Nursing Homes in Pennsylvania
Nursing homes provide skilled nursing care, such as preventive, therapeutic or rehabilitative care and assistance with daily living activities for seniors requiring 24-hour supervision. Most nursing homes offer short- and long-term care. Short-term care services are designed for seniors recovering from surgery or acute illness or injury until they're ready to return home. Long-term care is typically for those suffering from a chronic or terminal illness who need constant monitoring and supervision. Since these residents are usually there for the duration of their lives, nursing homes offer a secure, supportive environment to help them stay comfortable.
Out of Pennsylvania's 12.9 million residents, about 19% are 65 and older. Seniors have access to 684 certified nursing homes throughout the state, with an average of 127 certified beds. As of 2022, roughly 64,276 older adults reside in these homes. Nursing homes offer many benefits for aging adults, but they're also one of the more expensive care options. This guide covers the financial assistance available for nursing home costs, including Medicaid and Medicare benefits, and how these facilities are regulated to keep your loved one safe.
Popular Cities in Pennsylvania
Cost of Pennsylvania Nursing Homes
The average cost of nursing homes in Pennsylvania is $3,555 per month. This is higher than the national average which is $228 per month.
Can You Use Medicaid to Pay for Nursing Home Care in Pennsylvania?
Low-income seniors can use Medicaid to pay for nursing home care in Pennsylvania. State law requires Medicaid to pay for nursing home care for all residents who meet the program's financial criteria and have a medical need, regardless of the length of residency. Currently, there are over 3.6 million people enrolled in the program, which is a 53% increase over the past decade. Pennsylvania's Medicaid program, also known as Medical Assistance, helps eligible seniors pay for nursing home care by covering the difference between the facility's monthly charge and an individual's monthly payment.
The program provides a list of providers accepting new patients to help seniors and their families choose a facility aligning with their needs. Some older adults can also apply for waivers for extra coverage. The HealthChoices waiver program grants individuals access to additional services for mental health and substance abuse treatment, community-based programs and other outpatient or inpatient physical health services, depending on which waiver they apply for.
Eligibility for Medicaid in Pennsylvania
To be eligible for Medicaid in Pennsylvania, seniors must meet certain income requirements. For a single person, annual income must not exceed $32,904; for a two-person household, annual income must fall below $65,808. Applicants must also meet certain asset limits. A single person can possess up to $2,000 in assets, while a two-person household can have up to $4,000 worth.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,000 |
| Two-Person Household | $65,808 | $4,000 |
*Per year
Seniors also have to meet certain nonfinancial eligibility requirements to qualify for Medicaid. To receive Medicaid coverage for nursing home care, a person must:
- Obtain physician's orders stating nursing home care is medically necessary
- Have a valid driver's license, state identification card or other means of identification
- Have a Social Security number
- Be a Pennsylvania resident
- Be a U.S. citizen or qualified non-citizen
Applying for Medicaid in Pennsylvania
There are several ways seniors can apply for Medicaid in Pennsylvania. Through the COMPASS website, individuals can fill out an online application, renew their benefits or check eligibility requirements. Seniors can also apply in person by visiting their local county assistance office if they want help filling out their forms or have questions about coverage. If neither of these options works, seniors can download a paper application and mail it to their local county assistance office or apply over the phone by calling 1-866-550-4355.
What Information You Will Need
The following information is needed to complete an application:
- Household income
- Federal tax filing information
- Current or recent health insurance information
- Social Security numbers and birthdates of household members
- Proof of citizenship for U.S. citizens
- Documentation showing lawful residence for non-citizens
- Housing and utility expenses
- Asset information, including bank accounts, properties, vehicles and life insurance
Additional Medicaid Support & Resources in Pennsylvania
Pennsylvania offers several resources that provide information and support for accessing Medicaid benefits. By contacting the following nonprofits and government agencies, older adults can learn more about Medicaid enrollment or long-term care support and get all their questions answered for free.
| Contact | Service | |
|---|---|---|
| Pennsylvania Council on Aging | (717) 783-1550 | The Pennsylvania Council on Aging serves as an advocate for older adults by ensuring they have access to needed services throughout the state. Seniors can take advantage of multiple health and wellness services, including health care enrollment counseling and prescription assistance. |
| Pennsylvania SeniorLAW Helpline | (877) 727-7529 | The Pennsylvania SeniorLAW Helpline provides free, confidential telephone-based services for older adults throughout the state. Seniors can access advice, information and referrals on health insurance and other government benefits, including VA health care benefits. Adults must be 60 or older to receive services. |
| Pennsylvania Health Law Project (PHLP) | (800) 274-3258 | The PHLP provides free legal services, community education and advocacy to help individuals access and maintain health care services. Seniors can call the hotline for help with Medicaid coverage and learn about other long-term care services and resources. |
Can You Use Medicare to Pay for Nursing Home Care in Pennsylvania?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Pennsylvania
Several government agencies and nonprofits in Pennsylvania offer free assistance and information on Medicare benefits or dual enrollment in Medicare/Medicaid for nursing home care. Seniors and their families can use the contact information listed below to learn more.
| Contact | Service | |
|---|---|---|
| Pennsylvania Department of Aging (PDA) | (717) 783-1550 | The PDA provides several services for seniors throughout the state, including Medicare counseling to explore eligibility requirements, benefits and coverage options. It also oversees the Aging and Disability Resource Center, where older adults can find additional resources on health care eligibility and other government benefits. |
| Pennsylvania Department of Human Services (DHS) | (866) 550-4355 | The DHS is responsible for overseeing Pennsylvania's Medicaid program. For seniors who qualify for Medicaid and Medicare, the two programs work together to ensure individuals have access to optimum health care coverage for needed services. Seniors can contact their local county assistance office for eligibility or enrollment information. |
| Pennsylvania Health Law Project (PHLP) | (800) 274-3258 | The PHLP is a nonprofit providing free legal advice and education to help seniors throughout Pennsylvania access health care coverage. By contacting the organization's helpline, individuals can learn how to obtain Medicare benefits or dual enrollment for Medicaid/Medicare. |
| Pennsylvania Insurance Department | (877) 881-6388 | The Pennsylvania Insurance Department provides online health insurance information and services for seniors. Older adults can explore available Medicare supplement insurance, Medicare Advantage and prescription drug plans. They can also contact the agency's Consumer Services Bureau for insurance-related questions and concerns. |
| Pennsylvania Area Agencies on Aging | (717) 783-1550 | Pennsylvania's Area Agencies on Aging are monitored by the PDA and focus on developing community-based long-term care services for seniors. After finding their local agency, older adults can access connections and referrals for services in their area, including health insurance counseling. |
Other Financial Assistance Options for Nursing Home Care in Pennsylvania
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Pennsylvania
| Licensing Requirements | To legally operate, nursing homes must be licensed by Pennsylvania's Division of Nursing Care Facilities, Bureau of Quality Assurance, Department of Health |
| Staffing Requirements | The minimum staff-to-patient ratio in Pennsylvania is 1:20. This means one licensed staff member cannot be assigned more than 20 patients. Also, nursing homes must always have two nursing staff members on duty, a nursing director and a social worker. |
| Staff Training Requirements | Nursing home employees must have access to ongoing, coordinated training, including annual training on accident prevention, confidentiality, fire, infections and reporting elder abuse. Orientation must also be provided upon hire and include information on identifying and reporting abuse. |
| Admission Restrictions | Nursing homes in Pennsylvania can only admit a patient if they offer the services needed to properly care for an individual based on their physician's evaluation and recommendations. |
| Care Planning Requirements | Within 7 days of admission, all patients must receive individualized care plans. They should also be allowed to participate in their care planning when possible. |
| Dietary and Nutritional Services Requirements | A qualified dietitian must plan all menus to ensure healthy meals are offered. These menus should be available at least 2 weeks in advance and stay on file for 30 days. A dietitian-approved diet manual should also be supplied to all appropriate personnel. |
| Specialized Rehabilitative Services | Pennsylvania nursing homes aren't required to offer specialized rehabilitative services. However, if therapies are provided, rehabilitative services must begin within 7 days of admission according to each resident's care plan. |
| Medication and Pharmaceutical Services | Medications must be administered under the supervision of a licensed physician or pharmacist according to physician's orders. Facilities must also provide monthly pharmacy consultations for each resident and administer medications in original containers with the resident's name clearly labeled. |
| Activities Requirements | Helping residents stay active and maintain their physical and mental health are considered priorities in nursing home care. Facilities must provide activities that encourage social, physical and mental engagement. |
| Infection Control Requirements | According to state and CDC standards, infection control methods must be utilized in Pennsylvania nursing homes to prevent communicable diseases from spreading. The state also requires staff to report conditions to the Division of Nursing Care Facilities field office. |
| Medicaid Coverage | Qualified seniors can access Pennsylvania Medicaid benefits to pay for nursing home care. To be eligible, an individual must meet income and asset requirements, be a U.S. citizen with a Social Security number and receive physician's orders stating nursing home care is medically necessary. |
Find Communities
Senior Homes has an extensive directory of senior living options, with care and living providers across the United States.
Top Cities in Pennsylvania
- Philadelphia Nursing Homes
- Pittsburgh Nursing Homes
- Allentown Nursing Homes
- West Chester Nursing Homes
- Erie Nursing Homes
- Reading Nursing Homes
- Norristown Nursing Homes
- Scranton Nursing Homes
- Bethlehem Nursing Homes
- Wilkes Barre Nursing Homes
- Mechanicsburg Nursing Homes
- State College Nursing Homes
- Pottstown Nursing Homes
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