Even at the worst of his wife’s 10-year battle with dementia, Ron Stoudt was determined.
“I vowed I wouldn’t put her in a facility,” the Kimberton, Pa., resident said. “I wanted to keep her home.”
After connecting with the Chester County Department of Aging Services — the local Area Agency on Aging (AAA) that serves older county residents — Stoudt began receiving regular visits from support workers, who came to know him and his family. The AAA recommended services and connected him to an adult daycare, enabling Stoudt to take a break and focus on his own health while his wife received social interaction in a safe environment. The AAA provided support until his wife’s passing in 2022. Through it all, she remained living at home, just as the couple planned.
In the state with the fifth-largest older adult population in the country, Pennsylvania’s 52 Area Agencies on Aging provide these services in every county. But current funding projections threaten that work — and could spark a care crisis affecting older adults and their families.
One potential remedy could make a big difference — if legislators are willing to act on it.
PENNCARE is a dedicated state budget line item within the Pennsylvania Department of Aging that provides critical funding to AAAs across the commonwealth. These AAAs deliver essential services that enable older Pennsylvanians in every county to live independently, safely and with dignity in their own communities.
Importantly, PENNCARE funding comes from the Pennsylvania Lottery — revenue that, by law, is reserved to support older residents. These dollars fund a range of vital programs, including property tax and rent rebates, transportation services, prescription assistance, home-delivered meals, senior centers and more.
Equally significant is what PENNCARE is not: It does not rely on the state’s General Fund. No state tax dollars are used to support these services. Instead, this is a self-contained investment in aging services that directly benefits older Pennsylvanians.
Unfortunately, even as Pennsylvania’s older population has grown, PENNCARE funding has seen only modest increases for more than a decade. When paired with potential federal funding cuts, the strain becomes undeniable. AAAs are now forced into an untenable position, making increasingly difficult decisions about which essential services and senior centers they can afford to sustain, and which they must scale back or eliminate altogether.
A cutback in services — especially in-home care — doesn’t just trim budgets; it sends shockwaves through entire communities. Families must absorb the cost, both financial and emotional, as unpaid caregivers shoulder more responsibility with fewer supports. At the same time, the system strains elsewhere: Demand rises for preventative and mental health services, and too often, older adults end up in emergency rooms when earlier, less costly interventions could have made the difference.
The consequences are especially severe for rural and remote parts of the commonwealth, where access to care is already limited. When services disappear, there are few — if any — alternatives, leaving vulnerable residents increasingly isolated and at risk.
The reasons for insufficient state funding are complex, but because PENNCARE funding is a budget appropriation that comes from the Pennsylvania Lottery, older Pennsylvanians suffer when lottery participation declines.
One reason lottery participation fluctuates is that skill games have surged in popularity.
Skill game machines, commonly found in convenience stores, gas stations, bars, truck stops and laundromats, operate in a legal gray area. Marketed as games of skill, they function much like slot machines, generating passive revenue for businesses that host them. But unlike regulated gaming, they exist largely outside state oversight. As a result, they have proliferated across the commonwealth, siphoning revenue away from the Lottery Fund and destabilizing a system that millions of older Pennsylvanians rely on for essential services.
The Pennsylvania Lottery estimates at least $170 million in annual revenue is being lost to skill games, a figure that continues to climb. The true scale of the loss, however, is unknowable. Because skill games operate in a regulatory gray zone, there is no oversight and no centralized system to track how much money they actually generate.
Regulating and taxing skill games, then directing the revenues to the PENNCARE line item to support AAAs, would:
• Stabilize and strengthen home and community-based services;
• Reduce waiting lists and unmet service needs;
• Support stronger workforce recruitment and retention in aging services—an essential sector strained by rising costs, emotional demands placed on workers, and staff turnover;
• Improve service quality and program sustainability; and
•Generate long-term savings by delaying or preventing more costly institutional care.
By 2030, one in every three Pennsylvanians will be adults age 60 and older. At the same time, as skill games continue to surge in popularity and lottery participation declines, increases in PENNCARE funds will continue to be affected.
The real question is: Will older Pennsylvanians come out ahead, or be left behind?
Rebecca May-Cole is executive director of the Pennsylvania Association of Area Agencies on Aging.