I’m Ron Barth, the president and CEO of PANPHA, which is an association of more than 350 nonprofit senior living and service providers – with about 45 of them in Allegheny County.

In doing my homework for this hearing today, Representative Wagner, I visited your biography on your web site and noted that you completed the Marine Corps Marathon in 2005. I might suggest that, on many levels, training for and completing a marathon was first-rate preparation for tackling the gamut of long term living issues as you begin your legislative career.

The system – although using the word system for what we have today is debatable – is in trouble. It isn’t working for consumers, it isn’t working for providers and it isn’t working for government.

But adding to the frustration is that while it often seems as if we are arguing, the fact is that all of us generally want to end up in the same place. We all can agree that we can -- and must -- do better for our seniors than a fragmented system of funding, using a patchwork of federal, state and private funding, with various eligibility requirements and levels of oversight.

Yet, as always, it seems "the devil is in the details."

For instance, on "re-balancing," or "rightsizing:" PANPHA has long maintained that nobody should be in a nursing home unless they truly need to be there. But the fact is that that few alternatives exist yet for the low-income aged. The service infrastructure just is not there.

In addition, there is a shortage of workers available – not just in nursing homes, but in ALL settings. Where will all these caregivers come from?

Nursing homes today are serving a population that used to be in hospitals, providing quality of care and quality of life for people into their 90’s and 100’s. We hear that nursing homes are somehow crammed full of people who don’t need to be there – that if the state could only get everybody out of nursing homes and back "into the community," whatever that means, we could spend a lot less money on Medical Assistance.

It just isn’t the case. The demand for ALL services, across the entire continuum, is only going to continue to grow. So even as a smaller PERCENTAGE of people may need 24-hour skilled nursing care in the future, there are going to be a greater NUMBER of people who need them because Pennsylvania is getting grayer and grayer. So as you hear about "rightsizing" the system, please realize that we haven’t taken the time to determine what the "right size" IS – either now or in the future.

The Commonwealth has been using incremental policy tweaks to muddle through budget year after budget year, rather than taking on the challenge of systemic change to senior care and services.

Piecemeal attempts to rein in inevitable increases in spending on long term care has prevented enough growth to meet the needs of an expanding population of frail, low-income seniors. The fact is that MA is the primary payer of long-term care, yet we have had years of chronic under-reimbursement relative to the documented costs of care –- under-reimbursement not just by our arbitrary desires or whims, but according to the state’s own formula. The true victims of MA funding shortfalls are our seniors who pay privately – not only for their own care, but to subsidize the care that the MA rates don’t cover.

It is long past time to go beyond "business as usual." We are at a crossroads.

We reiterate our call for a legislative commission to determine exactly where Pennsylvania stands and where we need to go to adequately fund the entire range of long term living services.

The Senior Care and Services Planning Commission we seek would be comprised of legislative representatives, Administration officials, and a wide range of stakeholders in the system. It would be charged with developing a blueprint for a genuine, seamless system – and collaborating to craft a sustainable, predictable and truly adequate revenue solution to achieve it.

The commission we envision would:

The facts are irrefutable: Our population is aging in stunning numbers, the Baby Boomers are at the cusp of retirement age, and business-as-usual is not an option. We need nothing less than a fundamental re-examination of the care and services we offer, how we provide them at the levels required, and how we fund them. Anything else is just putting off the day of reckoning.

Thank you again for the opportunity to testify before you today. PANPHA and its members stand ready to assist in any way to confront the challenges facing the future of senior services in Pennsylvania.