One in four skilled nursing beds is offline in Pennsylvania, with providers tying reduced access directly to a lack of frontline staff and Medicaid payment shortfalls. But that’s no one-state issue, says Garry Pezzano, President and CEO of LeadingAge PA. “These are beds that are already licensed and the providers are self-limiting. [Providers are] telling us that they're not able to really work at full capacity or serve as many patients as they would otherwise be able to because of inadequate nursing aid staff,” Pezzano says, sharing results from his organization’s latest survey on access to care. “There is a workforce crisis, there's a funding crisis and what it's leading us to, ultimately, is an access-to-care crisis.” Two-thirds of the not-for-profit skilled nursing providers represented by LeadingAge PA responded to the survey. Nearly half (48%) are saying no to at least some hospital referrals, sending ripples through the state’s healthcare matrix. State lines don’t limit such concerns, Pezzano tells McKnight’s Long-Term Care News Senior Editor Kimberly Marselas. “What we see going on in Pennsylvania is really a reflection of what's going on nationally,” Pezzano says, “The growth of the over-65 population is outpacing the workforce population. There lies the workforce issue: the funding and the fact that care is more expensive and that reimbursement has not kept up with that.” Listen to see what providers say they need from their state, and what they plan to do with any Medicaid increases they see as the state’s latest staffing requirement increases kick in this summer.