Of the properties managed by the Housing Authority of the County of Butler, senior housing is predominant.

“As the population ages, there is more demand for services than supply,” said Edward Mauk, the housing authority's chief executive officer.

In a special report following up on his 2016 audit of oversight of nursing homes by the state Department of Health, Auditor General Eugene DePasquale warned that Pennsylvania is ill-prepared to serve a fast-growing population of older adults, according to Tuesday's news release.

“From a housing perspective, we are in a good position to provide affordable housing opportunities for senior residences,” Mauk said in response to the report.

The housing authority manages 568 units for senior housing in the county through a variety of programs.

Those units are about fully occupied and people are on waiting lists for the minimal occupancies available, Mauk said.

Overall, the demand for senior housing and the size of the wait lists have remained steady over the years, he said.

A countywide rule is to provide affordable housing based on need, he said.

Although no plans are on the drawing board, the housing authority does have plans to expand its housing options, he said.

As the need arises and funding is available, Mauk said the housing authority will continue to provide additional affordable housing for the elderly.

“Right now, there are nearly 90,000 Pennsylvanians living in more than 700 nursing homes,” DePasquale said in the news release. “Not only can Pennsylvania do a better job in ensuring the safety of today's older adults, but we must also get ready for the huge numbers of people who will need care in the not-so-distant future.”

DePasquale's 2016 audit cited issues at DOH with inadequate review of nurse staffing levels, complaint handling, and sanctions imposed against poor-performing facilities. It contained 13 findings and 23 recommendations.

His new special report, “Who Will Care for Mom & Dad?” was developed to see how the Department of Health has implemented the audit's recommendations. It contains nine observations and 30 recommendations.

“My team and I spoke with more than 50 experts for this report, and we heard from more than 20 nursing home residents, families and staff members about their experiences,” DePasquale said. “While much of what we heard was encouraging, we also heard about serious challenges such as staffing, equipment and supply shortages.”

The report suggests the Department of Health must adopt thorough, clearly outlined policies for vetting nursing home operators.

“We found at least one case where lax vetting processes resulted in granting a license to a financially unstable operator who had a poor quality track record in another jurisdiction,” DePasquale said.

In addition, the report urges the Department of Health to produce better data to offer a clearer picture of which homes are improving. While the Department of Health has shown progress holding homes accountable by increasing fines for care deficiencies, a recent decline in the use of provisional licenses as a means of encouraging operators to improve care requires further monitoring.

The report calls for stronger collaboration between state agencies to prepare for the large wave of baby boomers, some of whom may not have spouses or children to help them as they age.

“By 2040, nearly a quarter of Pennsylvania's population will be 65 or older,” DePasquale said. “That's over 3 million Pennsylvanians who will likely need some kind of care, many of whom may lack personal financial resources or family support and end up relying on taxpayer-funded programs like Medicaid.”

DePasquale said shortages of registered nurses and direct care workers will only worsen if prompt action is not taken to bolster the elder care workforce.

“By 2030, there will be 38 older adult dependents for every working-age resident,” DePasquale said. “At about the same time, Pennsylvania is projected to be short by thousands of registered nurses and tens of thousands of direct-care workers — creating a looming workforce crisis that must be addressed.”

DePasquale said a failure to prepare will create new costs that will burden families and impact the state's economic growth. He called on colleges and universities to help develop solutions.

“Pennsylvania's State System of Higher Education and community colleges across the state should view this health care workforce crisis as an opportunity to grow,” he added. “The public and private sectors, along with labor organizations and educators, must work together to recruit and prepare more professionals to enter the field and nurture the next generation of health care workers.”