Disabled advocates gathered at the State Capitol on Tuesday to protest what they said the quality of home care services under Pennsylvania’s new managed care system is declining, and the pandemic has exacerbated the problem.

Part of the problem, they said, is that it is becoming more difficult to get direct caregivers, and they need to be paid more through the state’s Medicaid reimbursement system.

They said that Governor Tom Wolf’s government and legislators should use federal funds approved by Congress and higher federal reimbursement rates to increase the salaries of direct caregivers.

“They have new possibilities to use this money in an effective way,” said Shona Eakin, CEO of Voices for Independence, a home care service provider based in Yili.

The Wolfe administration is waiting for the federal government to approve its plan to use a higher Medicaid reimbursement rate for home care under the American Rescue Plan signed by President Joe Biden in March.

Wolf’s government stated that the plan for this funding includes raising interest rates and wages through recruitment and retention programs, but Ekin said that long-term salary increases are needed, not temporary bonuses.

For a long time, low salaries and high turnover rates have been the reality of direct nursing staff in home care institutions and nursing homes.

But they say that due to the pandemic, it is now more difficult to find direct caregivers. Eakin said that the average hourly salary of home care workers was $12, and many direct care workers took a break during the pandemic and never returned.

She said that Eakin’s workforce has increased from 1,069 before the pandemic to 763 now, and her overtime pay has soared from US$227,000 in 2019 to US$573,000 this year to take care of about 800 people, she said.

Ekin said that Medicaid does not reimburse overtime pay, nor is it reimbursed for personal protective equipment, paid vacation or double wages. At the same time, she said, it was difficult to find direct caregivers, so much so that Eakin had to refuse 40% of those who contacted her agency for home care services.

In the past few years, the Wolfe government has placed tens of thousands of elderly and disabled home care services under managed care contractors to save money.

The plan involves moving thousands of people back to their homes and out of more expensive nursing homes.

However, disability advocates say that people trying to transition from nursing homes have to endure months of waiting before they can find and assign their home caregivers.

They said that others have seen their home care time cut by managed care companies, which are now signing contracts with the state government to run the program.

The Wolfe Department of Public Services stated that 90% of the people in the program received the same or higher level of service after being evaluated, and managed care institutions must do this every year.

Others may lose duplicate services. The department said that reviews by its long-term life office generally found that reducing services is appropriate and does not pose a risk to health and safety.

Lauren Alden, manager of Liberty Resources, an independent living center in Philadelphia, said the organization is looking for legal assistance to clients whose direct care time is decreasing and is trying to help them file appeals.

Alden said: “We have seen significant reductions, and the needs of these people have not changed.”

Eakin said the community-based program aims to get people out of institutional care and return to their homes, but shortening the time of direct care may have the opposite effect.

“How long before someone buckles and says,’I must be taken care of’,” Eakin said.