State Sen. Nikit Saval, D-Philadelphia, is pictured during a Senate hearing in June.

A state lawmaker wants to take pay raises for direct care workers out of the hands of the governor and state Legislature and instead create a wage board that could change direct worker pay every three years.

Legislation will soon be introduced in the state Senate to create a wage board for direct care workers in the state – though it’s unclear if the bill stands much of a chance in the Republican-led state Senate nor Gov. Josh Shapiro, who was criticized by the state Homecare Association earlier this year for not increasing pay for enough direct care workers as part of his executive budget proposal.

Sen. Nikit Saval, D-Philadelphia, is proposing legislation that will direct the state’s Secretary of Human Services to create a long-term care standards board as part of the state’s Medicaid rate setting process. The board will meet every three years and be charged with making sure wages paid to direct care workers are sufficient, advise the human services secretary on rate setting in long-term care support services, have the power to set pay rates for direct care workers and create a public process whereby recipients of care, direct care workers, private home care and long-term care employers, as well as the Medicaid program, can work together to determine the better pay rates.

Saval also wants to allow direct care workers to choose a union to represent them during wage board proceedings, make it easier for direct care workers to participate in a union and require all direct care worker employers funded by Medicaid to allow their direct care employees to allow a payroll deduction to support a union if they so choose.

“Direct care work is one of the fastest-growing job sectors in our commonwealth, and demand continues to increase,” Saval wrote in his co-sponsorship memorandum. “By 2030, 1 in 5 Americans are projected to be age 65 or older, and many Pennsylvania counties are aging at a far faster rate. Yet direct care is among the lowest paid workforces in our commonwealth, with a median wage of $14.41 per hour across all DCW positions. These wages are so low that a significant number of home care workers and personal care aides in Pennsylvania receive public assistance, like Medicaid and SNAP benefits, to meet their basic needs.”

Pennsylvania has 278,000 direct care workers, the vast majority of whom work in Long-term Services & Supports funded via the state’s Medicaid program, according to the Pennsylvania Homecare Association. The association requested a 10% increase in reimbursement rates for personal assistance services in the 2025-26 state budget that would cost $370 million investment in the as-yet finalized state budget to support direct care workers. That proposed increase would provide a 10% increase to all of Pennsylvania’s 150,000 direct care workers in the Office of Long-Term Living Home and Community Based Services programs, regardless of whether they are employed through participant-directed or agency-based models of care. 

Gov. Josh Shapiro included $21 million in additional funding to give a 10% rate increase for roughly 4% of the direct care workforce under the participant-directed services model. Shapiro’s budget proposal, the association said, offered no increase in reimbursement rates for pediatric and adult shift nurses or for agency employed direct care workers, which make up 96% of Pennsylvania’s direct care workforce.

The association said more than 400,000 seniors and medically fragile Pennsylvanians rely on in-home care, but caregivers and nurses are rapidly departing the industry to work in surrounding states or alternate settings that pay more competitive wages. More than 112,500 home care shifts go unfilled every month in Pennsylvania while 27% of total authorized hours are missed, largely due to the lack of staff, according to statistics provided by the Pennsylvania Homecare Association. 

“We understand that this is a challenging budget year, but Pennsylvania simply cannot afford to ignore this home care crisis any longer. The heartbreaking reality is that more than 112,500 caregiver shifts and 27% of allocated nursing hours in Pennsylvania are already missed every single month, and that number is only going to increase,” said PHA CEO Mia Haney in April. “Every state bordering Pennsylvania has invested in their direct care workforce while we’ve failed to meaningfully address our workforce needs. Inaction is no longer an option – the health and safety of our communities is hanging in the crosshairs of these budget decisions. If our legislators don’t act, the results will be devastating – medically complex children sent back to hospitals, families torn apart, wheelchair-bound adults left in bed all day, seniors laying alone on the floor after a fall, or worse…”