Thousands of workers who care for children, older adults, and Pennsylvanians with disabilities would receive higher wages under the budget proposed by Gov. Josh Shapiro.
The plan seeks to address longstanding recruitment and retention problems in the caregiving industry that affect workers, businesses, and families statewide. Still, it’s up to the divided legislature to negotiate the final budget deal ahead of the June 30 deadline, and there’s no guarantee the pitch will be in the final product.
The proposal, introduced last week in the state Capitol, seeks to allocate $55 million to licensed child care providers and $21 million to direct care workers who deliver support services such as housekeeping and personal care assistance like dressing and eating.
The two industries have struggled with retention as workers leave the industry for better wages, departures that can make some caregiving services harder to access for households statewide.
“If we filled those jobs,” Shapiro said of vacancies in the child care workforce, “25,000 more children in Pennsylvania could have access to child care and parents could have the peace of mind that their kids are well taken care of so they can go to work.”
The Democrat also pitched universal screening for postpartum depression, a mood disorder that affects an estimated 1 in 8 women who have recently given birth.
Caregivers and advocates variously celebrated and questioned the proposed budget, which the Shapiro administration will elaborate on in the coming weeks.
Child care funding
Shapiro's budget would shore up child care by providing $55 million in retention and recruitment grants. The governor said this funding would boost annual pay by roughly $1,000 per employee at licensed child care centers that receive funding from a state program for low-income families.
For years, early childhood staff and teachers have left classrooms for industries offering higher wages, say advocates of early childhood education.
The Start Strong PA coalition lobbied Shapiro to budget $284 million for the child care workforce. Though the proposed $55 million is a fraction of that initial ask, Jen DeBell of the Pennsylvania Association for the Education of Young Children still sees it as a victory.
"Folks are really excited and are applauding the governor for this," DeBell said of advocates. The proposal recognizes that Pennsylvania’s anemic child care industry requires state support, she added.
Diane P. Barber, executive director of the Pennsylvania Child Care Association, agrees with DeBell. She told How We Care via email that this is the first time a governor's proposed budget has included funding specifically for early childhood teachers.
Members of the business community are celebrating too.
"We are deeply grateful to Governor Shapiro," Robert S. Carl, the head of the Schuylkill Chamber of Commerce, said in a news release.
Carl leads a coalition of Pennsylvania business groups that advocate for increased child care funding. By addressing the workforce shortage, Carl said, high-quality child care centers in Pennsylvania can remain open, which would help employers recruit and retain staff who are parents.
When the Shapiro administration releases more details on the proposed budget, DeBell wants to know whether his administration will mandate that the $55 million be used for bonuses, wage increases, or improved benefits.
In addition to the child care funding, Shapiro proposed putting $15 million toward the staffing shortage in Pennsylvania's Pre-K Counts program. Many preschool classrooms are within child care centers, so this funding would further bolster the state’s early childhood ecosystem.
Direct care
Shapiro also wants to up state support for direct care workers, pitching $21 million to give them a pay bump. These caregivers are paid through the Community HealthChoices waiver, a program that helps older adults and Pennsylvanians with physical disabilities directly hire their caregivers instead of going through an agency.
The services these workers provide — which include housekeeping, grooming, dressing, and driving to medical appointments — allow people to live and receive care in their own homes, as opposed to skilled nursing facilities, which are generally more expensive and offer less independence.
Some direct care workers are relatives of the people they support, as is the case for Lynn Weidner of Allentown. She told Spotlight PA she's been her partner Brandon Kingsmore's paid caregiver for 12 years.
Weidner worked in nursing homes when she and Kingsmore started dating and could probably make a slightly higher hourly rate if she returned to that industry. But Kingsmore had difficulty finding consistent support because Medicaid sets such low wages for direct care workers.
After Kingsmore and Weidner got an apartment together, she figured it made more sense to care for him herself instead of going to a job to take care of other people.
Weidner said that she earns about $14 an hour and that she and Kingsmore live paycheck to paycheck. Weidner is a member of the union SEIU Healthcare, which said in a news release that Shapiro's budget would bump her pay to at least $15 and create benefits like paid time off.
Weider hopes the wage boost, if approved, draws more people to the home care workforce. Then Kingsmore, who has cerebral palsy, could hire additional support to back up Weidner.
Weidner initially worked for an agency when she became Kingsmore's caregiver. She told How We Care that she made less money then but figured that if she had an emergency and couldn't be there for Kingsmore, then he would be covered by another agency staffer.
But when Weidner needed surgery and requested someone to fill in, the agency told her they couldn't provide it. Shortly after, Weidner quit and Kingsmore switched to the direct care model so that she could remain his paid caregiver.
Kingsmore is one of 148,000 Pennsylvanians who receive this Medicaid-funded in-home support, according to the Pennsylvania Department of Human Services. Weidner thinks the state should encourage more people to directly employ their caregivers instead of going through a third party. That way more money ends up in the pockets of workers.
There isn't evidence that caregivers employed by agencies make less money, said Mia Haney, CEO of the Pennsylvania Homecare Association, which represents home health, home care, and hospice providers.
Haney said Shapiro’s budget should support agency workers as well as those directly employed by the people who receive services. When home health agencies are underfunded, Haney argued, the people who rely on these services have fewer options.
Shapiro’s proposed budget would target some 8,500 direct care workers, but Haney pointed out that’s just a fraction of this workforce, and that agency workers deliver the exact same support services.
"How could we say that direct care workers are more deserving than another? How can we say that the work you perform with this customer is more important than the work you perform with this one?" Haney said.
The Bureau of Labor Statistics reports that as of May 2023, there were 213,000 home health and personal care aides in Pennsylvania. This number includes people who work in hospitals and nursing facilities, in addition to those who provide direct support to people living at home.
Weidner agreed that everyone in her line of work deserves higher pay and better benefits. Both also argued that expanding Pennsylvania's home care workforce would lessen the amount of people in nursing homes.
Universal postpartum depression screening
Shapiro did not attach a dollar amount to his call for Pennsylvania to offer universal postpartum depression screenings.
The mood disorder can leave parents anxious and sad, affecting their ability to care for themselves and their children. To address this, Shapiro wants to train clinicians how to quickly identify the disorder and create a “resource hub” where families can go to find more information.
"Let's take an issue that lurks in the shadows and put it right in the middle of the conversation," Shapiro said during his address.
Maternal health advocates have called for universal screenings for a long time, said Rosemarie Halt, a policy consultant for the Philadelphia-based nonprofit Children First.
Most of these screenings happen at doctors' appointments that are typically scheduled about a month or two after someone gives birth. But Halt would like to see screenings continue during the half-dozen pediatric visits that are recommended throughout an infant's first year.
"Babies don't go to the doctor by themselves. And you know, often what's happening with mom is affecting baby," said Halt.
Identifying postpartum depression is just one part of addressing the issue, some advocates noted. Actually finding care is like the Wild West, said Sara Jann Heinze, senior director of policy and advocacy at the Philadelphia-based Maternity Care Coalition.
"There's a lack of providers in rural parts of Pennsylvania. And in urban parts, there's providers, but they're all full up," she said of the disparate availability of mental health care.
Well-meaning initiatives can be redundant, warned Sarah Horvath, Pennsylvania legislative chair for the American College of Obstetricians and Gynecologists.
In an emailed statement, Horvath told Spotlight PA that best practices already recommend postpartum depression screenings at various appointments following a birth. Meanwhile, receiving the care is a matter of supply, she said, noting the shortage of practitioners who can treat postpartum depression and the often six-week wait to see them.
If Shapiro wants to better support the mental health of pregnant and postpartum patients, Horvath argued, he should advocate for more funding for programs that connect OB-GYNs to perinatal psychiatrists.
Heinze contended that universal paid leave would also help families seeking mental health care. She cited a plan by a bipartisan group of lawmakers to reintroduce a bill that would provide financial support to workers who take time off for several reasons, including the birth of a child.
