mental and behavioral health needs.
Kathy Cubit, an advocacy manager for the Center for Advocacy for the Rights and Interests of Elders, expressed reservations about loosening the educational rule.
To ensure dropping the requirement doesn't diminish the quality of care, she would prefer to see the proposal piloted before it is implemented across the state.
'There's just so much at stake for both the worker and the resident, you want to make sure the work is being done right,' said Cubit, who otherwise supports the legislation.
The bill is part of a package of legislation Argall introduced to encourage people to work as caregivers as more Pennsylvanians reach retirement age.
'What we're trying to do is encourage more people to consider this as a profession, and in so doing, that helps everyone,' Argall said. 'Give it a chance. You might like it, you might not — but give it a chance.'
The other bills would permit 11th and 12th graders to work in direct care for school credit and add long-term care training to the state's nurse aide curriculum. Previous versions of the bills passed with bipartisan support in the state Senate last session.
As part of this year's budget, Democratic Gov. Josh Shapiro pitched a $21 million funding increase to bump the pay of some direct care workers. These caregivers are paid through the Community HealthChoices waiver, a program that helps older adults and Pennsylvanians with physical disabilities directly hire support instead of going through an agency.
Some critics called the proposal too narrow because it would apply only to caregivers who receive that waiver. The Pennsylvania Homecare Association said in a statement that the proposal 'disregards' hundreds of thousands of workers in the industry.
Shapiro's funding pitch faces long odds despite the relatively low cost. State Senate Republicans have pushed back against the governor's proposed budget, arguing it would worsen Pennsylvania's structural deficit.
Cody Jones, senior director of government affairs for the home care association, did not comment on Argall's legislation, but emphasized that the state's caregiver shortage 'cannot be solved' without increased wages.
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Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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