Preventing another Bristol is essential – and achievable

The tragic explosion at a Bucks County nursing home on Dec. 23 was a horrifying reminder of what’s at stake when our long-term care system is stretched to its breaking point. While we must wait until investigations determine exactly what went wrong, it is painfully clear that Pennsylvania cannot continue to allow conditions in skilled nursing facilities to deteriorate to the point where residents’ safety is compromised.

As we’ve seen, years of underfunding have dire consequences – for our seniors and the industry charged with their care.

Pennsylvania’s skilled nursing facilities care for our parents, grandparents, neighbors, and, eventually, many of us. These facilities should represent the highest standard of safety, dignity, and care. Yet today, they operate in a system that demands more each year while providing fewer resources to meet those expectations. The result is a statewide crisis that is nonpartisan, growing – and unsustainable.

Pennsylvania has the fifth-largest older adult population in the nation, with 3.4 million residents age 60 and over. By 2030, one in three Pennsylvanians will be over 60. This demographic shift is already reshaping demand for skilled nursing care across every region of the commonwealth. At the same time, much of our long-term care infrastructure is aging, regulatory requirements are increasing, and workforce pressures are intensifying.

Last year, 70% of Pennsylvania nursing homes lost money. There have been more closures in the last two years than there were in the previous decade. For the facilities that have remained open, it has been a budget-crunch crisis year after year, trying to make a dollar stretch further than virtually anywhere else in the country.

Despite these realities, our investment has not kept pace. More than 70% of nursing home residents in Pennsylvania rely on Medicaid. Pennsylvania also ranks lowest in the nation for Medicare coverage among nursing home residents, leaving facilities overwhelmingly dependent on state Medicaid reimbursement to keep their doors open. That reimbursement is simply inadequate, especially when that amount is further limited.

Compounding the problem is the state’s use of the Budget Adjustment Factor, or BAF. The BAF is a little-known mechanism that reduces Medicaid reimbursements below the actual, calculated cost of care. Currently set at 0.78, it means nursing homes receive only 78 cents for every dollar of care they provide. The calculation relies on outdated data from three years ago and does not account for inflation, rising food and utility costs, or recent regulatory changes.

The impact is severe. The BAF now creates an $893 million annual shortfall for nursing homes across Pennsylvania, up from $750 million last year. When staffing ratio requirements increased in July 2024, the BAF dropped sharply from 0.89 to 0.78, turning a quality mandate into an unfunded one overnight. Facilities were told to do more while being paid less.

This approach sets skilled nursing facilities up to fail and then punishes them when they fall short. Ultimately, it is our aging population that pays the price – through reduced access to care, workforce instability, deferred maintenance, and, in some cases, facility closures that displace vulnerable residents. It is completely unsustainable to have more seniors and fewer options for their care.

This is both a budget issue and a policy failure. We cannot claim to prioritize seniors while funding only a fraction of the care they require. We cannot expect safe, modern, well-staffed facilities while maintaining a reimbursement system that obscures true costs and masks deep underinvestment.

There are solutions. Bipartisan legislation has been introduced in both chambers to address the BAF, increasing transparency and stabilizing funding. In the long term, an additional $394 million in state investment would unlock nearly $500 million in federal Medicaid dollars, fully eliminating the shortfall and creating a sustainable, transparent rebasing process going forward.

This is not about politics. This is not a Republican issue, nor is it a Democratic one. It’s about responsibility. Pennsylvania’s seniors deserve safe, high-quality care. Our seniors deserve to be treated as partners, not afterthoughts. One life lost because of this chronic neglect is too many, but we risk more every day that the system remains on the brink.

If we fail to invest now, we are not just risking the stability of an industry; we’re failing the people who built this state and entrusted us with their care.