Of the 12.7 million people who live in Pennsylvania, 18.7% are aged 65 and older. The Pennsylvania Health Care Association estimates that one out of four residents of the state is aged 60 or older. The state has 705 licensed nursing homes with more than 88,000 beds, and the average nursing home is over 91% occupied. Pennsylvania seniors have a number of options for their health care and long-term care needs. Two hospitals, University of Pennsylvania-Penn Presbyterian and UPMC Presbyterian Shadyside, are ranked among the top 25 in the nation for senior care, according to US News and World Report.

Nursing home care provides an elderly person with extensive medical intervention and help with daily living needs. The average cost for Pennsylvania nursing home care, according to the 2020 Genworth Cost of Care Survey, is $10,038 for a semiprivate room and $10,828 for a private room. This is significantly higher than the national averages of $7,756 for semiprivate rooms and $8,821 for private rooms.

This guide discusses options for nursing home care in Pennsylvania, resources for seniors who need care and ways to pay for that care.

The Cost of Nursing Home Care in Pennsylvania

Pennsylvania has a high average cost for nursing home care compared to national averages. The 2020 Genworth Cost of Care Survey found that seniors in Pennsylvania pay an average of $10,038 for a semiprivate room in a nursing home, compared to $7,756 for the national average. However, Pennsylvania is among the most affordable in the area compared to neighboring states. In West Virginia, seniors pay $11,376 on average for nursing home care. New Jersey seniors pay an average of $11,254, while in New York, the average cost increases to $12,319. Maryland has an average cost for care of $10,190, while Delaware’s average is $12,349 a month. Only Ohio is less, at $7,148.

$10038

Pennsylvania

$7756

The United States

$7148

Ohio

$10190

Maryland

$11254

New Jersey

$11376

West Virginia

$12319

New York

$12349

Delaware

The cost for nursing home care varies based on the amenities and services available at the facility as well as its location within the state. While the state average is $10,038, in the northern part of the state in Erie, the cost is about $900 less, at $9,186 a month. Williamsport in the central part of the state has a cost of $9,604. In Gettysburg, the cost is higher than the state average, at $10,889, and Harrisburg has an average of $10,311. Philadelphia is much more expensive, with a monthly cost of $11,285. The York area has an average cost of $10,291, while Pittsburgh has an average cost of $9,125.

$10038

Pennsylvania

$9125

Pittsburgh

$9186

Erie

$9604

Williamsport

$10291

York Area

$10311

Harrisburg

$10889

Gettysburg

$11285

Philadelphia

In addition to nursing home care, seniors in Pennsylvania have other care options. The average cost for nursing home care is the highest, at $10,038. Seniors who choose to move to assisted living, which doesn’t provide skilled nursing care, pay an average of $3,955 per month. Home care and home health care both cost an average of $4,576. Adult day care, which provides care and interaction during the day, is the cheapest, with an average of $1,517.

$10038

Nursing Home Care

$1517

Adult Day Care

$3955

Assisted Living Facility

$4576

Home Care

$4576

Home Health Care

Does Medicaid Cover Nursing Home Care in Pennsylvania?

Over three million Pennsylvanians are enrolled in Medicaid/CHIP, and this includes approximately 38% seniors and those with disabilities. For recipients residing in nursing homes, Medicaid pays the cost of room and board, meals, laundry and room cleaning as well as medication administration and other general nursing and support care services. Medicaid also covers the cost of on-site medical care, including medications and physician services. 

Pennsylvania’s more than 700 nursing homes provide about 800,000 beds to Medicaid recipients, where care is delivered 24 hours a day in a hospital-like atmosphere. The Long-Term Care Services division of the Department of Human Services, the state’s Medicaid overseer, helps cover additional costs associated with nursing care, such as nonmedical transportation and personal care items. Seniors who require a nursing home level of care but wish to remain in their homes may qualify for Community HealthChoices.

Medicaid Eligibility in Pennsylvania

All applicants must meet particular income and medical criteria in order to qualify for Medicaid services. The application can begin through a referral or completed online, on paper or in person at the local county assistance office. The process includes a screening interview, done face-to-face or over the phone, and a reporting of all incomes and assets.

Income limits are just over $30,000 yearly for individuals or two-family households where one person is applying. Limits are double that amount for two-family households where both members are applying. Assets are limited to $2,000 for single applicants or $4,000 for dual, with the exception that, in two-person households where only one person is seeking Medicaid, the non-applicant can keep $137,400 in assets. 

2022 Medicaid Income Limits for Seniors in Pennsylvania

Annual Income Limits

Asset Limits

Single Applicant

$30,276

$2,000

Two-Person Household

(Only One Person Applying)

$30,276

$2,000 for applicant

$137,400 for non-applicant

Two-Person Household
(Both People Applying)

$60,552

$4,000

Applications are also required to be Pennsylvania residents and legal citizens of the United States.

How to Apply for Medicaid in Pennsylvania

Several options exist for those seniors seeking Medicaid benefits. Applications can be completed through COMPASS, by calling the Consumer Service Center for Health Care Coverage at (866) 550-4355 or by downloading and printing the paper application and bringing it to their local County Assistance Office. Before applying, seniors should ensure they meet all eligibility requirements, and have documents on-hand verifying all income and assets. Decisions are made within 30 calendar days from the date of submission but can take up to 45 days if insufficient information is provided.    

Information You Will Need:

  • Copy of birth certificate
  • Driver’s license
  • Social security cards
  • Medicare or other health insurance cards
  • Bank statements, including closed accounts, for 60 months prior to application date
  • Proof of all forms of income, including self-employment wages, for 60 months prior to application date
  • Proof of any stocks, bonds, trust funds or certificates of deposit
  • Property deeds
  • Proof of any real estate sales, purchases or transfers for 60 months prior to application date
  • Retirement income verification, including pension, 401K and IRA
  • Copies of life insurance documents
  • Car title, registration and insurance
  • Burial contracts

Additional Medicaid Support and Resources in Pennsylvania

The following list is a compilation of free resources for seniors and their family members to help them navigate the often complicated process of Medicaid application and eligibility. 

Resource

Contact

Service

(800) 753-8827

An interconnected statewide network, Pennsylvania’s Area Agencies on Aging provides a wide range of free supportive services and programs to elderly and their families. AAAs can help explain the Medicaid application process to families in more detail and provide referrals to local nonprofits who may be able to offer more specific information or counseling.

Online Only

The American Council on Aging gives families greater detail about how to qualify for Medicaid, including how to spend down assets if a person is over the limits. The website also offers a free Medicaid eligibility screening test for seniors, to help them see whether they qualify for Medicaid and, if they don’t, what other options exist for long-term care financial support. 

(866) 550-4355

A federal website, Benefits.gov, gives generalized information about Medicaid such as income limits and how to apply. Includes links to apply online and a toll-free number for answering general questions about Medicaid coverage in Pennsylvania.

Does Medicare Cover 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 and Resources in Pennsylvania

While Medicare health insurance cannot cover the cost of nursing home care per se, it may be useful to utilize in the interim between nursing home placement and at-home or community care. The resources listed below are staffed by helpful advisors who can offer families information more specific to their individual needs and situations.

Resource

Contact

Service

(800) 783-7067

In conjunction with local Area Agencies on Aging, PA MEDI offers free Medicare counseling services for families with a non-biased, objective view of how Medicare, long-term insurance, Medicaid and Medicare Supplemental Insurance compare. Counselors can explain what is and is not covered, give eligibility and enrollment requirements and provide information about financial assistance programs that may help pay for premiums, copays and prescription drugs.

(800) 794-6559

BenefitsCheckUp is a free service facilitated by the National Council on Aging that helps families identify pertinent Medicare resources and other potential healthcare benefits. After completing a brief questionnaire that asks individuals to specify which benefits they’re interested in, BenefitsCheckUp provides a listing of services, including specific programs, referral centers and waivers that may be applicable. Families can then select the resources they are interested in, then answer a more detailed series of questions to get them connected with the specific resource.

(800) 633-4227

Providing a wide range of information about the Medicare program, Medicare.gov provides families with information ranging from basic details regarding costs and eligibility to specific characteristics of each Medicare plan. Assistance is available for finding providers, comparing procedure costs and filing claims or appeals. Individuals can call the toll-free number to speak with a representative, or use the chat box feature to get their questions answered in real time. 

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. 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 able to use it to pay for skilled nursing care. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not typically be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in Pennsylvania

There are many resources for seniors in Pennsylvania who are transitioning into nursing home care. Below are some programs that help seniors to remain at home while others advise on the transition process and others can help seniors once they are situated in a nursing home. 

RESOURCE
CONTACT
SERVICE

(717) 783-8975

The Long-Term Care Ombudsman Program empowers those in nursing facilities by advocating on their behalf to resolve any complaints or concerns regarding their care. Volunteer-run, the ombudsman program educates individuals on their rights while listening and investigating complaints ranging from facility or staff issues to care concerns or resident rights. Ombudsmen work towards a satisfactory resolution for each client, ensuring that their needs and concerns have been met throughout the process.

(800) 783-7067

PA MEDI offers free Medicare counseling to families alongside information about other insurance options such as long-term care insurance, and Medicaid. Trained counselors provide the most current details about enrollment, eligibility and benefits. Families can learn how coverage options compare and find out whether financial assistance is available to help pay for premiums or copays. 

(717) 783-1550

Free legal service is available through the Older Pennsylvanians Legal Assistance Program. Open to those 60 and older, the program focuses on those with greater income or social needs. Counsel and representation is available for a wide number of legal matters, including Medicare or Medicare concerns, elder neglect or other issues pertaining to long-term care. Families can call the toll-free number to learn more, or contact their local Area Agency on Aging.

Contact local AAA

For residents 60 and older who are still living at home, the services provided through the Help at Home OPTIONS program enable seniors to live more safely and securely on their own. In addition to case management to ensure individuals receive appropriate and ongoing services, personal care services provide assistance with daily living activities such as cleaning, cooking and bathing. Transportation, home-delivered meals and home modifications are some of the other options available for helping seniors receive well-rounded and comprehensive care while still at home.

COVID-19 Rules for Nursing Homes in Pennsylvania

The following information is based on research done on several government websites, including dhs.pa.gov. These rules apply to Independent Living Communities and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

Rules for Pennsylvania Communities

Are loved ones allowed to visit to provide emotional support?

Yes (Conditions Apply)

Are relatives allowed to visit for end-of-life care?

Yes

Are residents required to quarantine after visiting with a loved one?

No

Are visitors required to wear PPE (including masks) in order to visit residents?

Yes

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?

Yes

Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?

Yes

Are visitors checked for elevated temperatures?

Yes

Are visitors required to answer questions about health, travel, and potential virus contact?

Yes


Outings & Social Activities

Rules for Pennsylvania Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Yes

Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?

No

Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for Pennsylvania Communities

Are staff members regularly required to do a temperature check?

Yes

Are staff members regularly tested for COVID-19?

Yes (Conditions Apply)

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?

Yes

Are residents regularly screened for COVID-19 symptoms?

Yes (Conditions Apply)

Are residents regularly checked for elevated temperatures?

Yes

Are residents regularly tested for COVID-19?

Yes (Conditions Apply)

Nursing Home Laws and Regulations in Pennsylvania

NURSING HOME LAWS AND REGULATIONS IN PENNSYLVANIA
Licensing Requirements
All skilled nursing facilities must be licensed with the state of Pennsylvania’s Division of Nursing Care Facilities, Bureau of Quality Assurance, Department of Health.
Staffing Requirements
Pennsylvania has a minimum 1:20 nursing staff-to-patient ratio. This means there must be one licensed nursing staff member for every 20 residents. In addition, at least two nursing service personnel must be on duty at all times. Finally, all SNFs must have a Director of Nursing who is an RN on staff for a minimum of 35 hours and four days per week.Any nursing home with 120 or more residents must have a full-time social worker on staff to plan activities. Smaller facilities must have a social worker to plan and document activities, but they don't have to be full-time staff members.
Staff Training Requirements
Ongoing, coordinated education for all staff at SNFs in Pennsylvania is required by law. Employees also must have an orientation before starting their roles, and the orientation must include instruction on abuse and reporting. Annual service training on infections, fire, accident prevention, confidential information, psychosocial needs and abuse reporting is required.
Admission Restrictions
Individuals can only be admitted to SNFs in Pennsylvania if the facilities can attend to their needs based on their physician’s recommendations and evaluation.
Care Planning Requirements
All residents must have a care plan in place within seven days of admission. When possible, residents should participate in their care planning.
Dietary and Nutritional Services Requirements
SNFs must provide menus at least two weeks in advance and keep records for 30 days. A full-time, qualified dietary services supervisor must plan the menus. If the facility doesn't employ a full-time dietitian, it must consult with one at appropriate times and frequency to ensure healthy meals. A diet manual must be approved by the dietitian and medical director and be available to attending physicians, nursing staff and dietetic personnel.
Specialized Rehabilitative Services
Pennsylvania doesn't require SNFs to offer specialized rehabilitation services. However, if the SNF does, then the therapies in the resident’s care plan must start within seven days of admission.
Medication and Pharmaceutical Services
SNFs must administer medications under the oversight of a pharmacist or licensed physician. All residents must have written physician's orders for medications they take. Medications and biologics can be administered by qualified nurses and licensed practitioners only. The facility must have a monthly pharmacy consultation for each resident to check medication profiles. All medication, including over-the-counter, must remain in the original container and carry the resident’s name on the label.
Activities Requirements
Preserving physical and mental health is an important part of nursing home care. Pennsylvania requires all facilities to have activities that encourage physical, social and mental engagement.
Infection Control
Nursing homes in Pennsylvania must take measures to prevent infections following current state and CDC standards for preventing the spread of communicable diseases. The state also requires that staff reports any reportable conditions to the Division of Nursing Care Facilities field office.
Medicaid Coverage
Pennsylvania Medicaid covers nursing home care for qualified seniors. To qualify, an individual must be a U.S. citizen with a Social Security number, meet income and asset requirements and have a medical need for nursing home care based on a physician’s evaluation.

Nursing Homes Facilities in Pennsylvania (144)