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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Coaches in the Renton School District, just south of Seattle, are organizing with the American Federation of Teachers to fight for what they say are "fair wages" in their first union contract.

Buddy Ryan, head boys track and field coach at Hazen High School, said Renton coaches get paid much less compared with neighboring school districts, which contributes to a 45% turnover rate in coaches from year to year.

"I'm not expecting to go buy a new car off a season of coaching, but I'm not expecting to make minimum wage to be responsible for all these kids," he said. "I think the reality is, a fair wage for a fair day's work is what everybody looks for."

Renton School District has proposed a 2.5% wage increase, far below what the coaches asked for. AFT has said the district has the funds to pay coaches fairly. The district did not respond to a request for comment.

Ryan said the low pay and high turnover rate costs the district more money in training and degrades the quality of the sports programs.

"And then what's the cost to the kids that get a different coach every year? Well, you know what ends up happening? These parents get tired of it and they take their kids to private schools, or they move and transfer them to other schools," he said.

Ryan noted that sports, along with other extracurriculars such as band, are what motivate many kids to keep their grades up in order to participate. He said the district should want to keep the programs strong.

"It's just like when you're a kid at dinner," he said, "and your parents say, 'You've got to eat your vegetables or you don't get dessert.' Well, that dessert is the after-school activities."

Nevada groups concerned about affordability, clean air and health care are speaking out against the "One Big Beautiful Bill Act" recently signed by President Donald Trump.

The new law extends tax cuts from 2017, funded partially by huge cuts to Medicaid and SNAP food benefits.

Dr. Joanne Leovy, steering committee chair for the Nevada Clinicians for Climate Action, noted it also ends the tax credit for electric vehicles on Sept. 30, which drives up the price of an EV by $7,500 while promoting the sales of gas-powered vehicles.

"This bill will dump an extra 2.1 billion tons of climate pollution into the atmosphere over the next decade," Leovy pointed out. "Increasing greenhouse gas emissions by about 7% over prior projections; the equivalent of adding more than 400,000 cars to the road."

The new law also cuts tax credits for rooftop solar and energy efficient home upgrades. Backers said the savings were necessary to fund other administration priorities, such as increased funding for immigration enforcement.

Yolanda Kemp, a member of the American Federation of State, County and Municipal Employees Local 4041, said she worries about job losses in the public sector.

"When states, cities, towns, and schools lose essential federal funding, they will be forced to make cuts to their budgets as well, putting all public services and jobs at risk of being cut," Kemp stressed. "And let me tell you, the 'Big, Beautiful Bill' that is supposed to help hardworking Americans is nothing more than another billionaire giveaway paid for by us."

The change to Medicaid and SNAP are not immediate but will be phased in mostly in 2027 and 2028.


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More than 1,100 caregivers at Portland's Providence St. Vincent Medical Center have voted to unionize, joining the Service Employees International Union Local 49.

Hospital staffers, including certified nursing assistants, cooks, lab assistants, pharmacy techs, environmental workers and patient representatives, will soon begin collective bargaining with management over a new work contract.

Finn McCool, senior food service attendant at Providence St. Vincent Medical Center in Portland, said changes to working conditions in the hospital were a major driver to organize.

"There's a lot that makes St. Vincent a great place to work, but we've also seen just tons of changes over the years around staffing and benefits," McCool explained. "My fellow caregivers really knew that jobs were only going to get harder."

The St. Vincent caregivers will join thousands of other unionized workers at Providence hospitals in Oregon, Washington state and other parts of the country. Providence officials released a statement, recognizing the union and saying they were prepared to work with it toward a new contract.

McCool noted the company made several changes to staffing and work policies without feedback from its employees, with changes to the employees' health care benefits causing a major upheaval.

"It's been a recent change to our health care plan with Aetna switching over, and that was probably a very large reason why a lot of us decided to vote yes," McCool pointed out. "We had our own internal health care system. We changed to a different thing. Co-pays changed. Things were definitely a lot harder with increased deductibles."

McCool stressed political uncertainty, particularly in the government's health care policies, was also a significant concern.

"We're seeing a lot of changes going on with the government with cuts, especially right now," McCool observed. "What threatens us is cuts to Medicare and Medicaid. Our CEO said, 'These cuts are threatening the hospital.'"