A Q&A with Maureen Madden

As the Democratic chair of the Pennsylvania House Aging and Older Adult Services Committee, State Rep. Maureen Madden leads the chamber’s bipartisan efforts to address the needs of the commonwealth’s fast-growing geriatric population. Madden, who has represented her Monroe County district since 2017, is an older Pennsylvanian herself – she turned 65 in December – and, having lost both parents to dementia, has a first-hand perspective on the exigencies of caregivers.

This conversation has been edited and condensed for length and clarity.

What are the biggest challenges currently facing PA’s aging space?

The most pressing problem is how fast our aging population is growing: By the year 2030, 60-year-olds will outnumber 20-year-olds. For many years, we didn't focus on the senior population the way we should.

Also, we're not paying our workforce enough. We have one of the lowest reimbursement rates in the area – lower than all the contiguous states. It's a problem when folks can leave caregiving and make more money at Sheetz. I'm looking to bring as much money as possible home, so we can start filling those 112,500 shifts a month that go unfilled.

What policy initiatives are on the table to address these challenges?

We're lobbying to get a reimbursement rate increase (for state funding for nursing home care costs, in a current House bill). We have over 400,000 individuals in Pennsylvania who rely on home health care, while 27% of our home nursing hours are unstaffed.

Because we change the budget adjustment factor every year, there's no predictability, and nursing homes can't plan for the long term. We're asking for an adjustment in perpetuity so that the state is paying 90 cents on the dollar for Medicare expenses – and facilities know what they're getting.

How is the legislature addressing the workforce shortage?

Just from 2019 to 2022, we've lost 14% of our caregiving workforce. One proposed bill would provide competency examination opportunities, in lieu of a high school diploma or a GED, to give individuals employment as a direct caregiver, to open up the workforce.

Another bill would allow high school juniors and seniors to earn up to two credits toward their graduation requirement for employment in a congregate health care setting or assisted living. And a third bill would allow nursing students to immediately take the certified nursing assistant exam upon completion of their program.

And last session, $1.9 million was appropriated to set up an Alzheimer's, Dementia and Related Disorders Advisory Committee, which I will serve on.

Are there aging-related policy issues beyond health care?

Aging Our Way is a 10-year plan initiated by the Shapiro administration. We want seniors to be able to age in place, we want better transportation and want to improve how services are delivered.

We’ve got community choices in the Options Program (“Help at Home”) and our LIFE (senior) centers, mostly covered under Medicare. In our LIFE program, someone gets picked up a couple of days a week so they can see their doctors, see their barber, get physical therapy. They get socialization that way – and two meals. But for these programs, many people would be in skilled nursing facilities.

Does Harrisburg have the money for all these priorities?

Our budgets are statements of our priorities and our moral values. We have to work together to bring more money into our budget, whether that's through recreational cannabis or regulating and taxing skill games in a way that helps our seniors. We can't keep taxing people. Our lottery hasn't been performing as well as in past years. We can't keep draining the Rainy Day fund.

You’ve said that this issue is personal for you. Can you elaborate?

I lost both my parents to complications from vascular dementia. My dad died of a heart attack at 56, and my mom was diagnosed at 69 and died at 82. She lived with my husband and I for many years, until it was extremely hard to find care for her.

My mother had been a certified nursing assistant, and when she first went to a nursing home, she thought she worked there. She’d be at the nurses’ station, or combing someone's hair. She remembered the years of caregiving that she gave to other seniors, and held onto that.