Pennsylvania Official Pushes for Better SNF Vetting, Warns of Workforce Crisis

The state of Pennsylvania should adopt stronger policies for vetting nursing home operators in the wake of the Skyline Healthcare collapse, a report issued Tuesday from Pennsylvania Auditor General Eugene DePasquale recommended.

“Nearly 90,000 Pennsylvanians live in more than 700 nursing homes throughout the state, and they represent just a fraction of our aging population,” DePasquale wrote in his introduction to the report. “Pennsylvania already has more seniors than all but seven states.”

The report contains nine observations and 30 recommendations; it is a follow-up to a 2016 audit that found inconsistency in nursing home surveys and quality standards.


The Keystone State was one of several states affected by the meltdown of Wood Ridge, N.J.-based Skyline, which underwent a financial collapse last spring that saw nine Pennsylvania facilities taken over by temporary leadership.

That takeover ultimately cost the state $408,000, the auditor general report said. And when a company like Skyline fails, DOH employees are the ones who have to install temporary management. The costs of this are covered by the Civil Money Penalty (CMP) Fund, and while those are not direct taxpayer funds, they should go to better use than covering for the poor financial decisions of a private company, according to the auditor general.

“Through DOH’s licensing process, the commonwealth should have the authority to demand collateral or a form of insurance from operators that would cover the costs of installing temporary management, should that become necessary,” the report said.


When it comes to setting better standards for reviewing nursing home operators, DOH should specifically work with its general counsel to examine how other states review new applicants for nursing home facility licenses. In addition, the DOH should set a policy to mandate “detailed, thorough vetting,” the report recommended. That includes reviewing applicants’:

  • Past and current litigation
  • Vendor relationships
  • Real estate relationships
  • Ownership interest in other health care providers
  • Staff and client complaints

“The investment trend of private equity firms buying up nursing home chains is a salient example of why state governments need ownership information in order to make license decisions: Private equity investors are career investors, not elder care specialists,” the report said. “The burden of proving they have competent management and genuine interest in the health and safety of clients should rest on these firms.”

Addressing dire worker shortages

The Keystone State is also facing a “looming health care workforce crisis,” which has to be addressed to ensure that seniors have the care they need, according to the auditor general’s findings.

According to data cited in the report, Pennsylvania could be short by more than 4,000 registered nurses (RNs) by the year 2030. Issues that compound the workforce problem include low wages, direct-care staffing being left out of care plan discussions, physical challenges and injuries, burnout, and few paths from direct care to management roles, according to the report.

Recommendations for employers to address the workforce environment included:

  • Raising wages to family-sustaining levels and increasing non-salary benefits
  • Forming partnerships with labor associations to facilitate collaboration and communication between management and the workforce
  • Including direct-care staff in organizational, safety and care decisions and implementing mentorships, as well as encouraging career advancement
  • Exploring different employment programs, such as shared employment agreements

The DOH, meanwhile, should clarify and consolidate titles, certifications and licenses for nursing and health care professionals, as well as ease licensing restrictions for medical professionals,.

The DOH is currently committed to reviewing and revising the current nursing home licensure regulations, which have not been updated since 1999, Pennsylvania Secretary of Health Dr. Rachel Levine said in her response to the report. She noted that the DOH has reviewed how other states assess new nursing home license applicants.

“We are presently exploring opportunities for the improvement of this process related to vetting new owners,” Levine wrote in her response. “With the current review and revisions of the Long-Term Care Licensure regulations, this process is a focus area.”

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