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Pennsylvania's Strained Nursing Homes

The IFO posted a new research brief that discusses placement waitlists and potential cost implications from the contraction in nursing home capacity since 2019.

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Pennsylvania's Strained nursing Homes

The IFO posted a new research brief that discusses placement waitlists and potential cost implications from the contraction in nursing home capacity since 2019.

10/25/2023

PBB_2022_DHS_REPORT_ADDENDUM.pdf

2 LIFE Program.............................................. Support residents age 55+ to live independently 3 FFS Long-Term Care.................................... Manage delivery of waiver and nursing home services 4 Adult Protective Services............................... Handle reports of suspected abuse for adults age 18-59 5 Licensing and Inspections 3 Data by calendar year. Data exclude supplemental payments. Calculation based on state capitated payments and a monthly average of nursing facility ineligible (NFI) participants. 4 Data by calendar year. Data exclude supplemental payments. Calculation based on state capitated payments and

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PBB_2021_DMVA_REPORT_ADDENDUM.pdf

disabled veterans. ▪ Provide safe and efficient operation of six state-owned veterans homes that deliver quality daily per- sonal, skilled nursing and secure care to roughly 1,000 veteran residents and spouses. From March through December 31, 2020, 393 residents tested agency. Notable metrics that policymakers should monitor closely include the following: While Pennsylvania veterans homes have higher ratings than other nursing homes in the Com- monwealth, ratings vary across veterans homes. The U.S. Centers for Medicare and Medicaid Ser- vices

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PBB_2022_AGING_REPORT_Addendum.pdf

13% 13% 15% Physical abuse -- 16% 19% 17% 13% Sexual abuse -- 1% 1% 1% 1% Share of older adults in nursing homes 2,5 Residents age 75 to 84 in nursing homes 20,102 20,356 20,360 18,015 -- Share of all residents age 75 to 84 3.0% 3

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RB_10_2023_PA_Strained_Nursing_Homes.pdf

A recent Wall Street Journal analysis of nursing home data from the Centers for Medicare and Medicaid Services (CMS) found that U.S. nursing home capacity has contracted since 2019. 1 Data show that Pennsylvania recorded a similar contraction in nursing home facilities (-3

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PBB_2020_DOS_REPORT.pdf

40 $43 $44 $48 $56 # Transactions processed/activity FTE 3 Activity cost per transaction processed 3 Outcome Registered Nurse 4 Avg. weeks for initial licensing review 5 -- -- -- 2.5 3.0 2.5 Avg. weeks for discrepancy notices sent 6 -- -- -- 5 began tracking licensing times for a few occupations and plans to roll this out to other occupations. Registered nurse, cosmetologist, and osteopathic physician and surgeon were the first occupations tracked. 3 Transactions include (1) issuances, renewals, change applications and reactivations of

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PBB_2020_DOH_REPORT_Final_Update.pdf

rate 3 91.7% 95.5% 93.7% 96.8% 97.0% 97.0% % SDs with required school nurse/student ratio 4 95.5% 94.9% 95.8% 95.8% 98.2% -- Health Professional Shortage Area (HPSA) # Physicians with J-1 healthcare centers or in community settings. 4 SD stands for school districts. The required ratio is one school nurse per 1,500 students according to 24 P.S. Education § 14-1402(a.1). 5 The J-1 visa waiver allows eligible

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Revenue_Proposal_Analysis_2023_05.pdf

9%. Recruitment and Retention Tax Credit The Executive Budget proposes a Recruitment and Retention Tax Credit (RRTC) for newly certified nurses, teachers and police officers. This personal income tax (PIT) credit is equal to 3.07% of wages earned from nursing, teaching or policing during the tax year. The credit is capped at $2,500 annually and is available for up

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PBB_2021_DHS_REPORT_ADDENDUM.pdf

13.81 Home health and personal care aides 10.26 10.97 11.75 11.72 11.99 12.40 Nursing assistants 13.46 13.79 14.13 14.46 15.00 15.51 Healthcare social workers 23.18 23.62 clock basis, utilizing approximately 2,700 staff, over half of whom work in direct care positions. These state centers provide nursing and physician services, residential living, recreational and vocational services and dietary or nutritional needs for all residents. ODP also maintains

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PBB_Board_Hearing_Jan_25_2022.pdf

which may have contributed to increase in self-neglect cases (from 38% to 48%) Share of older adults residing in nursing homes declined in recent years ▪ Share of residents age 75+ living in nursing homes declined from 5.4% June 2017 to 5.1% in June 2019 and to 4.3% in June 2020

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PBB_2020_DHS_REPORT_Final_Updated.pdf

process waiver app. 2 12.3 10.7 10.8 13.6 13.5 -- Avg. # days to process nursing home app. 2 19.8 17.5 16.5 18.3 15.5 -- % Accurate eligibility long-term care -- -- 97.1% 97.6% 11,750 Nutritionist 703 Dentist 9,231 Case Manager 635 Optometrist 4,625 Public Schools 569 Certified Registered Nurse Anesthetist 4,522 Audiologist 516 Pharmacy 3,328 Nurse 516 Psychologist 2,517 Home Health 362 Podiatrist 1,816 Renal Dialysis Center

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Five_Year_Outlook_2021.pdf

additional employment detail for certain subsectors. Full-service restaurants (-31,200, -15.9%), employment services (-30,500, -24.9%) and nursing-residential care facilities (-26,100, -12.9%) recorded the largest contractions based on the number of part- and full-time home schooling or care for elderly parents who prefer to live with children and not resi- dential care facilities or nursing homes. ▪ Early retirements. However, it is unclear whether that is a permanent or temporary trend. Sept '19 Sept '21 Number

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RB_2022_08_Worker_Shortage.pdf

data show a total contraction of 59,900 payroll jobs. Two subsectors comprise 80% of the July net jobs contraction: nursing home and residential care (-27,500) and full-service restaurants (-20,300). Other sectors or subsectors with notable job losses advancement-feeling-disrespected/. July 2019 July 2022 Change Total Payroll Employment (000s) 6,040.9 5,981.0 -59.9 Nursing Home and Residential Care 203.8 176.3 -27.5 Full-Service Restaurants 200.8 180.5 -20.3 All

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RB_2022_07_Worker_Shortage.pdf

The data show a total contraction of 139,200 payroll jobs. Two subsectors comprise 40% of the net jobs contraction: nursing home and residential care (-29,700) and full-service restaurants (-26,600). Other sectors or subsectors with notable job losses advancement-feeling-disrespected/. May 2019 May 2022 Change Total Payroll Employment (000s) 6,094.2 5,955.0 -139.2 Nursing Home and Residential Care 203.3 173.6 -29.7 Full-Service Restaurants 202.6 176.0 -26.6 Non-

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NewsStand_2019_July.pdf

July 2019 | | www.ifo.state.pa.us Pennsylvania News National News IFO NEWS STAND Nursing Home Costs Outpacing Medical and Consumer Inflation On June 25, Bloomberg featured the results of a six-year study on nursing home prices by Georgetown Univer- sity Medical Center. It found that nursing home prices between 2005 and 2010 generally increased

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Five_Year_Outlook_2022.pdf

social assistance sector lost most jobs with 30,000 (-2.8%) fewer payroll jobs. Most job losses occurred in the nursing facility and residential care subsector (-26,500). ▪ The all government sector (state, local and federal) contracted by 28,200 payroll forecasts. Support for MA and LTL programs is derived from augmenting revenues from various assessments (e.g., MCOs, hospitals and nursing facilities). These assessments expire at various points prior to the end of the forecast period in this report, but the

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RB_2022_10_Worker_Shortage.pdf

data show a total contraction of 85,200 payroll jobs. Three subsectors comprise 73% of the September net jobs contraction: nursing home and residential care (-26,500), employment services (i.e., temp jobs, -19,200) and full-service restaurants (-16,600 could motivate labor force contraction include: long-term demographic trends, increased home schooling, care of elderly parents reluctant to enter nursing homes, recent accumulation of savings and wealth due to inflated asset markets, on-going COVID emergency declarations, early retirements, personal

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Five_Year_Outlook_2020.pdf

Retail - Clothing Stores 44.5 22.8 -21.7 -48.8 Accommodations 58.5 37.9 -20.6 -35.2 Nursing and Residential Care 201.8 189.3 -12.5 -6.2 State Government-Education 63.4 54.3 -9.1 will remain at home to school children and/or provide care for elderly parents who prefer not to reside in nursing homes. In general, that outcome would translate to lower economic growth as those family units reduce consumption in response to

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2002_dbdc_report.pdf

where administrative duties or the agency was transferred to some other governmental entity with PSERS coverage; service as a county nurse; service for time spent on a mandated maternity leave prior to 1978; and certain service performed while in the Cadet Nurse Corps during World War II. Active members of SERS currently are permitted to purchase service credit for the following types

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Senate Appropriations Response Letter 3-6-2020.pdf

enters or leaves the state during the six- 2 Households exclude individuals living in various group quarter settings such as nursing homes, college dormitories and prisons. 3 See https://www.pewsocialtrends.org/2020/01/09/trends-in-income-and-wealth-inequality 2012 vs 2018 Notes: AAGR is average annual growth rate. Households exclude individuals living in group quarters such as prisons, nursing homes and dormitories. Middle income is defined as households that have between 67% and 200% of the median household income

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PMTA_Presentation_April_2023.pdf

Warehousing and Storage +30 Management (HQs) +14 Social Assistance Services +13 Computer System Design and Related +8 Truck Transportation +3 Nursing Home and Residential Care -27 Full-Service Restaurants -19 Local Gov’t: Municipals -11 Colleges and Universities -9 All Other tax credit ▪ Effective Jan. 1, 2023 | 3-year $2,500 annual credit from personal income tax ▪ Newly certified and licensed: nursing, teaching, public policing 3 Eliminate taxes on cell phone service (regressive) ▪ 5.0% gross receipts tax + 6.0% sales tax

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PBB_Board_Hearing_Sept_28_2021.pdf

health services programs Department of Military and Veterans Affairs ▪ Activity 1 – Veterans Homes: (1) Average costs per resident in private nursing/skilled nursing homes and (2) Average costs per individual for private care in the community September 28, 2021 1 PBB Addendum Requests

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PBB_Board_Hearing_Apr_28_2021.pdf

line items (combined total = $1.1 million). DMVA Metric Highlights U.S. Centers for Medicare and Medicaid Services (CMS) rates nursing homes ▪ PA veterans homes rank 3.9 overall compared to 3.1 for All PA nursing homes (Jan 2021) ▪ Individual homes rank from 2 (Southeastern) to 5 (Soldiers & Sailors, Southwestern, Delaware Valley) ▪ 37 states have vet

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PACBI_Presentation_March_13_2023.pdf

March 13, 2023 5 Sector or Sub-Sector Change Warehousing and Storage +30 Management (HQs) +14 Couriers and Messengers +6 Nursing Home and Residential Care -27 Full-Service Restaurants -18 Local Gov’t: municipals -10 Colleges and Universities -9 Non-Profits 2024 Adult Use Cannabis Tax 20% wholesale price, effective Jan 1, 2025 Recruit and Retention Tax Credit New professionals in nursing, teaching, public policing, effective Jan 1, 2023 (-$25m) Surplus Funds (~$13 billion) Rainy Day Fund and Carryforward Balances largely depleted

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NewsStand_2019_August.pdf

million to 9 million since 2000. In 2017, three-quarters of these health care jobs were filled by women. Registered nurses were the most common job in health care in 2017, and more than 85% of registered nurses were women. Women also held a larger share of health care jobs that require an advanced degree, such as pharmacists

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Lancaster_Chamber_Presentation_ Oct_6_2021.pdf

Percent Jobs Contraction (000s) Full-Service Restaurants 200 170 -30 -15.0% Employment Services (temps) 116 88 -28 -23.9% Nursing and Residential Care 204 178 -26 -12.8% Amusements-Gaming 92 74 -18 -19.9% Accommodation 69 51 -18 -26 a timing issue? | When would they have retired? More workers stay at home in caretaker/teacher roles ▪ Large drop in nursing home staff ▪ Childcare availability remains below pre-pandemic levels ▪ Cyber charter enrollment doubles in 2020-21 Structural unemployment likely unusually

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IFO_Hearing_Packet_Feb2018.pdf

School Property Taxes: Households Age 60, 65 and 70 or Older (December 2017)  A Review of Overtime Paid to Nurses in DOC (December 2017)  Updated Monthly and Quarterly Revenue Estimates (December 2017)  Revenue Estimate Performance (December 2017)  470.4 488.0 20.3 17.6 Home Healthcare 32.5 40.8 59.1 8.3 18.3 Nursing Home 188.2 199.8 204.7 11.6 4.9 Substance Abuse Facilities 45.7 50.7 55.5

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IFO_Hearing_Materials_Feb_22_2022.pdf

Affected by COVID (Jobs in 000s) -40 -30 -20 -10 0 10 20 30 EmploymentServices (temps) -33 Full-ServiceRestaurant -30 Nursing and ResidentialCare -28 Accommodations -17 Amusements-Gaming -15 Retail-Building and Garden +4 Couriers andMessengers +15 Warehouse and Storage +21 000s) 5.1 5.2 5.7 5.9 5.9 -- Notes: CHC stands for Community HealthChoices, NFCE stands for nursing facility clinically eligible; HCBS stands for home- and community-based services; ED stands for emergency department; STARS stands for Standards

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Five_Year_Outlook_Presentation_2022.pdf

Excludes self-employed. Source: U.S. Bureau of Labor Statistics, State and Metro Area Employment. Subsectors: Persistent Staff Shortage at Nursing Facilities November 15, 2022 10 Number (000s) 3-Year Change Subsector Sept 2019 Sept 2022 Number Percent Nursing and Residential Care 202 176 -27 -13.1% Employment Services (temps) 123 103 -19 -15.7 Full-Service Restaurants 196

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index.cfm

bargaining agreement between the Commonwealth of Pennsylvania and the Correctional Institution Vocational Education Association (CIVEA). ... (Full Report) Pennsylvania's Strained Nursing Homes Economics and Other October 25, 2023 The IFO posted a new research brief that discusses placement waitlists and potential cost implications from the contraction in nursing home capacity since 2019. ... (Full Report) UFWC Wage Contract Analysis Wage Contracts October 25, 2023 This letter provides a fiscal

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Select Committee Oct 1 2012 FINAL.pdf

e.g., pain relievers, vitamins)  Personal hygiene (toiletries, diapers)  Newly taxed services:  Certain health care (for-profit nursing homes, day care)  Recreation (movies, bowling, amusement parks)  Basic cable  Personal (barber, beauty salons)  Intrastate transport

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Roundtable_Jan_24_2023.pdf

Change from Nov 2019 January 24, 2023 8 Number (000s) Percent Subsector Nov 2021 Nov 2022 Nov 2021 Nov 2022 Nursing and Residential Care -30 -26 -14.8% -12.7% Colleges and Universities -15 -18 -8.2 -10.1 Employment Services

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Roundtable_Jan_2024_Final.pdf

Social Assistance +32 (most is elderly-disabled services) • Warehouse-Storage +23 • Comp System Design +10 • Home Health Care +9 Contraction • Nursing Home -17 • Full Serve Restaurant -13 • Retail Sales -12 Slide 9 Jan 2024 Roundtable 5,000 5,200 5,400

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Revenue_Estimate_2023_06.pdf

not contracted compared to 2019.  The accommodations-food service sector had the largest relative contraction (-3.4%).  The nursing and residential care subsector (not shown, included with healthcare) contracted by 26,100 payroll jobs (-12.8%).  The government

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Revenue_Estimate_2022_06.pdf

couriers and messengers (+12,000). ▪ The administration-waste management and accommodations-food service sectors had the largest relative contractions. ▪ The nursing and residential care subsector (included with healthcare-social assistance) contracted by 30,000 payroll jobs (-14.6%) relative to May

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Revenue_Estimate_2022_05.pdf

entertainment (e.g., movie theatres, sports events, bowling alleys) and accommodations- food service sectors have the largest relative contractions. ▪ The nursing and residential care subsector (included with healthcare-social assistance) contracted by 32,000 payroll jobs (-15.6%) relative to April

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Revenue-Estimate-2023-05.pdf

400 payroll jobs (+3.0%).  The accommodations-food service sector had the largest relative contraction (-4.5%).  The nursing and residential care subsector (not shown, included with healthcare) contracted by 27,500 payroll jobs (-13.5%).  The government

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Revenue-Estimate-2019-05.pdf

provided on an outpatient basis including diagnosis, observation, treatment and rehabilitation services. All Other Healthcare includes hospitals and nursing/residential care facilities. Data exclude agriculture, military, self-employed individuals and independent contractors. Due to rounding, detail may not sum to total

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RB_2021_02 County Income Patterns.pdf

is institutionalized, which produced artificially low personal income and net earnings data. (Note: This analysis does not control for student, nursing home or institutionalized populations in other counties.) Counties with lower shares of net earnings are more likely to be older

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RB-2020-03 County Income Patterns.pdf

the population was institutionalized, which produced artificially low per capita income levels. (Note: This analysis does not control for student, nursing home or institutionalized populations in other counties.) Second, Montour County is a relatively small county and the median income level

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Presentation-2019-5-1-PAEL.pdf

All Other Sectors 12.0 5.5 8.8 17.3 Note: All Other Healthcare includes ambulatory care, hospitals and nursing/residential care facilities. Source: U.S. Bureau of Labor Statistics, State and Area Employment. The Minimum Wage Proposal Increase minimum

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Pennsylvania_Aging_Presentation.pdf

Shared Ride = $83m PTRR = $270m 100% Lottery Fund (Aging) Note: Dollar amounts in millions. Other includes Tobacco Settlement Fund and Nursing Home Assessment. Funding Sources for Departments of Human Services and Aging 53% 9% 38% Long-Term Living (DHS) = $1,975m

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PBB_Board_Hearing_Apr_27_2021.pdf

statewide results ▪ DMVA veterans homes - overall quality ratings range from 2 to 5 (vs. 3.1 average for all PA nursing homes) Policymakers can monitor outcomes related to additional resources for new or existing programs ▪ PennDOT REAL ID program ▪ DMVA Keystone

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PBB_2023_EO_REPORT.pdf

34 Notes on Measures ▪ Arts education programs are also conducted at other venues including, but not limited to, arts organizations, nursing homes and veterans’ homes. ▪ Grants awarded include grants to subgrantees. FY 2021-22 data are not available until Spring 2023

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PBB_2022_PDE_REPORT_Amended.pdf

000s) 13.6 14.0 11.5 10.3 9.5 -- % Receiving credentials 73% 76% 71% 67% 74% -- Licensed Practical Nurse Program Enrolled (000s) 3.9 3.9 3.8 3.7 2.8 -- % Receiving credentials 37% 38% 39% 41% 51%

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PASBO_Presentation_March_16_2023.pdf

March 16, 2023 5 Sector or Sub-Sector Change Warehousing and Storage +30 Management (HQs) +14 Couriers and Messengers +6 Nursing Home and Residential Care -27 Full-Service Restaurants -18 Local Gov’t: municipals -10 Colleges and Universities -9 Non-Profits

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PASBO_March_17_2021.pdf

Passenger 39 27 -12 -31% Employment Services (temps) 117 96 -21 -18% Personal Care-Dry Cleaning 71 59 -12 -17% Nursing and Residential Care 202 183 -20 -10% Note: Data are not seasonally adjusted. Figures for January 2021 are preliminary. YOY

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Official-Revenue-Estimate-2019-06.pdf

provided on an outpatient basis including diagnosis, observation, treatment and rehabilitation services. All Other Healthcare includes hospitals and nursing/residential care facilities. Data exclude agriculture, military, self-employed individuals and independent contractors. Due to rounding, detail may not sum to total

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NFIB_Feb_2024.pdf

Assistance* +32 (most is elderly-disabled services) • Warehouse-Storage +23 • Comp System Design +10 • Home Health Care* +9 Contraction (000s) • Nursing Home* -17 • Full Serve Restaurant -13 • Retail Sales -12 Slide 3 Feb 2024 Economic Forum 5,000 5,200 5

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Labor_Market_Update_Aug_2021.pdf

and government (+10,900) sectors. Conversely, job losses in the healthcare sector increased, largely due to continued weakness in the nursing home and residential care subsector. Through July 2021, employment in that subsector is down 24,500 from its pre-pandemic

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Initial_Revenue_Update_May_2023_Final.pdf

Down: Subsector Detail May 24, 2023 8 Payroll Jobs (000s) Number Percent Mar 19 Mar 23 Change Change Jobs Contraction Nursing and Residential Care 203 176 -28 -13.5% Full-Service Restaurants 196 182 -14 -7.3 Local Govt (exclude education

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Initial_Revenue_Estimate_Presentation_May_2023_Final.pdf

Down: Subsector Detail May 24, 2023 8 Payroll Jobs (000s) Number Percent Mar 19 Mar 23 Change Change Jobs Contraction Nursing and Residential Care 203 176 -28 -13.5% Full-Service Restaurants 196 182 -14 -7.3 Local Govt (exclude education

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IFO_Testimony_Min_Wage_Feb_16_2021.pdf

Dry Cleaning 70.9 49.6 -21.3 -30.0 Amusements-Gaming 61.5 48.0 -13.5 -22.0 Nursing and Residential Care 202.0 189.0 -13.0 -6.4 Expansion Couriers and Messengers (FedEx, UPS) 48.8 58

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IFO_Hearing_Packet_Feb2019.pdf

472.7 494.9 14.0 22.2 Home Healthcare 33.7 43.2 66.0 9.5 22.8 Nursing Home 190.2 200.0 204.4 9.8 4.4 Substance Abuse Facilities 46.1 51.3 55.2

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IFO_Hearing_Materials_March_2023.pdf

5 All Government (includes local SDs) 708 678 -31 -4.3 All Other 271 289 18 6.5 Subsector Detail Nursing and Residential Care 202 175 -27 -13.5 Full Service Restaurants 195 176 -19 -9.9 Employment Services 179 169

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IFO - Economic and Budget Outlook - January 2012.pdf

following services: Outpatient care (non-hospital, $648 million), Inpatient care (hospital, $364 million), Capitation ($3,272 million), Long-Term care (nursing homes, $730 million), and Medicare Part D (reimbursement to federal government for certain pharmaceuticals, $481 million). Over the past decade

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Five_Year_Outlook_Presentation_2021.pdf

Sept 2021 Number Percent Full-Service Restaurant 196 165 -31 -15.9% Employment Service (temps) 123 92 -31 -24.9% Nursing and Residential Care 202 176 -26 -12.9% Accommodations 61 46 -16 -25.6% Amusements and Gaming 75 61 -15

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Five_Year_Outlook_2020_Presentation_Final.pdf

Government 465 443 -22 -4.7% Retail – Clothing Stores 45 23 -22 -48.8% Accommodations 59 38 -21 -35.2% Nursing and Residential Care 202 189 -13 -6.2% State Government - Education 63 54 -9 -14.4% Air Transportation 13 8

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Five_Year_Outlook_2019.pdf

for MA and LTL programs is derived from augmenting revenues from various assessments (e.g., MCOs, hospitals and nursing homes). Act 92 of 2015 replaced the previous gross receipts tax on Medicaid MCOs with a monthly, per-member assessment on all

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EPLC_3_4_2022_update.pdf

COVID (Jobs in 000s) -40 -30 -20 -10 0 10 20 30 Employment Services (temps) -33 Full-Service Restaurant -30 Nursing and Residential Care -28 Accommodations -17 Amusements- Gaming -15 Retail- Building and Garden +4 Couriers and Messengers +15 Warehouse and

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EPLC-2-19-21.pdf

24 -22 -47.4% Personal Care-Dry Cleaning 71 50 -21 -30.0% Amusements – Gaming 62 48 -14 -22.0% Nursing and Residential Care 202 189 -13 -6.4% Air Transportation 13 8 -6 -41.0% Expansion Courier and Messengers 49

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Economic_and_Revenue_Update_2021.pdf

Dry Cleaning 70.9 49.6 -21.3 -30.0 Amusements-Gaming 61.5 48.0 -13.5 -22.0 Nursing and Residential Care 202.0 189.0 -13.0 -6.4 Expansion Couriers and Messengers (FedEx, UPS) 48.8 58

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BEFC_Survey_Results_FINAL.pdf

included in the PDE 363 calculation). The multiplier above incorporates expenditures related to school psychologists, social workers, administrative support, nursing, building security and tuition to career and technology centers. Additionally, in a community with low property values and low average income

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2024_Mid_Year_Update_Final.pdf

Social Assistance +32 (most is elderly-disabled services) • Warehouse-Storage +23 • Comp System Design +10 • Home Health Care +9 Contraction • Nursing Home -17 • Full Serve Restaurant -13 • Retail Sales -12 Slide 8 Mid-Year Update 5,000 5,200 5,400

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2023_Mid_Year_Update.pdf

January 31, 2023 7 Change From Dec 2019 Annual Share of Dec 21 Dec 22 Gain Dec 19 Jobs Contraction Nursing and Residential Care -32 -25 7 87.8% Full-Service Restaurants -30 -17 13 91.5 Employment Services (temps) -17

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2022_Mid_Year_Update.pdf

Jun 21 Dec 21 Jobs Contraction Employment Services (temps) -27 -33 -23% -34% Full-Service Restaurants -37 -30 -18 -17 Nursing and Residential Care -26 -28 -13 -16 Accommodations -20 -17 -31 -40 Amusements and Gaming -20 -15 -22 -31 Jobs

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