Pennsylvania’s senior care system is in crisis and is losing nursing home capacity by the thousands; fewer communities, fewer beds, and most importantly, more older adults are being turned away from the high-quality care they need and deserve close to home.

The term “silver tsunami” was initially meant to signal a future challenge: the rapidly growing aging population that will inevitably flood the healthcare ecosystem. Instead, the crisis has quietly become our present. Those of us involved in aging services have sounded the alarm for years, emphasizing the need for investment and policies that prepare the system for this impending crisis.

That moment of crisis is here.

Since 2020, Pennsylvania has lost 37 nursing homes and more than 4,300 skilled nursing beds, reducing capacity for older adults in need of care. At the same time, the 85+ population is expected to triple by 2050.

A recent LeadingAge PA report breaks this down further. Of association members surveyed in January 2026, in the past year, 10% report permanently de-licensing nursing home beds, and 29% have taken licensed beds “offline” or intentionally unfilled. Nearly half (49%) declined hospital admission referrals in the last 90 days.

This shows that demand for services is rising while supply drops, leaving many older adults without the necessary care and their families searching for options. Many face prolonged hospital stays, placements far from home, and a patchwork of both family and professional in-home options that may not meet their needs. Is this what we want for our loved ones and eventually ourselves?

Why are we in this situation? When asked about bed reductions and declined admissions, LeadingAge PA members identified inadequate funding as the primary concern, followed by a workforce shortage. The gap between the actual cost of care and Medicaid reimbursement rates is simply unsustainable. Without adequate funding or staff, their only option is to reduce the amount of individuals they are able to serve.

Now, more than ever, it is critical that the state invest in Pennsylvania’s senior care system. LeadingAge PA is fighting for solutions, and it starts with funding. It’s time to make a strategic change to the funding system to provide greater stability and predictability in Medicaid reimbursement, ensuring that our mission-driven providers receive the support they need and can rely on.

For nursing homes, we propose modernizing the Budget Adjustment Factor (BAF), an outdated funding mechanism instituted by the PA General Assembly more than 20 years ago, by implementing a floor. Here is how it works: The state calculates what it considers “allowable costs” to care for residents each quarter and then uses the BAF to cut those rates to fit the available budget. As a result, nursing homes are routinely paid significantly below the cost of care. This is why we are advocating that the General Assembly implement a floor to the BAF, which would help stabilize the funding system and bring reimbursement payments closer to actual costs.

Understanding the need for comprehensive care and for supporting the entire aging services ecosystem, we cannot overlook the innovative Living Independence for the Elderly (LIFE) program, which helps older adults who qualify for skilled nursing care remain in their homes and communities while receiving appropriate care and support. Like LeadingAge PA’s recommendation for Nursing Homes, we propose setting LIFE providers’ Medicaid payment rates at a minimum percentage floor of the Amount that Would Otherwise be Paid (AWOP) (a metric comparing alternative programs to default managed care costs) to stabilize the system.

Turning to the ongoing workforce shortage, nursing homes currently face conflicting staffing standards: rigid per-shift staffing ratios alongside misaligned per-patient-day (PPD) requirements. As a result, mission-driven providers are being forced to further reduce admissions or limit services, making it increasingly difficult for Pennsylvanians to find care.

While we are grateful for efforts to strengthen the workforce pipeline, providers need relief from overly prescriptive per-shift requirements that fail to reflect today’s workforce realities and exclude key members of the care team, including therapists and other clinical professionals who contribute directly to resident care and outcomes.

Seeking this relief does not mean lowering standards. A minimum PPD and existing regulatory requirements for staffing according to clinical need, ensure accountability while allowing the flexibility necessary to staff appropriately across shifts and adapt to changing care demands.

The challenges we face are not inevitable; they are the result of policy choices. At its core, this is about people: older adults who need care and families trying to do right by their loved ones. With smart, targeted investments and reforms, Pennsylvania can strengthen its senior care system, protect access to high-quality aging services, and ensure older adults have real choices.

The crisis is now. We call on our state government to act to ensure the senior care system is robust and accessible for generations to come.

Garry Pezzano is president and chief executive officer of LeadingAge PA.