Most vulnerable face shortage of space at personal care homes in Lancaster County

(Lancaster Online) At the Welsh Mountain Home near New Holland, executive director Andrew Maines fields five to 10 calls a week from people looking for a spare bed for a relative or a friend.

The answer is usually, “Sorry.”

“As soon as someone leaves, we’re able to fill the room,” said Maines of the 46-bed personal care home. In fact, demand is so strong — and the home, affiliated with the Mennonite church, feels such an obligation to accommodate as many residents as possible — that officials hope to enclose a porch and build another room above it.

One more bed won’t solve the dire shortage of space in Lancaster County personal care homes.

But it can’t hurt.

Welsh Mountain Home is one of 53 personal care homes licensed by the Pennsylvania Department of Welfare in Lancaster County. The homes provide long-term care for some of society’s most vulnerable citizens, the elderly and people with physical and mental disabilities. They’re not nursing homes; they’re places where residents can get help with day-to-day activities and, like boarding homes, they provide a bed and three meals a day.

But one thing they do have in common with nursing homes: There’s little room at the inn, particularly for people with little to no money.

In Pennsylvania, Medicaid pays for nursing home care and some in-home services, but not personal care homes. Most of the nearly 2,500 Lancaster County residents who live in these homes pay out of their pockets.

And there is space available for those residents: Statewide, personal care homes have an occupancy rate of 70.3 percent.

But if you’re poor, relying on government help, your choices are far more constrained.

Only a handful of personal care homes here, many of them faith-based nonprofits, accept “SSI” residents. There used to be more, but many homes closed because of stricter state regulations — and the punishing economics of caring for poor people.

Unless those economic fundamentals change, the shortage is likely to worsen, officials say.

The push statewide is toward independent living — keeping people in their homes as long as possible, with homecare services as needed. But the Pennsylvania Health Care Association, which represents long-term care providers, asserts that nearly 70 percent of those turning 65 this year will need long-term care in their lifetimes.

That includes nursing homes for those who need around-the-clock care. For those who don’t, personal care homes are a far more affordable option; according to the Pennsylvania Health Care Association, the median monthly cost at Pennsylvania’s 1,325 personal care homes is $3,251 per month for a one-bedroom unit, or $39,015 annually.

The median annual cost for a private room in a Pennsylvania nursing home is more than twice that — $99,280.

Forty percent of the county’s 53 personal care homes are private-pay: If you can’t pay the bill out of your pocket, there’s no room for you. Those who run out of money can be asked to leave. Other homes let residents who have spent down their assets remain.

Many of those facilities have available rooms. “We currently have capacity for additional residents,” said John D. Sauder, vice president of operations at Mennonite Home Communities, which owns the Woodcrest Villa retirement community and the Mennonite Home, which offers personal care and skilled nursing care.

But prospective personal care residents, he said, are financially qualified, as the facility’s cost to provide care is about $100 per day more than what the government pays for those without assets or income.

According to welfare department statistics, there are 358 SSI “beds” in Lancaster County. The economics involved explain why there aren’t more.

SSI pays a maximum of $730 per month, money which a resident remits to the personal care home — less an $85 “personal care allowance.” The state supplement kicks in an additional $439.30. So the most a personal care home can charge an SSI resident is $1084.30 per month.

That’s about $36 per day.

“Tom Bodett [Motel 6 founder] does not leave a light on for you for that amount,” said Ron Barth, president and CEO of LeadingAge PA, formerly the Pennsylvania Association of Non-Profit Homes (28 of the county’s 54 personal care homes are not-for-profit).

In 2007, a law went into effect reclassifying personal care homes as “assisted living facilities”; the Rendell administration indicated it would seek changes that would allow Medicaid to cover the cost of care in the homes, though not room and board. That never materialized, and the Corbett administration has said that in an era of benefit cuts, expanding benefits for this population is out of the question.

There used to be more personal care homes that took in low-income residents — but many were substandard, a situation that forced the state Department of Welfare to take action. In 2005, the department issued stringent new regulations; partly as a result, the number of personal care homes in Pennsylvania fell from 1,830 in 2000 to 1,326 by 2011, the latest year for which figures are available. County-by-county data was unavailable.

Ron Melusky, director of DPW’s Department of Human Services Licensing, said he personally was involved with some 300 homes that closed across Pennsylvania, and “there’s not a single personal care home that was closed due to regulatory action that did not need to close. They were not safe.”

But he and other state officials realize that fewer homes has meant fewer beds for the needy.

“Homes can only live off what the clientele can afford to pay, and there’s no more [government] money available,” he said. “Given that, the ebbs and flows in economic conditions are going to have a great impact on whether or not homes can make ends meet.

“I can tell you that it’s correct to say there really aren’t very many available beds for persons with low income in Lancaster County,” he said.

That shortage of available beds for low-income residents was deemed “dire” by the Lancaster County Office of Aging in a report issued last year. And as the elderly population of the county grows, the situation could worsen.

Steve Dietch is president of Faith Friendship Villa in Mountville, with a licensed capacity of 74 — almost all of which are low-income.

“I think we have three or four people who pay full price,” said Dietch.

But he’s not in it for the money. “If this was about dollars and cents, I wouldn’t be here,” he said. “Taking care of poor people is a terrible business model.”

But it’s a good moral model. Dietch and his wife, Patti, are Christians who feel called to provide “a caring, supportive living arrangement” for people in need. That moral obligation can make it tough to keep the lights on, however.

The new DPW regulations — while necessary, he says — required him to hire staff to interpret the rules and make sure the home was in compliance. And the budget’s so tight that a major unexpected expense can be disastrous.

But he’s convinced that — at least in the past —- God has provided. Like the time the home developed a “significant” pest problem; as Dietch wondered how he could pay that bill, he opened the mail — to find a $4,000 check from a former resident’s daughter-in-law.

“Stuff has happened here that’s supernatural,” he said.