The Reality of Caregiver Pay in PA

In Pennsylvania, thousands of older adults and people with disabilities depend on the Office of Long-Term Living’s Fee‑for‑Service program to remain in their homes. Behind that care are dedicated caregivers who lift, bathe, comfort, prepare meals, keep track of medications, and often serve as the most trusted person in a participant’s day. It’s work that requires skill, patience, and heart — but for far too many, the paycheck just doesn’t match the responsibility.

As of 2023, the average base wage for an agency‑employed caregiver under OLTL FFS in Pennsylvania was just $15.69 an hour. The same state study found turnover in the home care industry at 64%, and over 112,000 home care visits go unfilled each month. Meanwhile, in the same state, a Walmart stocker earns an average of $18.37 an hour, with top rates over $20. Amazon warehouse associates make $19 to $21. Fast food managers can bring in $20 to $25. School bus drivers often start at $22. Those jobs may be physically tiring, but they don’t require lifting another person, watching for medical emergencies, or carrying the weight of someone else’s safety, dignity, and wellbeing on your shoulders every day.

It’s no surprise, then, that many caregivers — who love their clients — are leaving for other lines of work just to keep up with rent, groceries, and gas. Every time a caregiver leaves, the client loses stability, the agency scrambles to cover shifts, and trust is disrupted. Families are left worrying who will show up next week — or if anyone will at all.

What makes it even harder to swallow is knowing that Pennsylvania’s Medicaid budget has grown, and certain direct‑hire caregivers received a $21 million statewide increase in funding — but 94% of in‑home care is delivered through agencies, and the OLTL FFS agency reimbursement rate has stayed at $20.63 an hour. That’s the total an agency receives to cover caregiver wages plus payroll taxes, insurance, training, compliance, and all operational costs. The state’s own commissioned study recommended raising that rate to $25.42 to stabilize the workforce. Neighboring states already pay more — Ohio at $28.96, Maryland at $25.58, and West Virginia at $25.44 — so Pennsylvania is losing caregivers to states that value their work at a higher rate.

This isn’t just a workforce problem. When caregivers leave, clients lose care, families are stretched to the breaking point, and people end up in hospitals or nursing homes that cost Medicaid far more. It’s a community problem, an economic problem, and a human problem. Caregiving is skilled, essential work. It deserves pay that reflects its value. Until Pennsylvania raises OLTL FFS agency rates — with the guarantee that increases go directly to caregivers’ wages — we’ll keep watching good people walk away from a job they love, not because their hearts changed, but because the numbers stopped adding up.