Personal Care Homes Briefing Paper

Definition of Personal Care Homes in Pennsylvania

Personal Care Homes (PCH) are residential facilities that offer personal care services, assistance and supervision to four or more persons who are not relatives of the operator. A PCH is not a nursing home and no skilled or intermediate care is offered or allowed. Residents of a PCH need assistance or supervision in activities of daily living (e.g. dressing, bathing) or instrumental activities of daily living (e.g. laundry, cleaning). Personal Care Homes are required to hire staff who meet basic education requirements. Personal Care Homes also must provide initial and ongoing training for staff persons.

Licensure of Personal Care Homes

The Pennsylvania Department of Public Welfare (DPW) licenses and inspects Personal Care Homes. For settings that provide services to four or more people who don't need nursing care there currently is no category of licensure available in this state other than the personal care homes. These homes are sometimes referred to or marketed as "assisted living" homes or facilities and may also be called retirement homes or communities. Thus, all assisted living facilities are personal care homes by licensure, but not all personal care homes call themselves or market their services as "assisted living." There are no federal regulations for Personal Care Homes or for Assisted Living Facilities. The Pennsylvania PCH regulations, found at 55 PA Code Chapter 2600, include requirements for fire safety; staff training and education; nutrition and meal preparation; resident health and medical care; personal care service delivery; physical site conditions; and other factors effecting the health, safety and well-being of residents. The Department of Public Welfare is charged with enforcement of the PCH regulations. Annual licensing inspections are to be carried out by four DPW Regional Offices. The current regulations have been in effect since October 24, 2005. The development of a definition, standards, and licensure of "assisted living facilities" in this state has been under discussion for many years.

Description of Personal Care Homes and Assisted Living Facilities

Personal Care Homes/Assisted Living Facilities serve from four to several hundred residents. A setting that serves fewer than four people is not licensed and is not currently inspected. All but one county in Pennsylvania ( Forest) have at least one licensed home. Generally, the more populous areas have more licensed beds. Of the 1,586 licensed homes statewide on April1, 2007, 74% are for-profit businesses; the others are operated by non-profit organizations or by government entities. Almost half have fewer than 30 residents, with 11% of the homes having over 100 residents. Forty-one percent of homes have between 30 and 99 residents. Beds per facility and Personal Care Home ownership are displayed in the charts below.

Payment for Personal Care Home Services

Fifty-nine (59) percent of the licensed Personal Care Homes accept some residents who receive Supplemental Security Income (SSI) and the PCH Supplement that is available to low-income residents as payment for services. The remaining homes are private pay only and generally have higher rates and offer additional services and amenities. Many of these are associated with larger retirement communities that may include nursing facility level of care units and/or independent living units. In 2007 the PCH Supplement went up by $45 per month (retroactive to July 1, 2006) to an average of $439.30. The average SSI payment is $603 per month. An Individual who receives Supplemental Security Income is eligible to receive the PCH supplement if he/she needs the services of and resides in a Personal Care Home. Of the total PCH population statewide on April 1, 2007, over 9,000 residents, or 18%, receive SSI. Generally, individuals who need nursing home level of care are not served in a PCH and are therefore not eligible for services paid through Medicaid home and community based waivers.

Demographics of Personal Care Home Residents

As of April 1, 2007, there were almost 51,000 PCH residents across the state. Personal Care Homes typically serve adults who have age-related care needs. All residents have a need for some assistance or supervision which could be due to a physical, behavioral health, cognitive, or developmental disability. The most recent data on individual residents of Personal Care Homes are FY 05-06 which includes all individuals who lived in a PCH during that time period. Of the residents who received the SSI Personal Care Home Supplement as payment to the provider the largest group (45%) were white women, followed by white men (33%). Individuals under age 60 accounted for over 38% of the residents in this group, individuals 60 to 79 accounted for 35% and individuals over 80 totaled 27%. In FY 05-06, half of the individuals with SSI living in a PCH had a diagnosis of mental retardation (6%), or mental illness/substance abuse (44%). The bar chart below shows the relative proportions of PCH residents with SSI by race and sex and the pie chart shows these residents by age.

Individuals' Resources in Personal Care Homes

Personal Care Home residents whose disability and income qualifies them for SSI receive a monthly personal needs allowance of $60. The amount of the personal needs allowance has not had an increase since 1993. Most residents find that the allowance is not enough to ever save the funds needed to secure any other arrangement because the allowance must also cover prescription co-pays and other personal items such as toiletries, bus fare, clothing and phone calls. Low-income residents of personal care homes generally lack the resources to change their circumstances.

Data Sources:

Department of Public Welfare Monthly Statistical Report April 1, 2007

2007 Department of Public Welfare ( Commonwealth of Pennsylvania) Data Warehouse Report (Personal Care Home Request FY 05-06)