Choosing Elder Care in Pennsylvania

Pennsylvania Has Four Distinct Levels of Care

The Commonwealth splits elder care into four regulated tiers, and each one answers a different clinical question about your parent's daily functioning.

Non-medical home care covers help with bathing, dressing, meals, and companionship inside the home. Pennsylvania's statewide median rate runs about $34 per hour, and care is regulated by the Department of Health. If your parent can still manage most of their day but needs a few hours of hands-on support, this is the starting point.

Personal Care Homes (PCHs) are licensed under 55 Pa. Code Chapter 2600 by the Department of Human Services. They provide housing, meals, and 24-hour supervision with assistance for basic activities of daily living. PCHs cannot provide continuous clinical nursing — if a resident becomes permanently bedfast or develops advanced pressure ulcers beyond the facility's license, Chapter 2600 requires the facility to issue a discharge notice. Monthly costs typically range from $3,500 to $5,000 depending on location and room size.

Assisted Living Residences (ALRs) operate under Chapter 2800 and carry a legal aging-in-place mandate. An ALR must allow a resident to remain even as their medical needs increase, as long as those needs can be met through supplemental healthcare services. ALRs require larger private living spaces with kitchenettes and bathrooms. They're substantially more expensive — $5,550 to $8,400 per month — and only about 33 facilities in the entire state hold this license.

Skilled Nursing Facilities (SNFs) deliver around-the-clock nursing care under Department of Health regulations (28 Pa. Code Chapters 201–211). They handle complex medical management, wound care, and inpatient rehabilitation. Annual costs average $114,975 for a semi-private room and climb past $164,000 for a private room.

The Clinical Assessment That Determines Your Options

Pennsylvania uses a formal evaluation called the Functional Eligibility Determination (FED) to decide whether someone qualifies as Nursing Facility Clinically Eligible (NFCE). Your local Area Agency on Aging conducts this assessment — there are 52 AAAs across the state — and it evaluates ADLs, IADLs, cognitive status, and safety risks.

The Needs Assessment Tool (NAT) used during this process generates a standardized Needs Assessment Score (NAS), which the AAA uses to allocate state-funded services and prioritize enrollment. Meeting the NFCE threshold can support eligibility for Community HealthChoices (the state's mandatory Medicaid managed care program) and, subject to LIFE's additional requirements, the LIFE program (Pennsylvania's version of PACE for adults 55 and older).

If your parent doesn't meet the NFCE standard but still has functional needs, the state OPTIONS program provides home-based services to adults 60 and older regardless of Medicaid eligibility, using a sliding-scale copay based on income.

Three State Programs You Should Know About

Community HealthChoices (CHC) covers Medicaid-eligible adults who meet the NFCE clinical threshold. Three managed care organizations — AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices — administer services across five geographic zones. CHC covers home health aides, personal assistance, home modifications, delivered meals, and personal emergency response systems at no copay for eligible participants.

The OPTIONS program fills the gap for seniors who don't qualify for Medicaid. There's no income cap or asset limit — instead, participants with incomes above 133% of the Federal Poverty Level pay on a sliding scale. Monthly care plan costs are capped at $765, though meals, home modifications, and specialized medical transport are excluded from that cap. Contact your local AAA to apply.

The LIFE program (Living Independence for the Elderly) integrates Medicare and Medicaid services through a single provider. It's a voluntary alternative to CHC for adults 55+ who meet the NFCE standard, live within an active LIFE provider's service area, and can live safely in the community with the program's support. It requires using the program's contracted physicians and day centers. Currently 19 LIFE providers operate 57 centers across 54 of Pennsylvania's 67 counties.

How to Start the Decision Process

Begin with your parent's primary physician. For home-based care pathways, the doctor completes a Physician Certification Form (MA 570). For skilled nursing placement, the Medical Evaluation Form (MA 51) is required instead. Only an MD or DO can sign these — forms signed by physician assistants or nurse practitioners will be rejected.

Next, contact your local AAA or the PA Independent Enrollment Broker (Maximus) to request the FED assessment. The IEB or AAA arranges this in-home evaluation, which establishes the clinical baseline that drives everything else.

While waiting for the assessment, visit potential facilities in person. For nursing homes, pull their inspection reports through the Department of Health's Nursing Care Facility Locator. For personal care homes, check their licensing status in the DHS Human Services Provider Directory. Look at the Statement of Deficiencies and the facility's Plan of Correction — and verify whether corrections were actually completed.

The full IEB enrollment process for Community HealthChoices runs up to 90 days from referral to active services. The physician certification form is the single biggest bottleneck: the doctor has 86 days to return it, and delays here stall everything downstream.

If you're navigating this process and want the complete step-by-step workflow with every form, deadline, and cost figure organized in one place, the Pennsylvania Care Decision Guide walks you through legal stabilization, clinical assessments, benefit applications, and plan selection week by week.

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