Why Home Care Matters – Meet Lacy!

Lacy and her primary caregiver–her grandmother–rely on in-home nurses to keep Lacy safe and comfortable at home
Lacy is a three-year-old diagnosed with cerebral palsy (CP) and chronic respiratory failure living with a tracheostomy and feeding tube. Lacy and her family rely on skilled nurses to provide continuous hands-on care so that she can avoid hospitalization and stay where she belongs – at home.  

“I don’t know what I’d do without my nurses,” says Lacy’s grandmother – her primary caregiver following the murder of her daughter when Lacy was in utero, “They’re my lifeline.”

Although Lacy receives services under the NC’s Private Duty Nursing (PDN) program, she doesn’t get all the coverage for which she qualifies and needs because nurses are difficult to recruit and retain.  Open shifts are common in PDN due to Medicaid’s low reimbursement rate. Lacy’s grandmother had to quit her job in order to take care of her, and nursing coverage is only enough so that she can get sleep and perhaps run an errand.

Hearts for Home Care advocates are serving as a voice for home care clients like Lacy, and for family members who are impacted by the lack of nurses like her grandmother. To encourage state and federal legislators to support higher wages for in-home caregivers and increase vulnerable residents’ access to services, you can make a difference! Learn about ways you can participate in advocacy through our website, or by emailing advocacy@bayada.com today!

North Carolina State Representative Zack Hawkins Experiences a Day in the Life of a Durham Veteran Receiving Support at Home

NC state representative Zack Hawkins (left) meets home care client Mr. Mendenhall (seated) and his wife

State Representative Zack Hawkins, an active supporter of home health care, recently visited with a Durham family who rely on services to stay safe at home.

Representative Hawkins visited with a constituent, Mr. Aubrey Mendenhall, an armed service Veteran with a wonderful sense of humor. As a young US Sargent in Germany, he saw the prettiest lady working at the base general PX store…and spent the next thirty days asking her out. Margarete finally agreed and they’ve been together for more than 65 years.

Some five years ago, Mr. Mendenhall was diagnosed with Dementia – a condition characterized by a decline in memory, language, problem-solving and other thinking skills that affect a person’s ability to perform everyday activities. His dementia makes it difficult for him to manage without constant supervision and puts him at a high risk of falling. A certified nursing assistant (CNA) comes to help him bathe, toilet, and dress. “The aide’s goal is to help Mr. Mendenhall stay as independent as possible. Make sure he doesn’t fall or get an infection that can put him in the hospital,” said BAYADA Home Health Care Clinical Manager Megan Russell, RN.  

The Department of Veterans Affairs covers 11 hours of aide services per week. Outside those 11 hours, Margarete is his constant companion and support. She uses the 1 ½ – 2 hour breaks she receives each day to perform other necessary tasks such as running to the grocery store, to a doctor’s appointment, or to simply have an uninterrupted cup of tea. It is her only break from caregiving. At 90 years old, dealing with her own health issues, and after five years of serving as Mr. Mendenhall’s primary caregiver, Margarete finds herself exhausted!

With tears in her eyes, their only daughter, Kathy, commented that she is considering quitting her job as a nurse and move in with her parents so that she can better manage their care. While carrying for a loved one with a chronic illness can be profoundly meaningful, it can also be overwhelming as the physical, emotional, financial tolls compound on the family caregivers.  

“Having personally been touched with seeing my mother and aunt provide care to my grandmother, I understand how important it is to be able to take care of one’s family,” said Representative Hawkins. “And as a lawmaker, we need to support seniors and their families. To ensure they can live a full life at home. Care at home is an important option, less expensive, and where people want to be.” 

According to AARP’s online article, Caregiver Burnout, “over time, that physical and psychological wear and tear can lead to caregiver burnout – a condition of feeling exhausted, listless and unable to cope.”  Russell has reached out to the VA case manager to explore respite care which would allow for the family some much needed breaks. The Mendenhalls want to stay together, however, they need some additional support to effectively care for themselves while maintaining their responsibility to their loved one.

“In-home care programs provide one-on-one care by licensed nurses or certified nursing assistants under the care of a physician,” said BAYADA Area Director Lee Dobson.  “They allow families to stay together and be safe at home. It really gives the state more for less and is clearly part of the health care budget solution.”

Home Health Care in the News

The New York Times recently published an article that highlights caregivers’ and home health care clients’ challenges

The looming home health care crisis has recently been making headlines. From Home Health Care News to the New York Times, industry leaders, home health aides, clients, and family caregivers have been sharing the same message: As Medicaid rates continue to stagnate, home health aides and nurses can’t make a fair wage. As a result, the industry is facing a worker shortage and clients’ access to care is being significantly threatened across the country. Below, please find links to recent media coverage on the issue, all of which present compelling data that point to an impending home health care crisis for the most vulnerable and medically fragile populations.

Home Health Care News, September 5: “Home Health Care Training Programs Popping Up As Caregiver Crisis Worsens”

New York Times, September 2: “On the Job, 24 Hours a Day, 27 Days a Month”

Thrive Global, August 30: “The Future of Healthcare: “First and foremost, reprioritize long-term care into the home setting” with David Totaro of BAYADA Home Health Care”

Vox, August 21:https://www.vox.com/the-highlight/2019/8/21/20694768/home-health-aides-elder-careHome health aides care for the elderly. Who will care for them?”

Everyday Health, July 27: “Demand on the Rise for Home Healthcare”

Home Health Care News, June 20: “Bayada Hits 1M Clients Served. Here’s Why Hitting 2M Will be More Difficult”

NC Clients Make Their Voices Heard

To achieve our legislative priorities, we utilize a variety of tactics to ensure our legislators are educated about the obstacles our clients’ and employees’ face and the urgency of increasing funding for home care. We are grateful to our many Hearts for Home Care Ambassadors, and office employees who have participated in these important advocacy efforts; whether you’ve met with your legislator at a Legislative Day, helped organize a home visit or legislative round table, or taken the time to respond to one of our several action alerts this session, your continued advocacy is vital to achieving our goals.

Further, many of our clients have gone above and beyond in making advocacy a priority and have articulated the obstacles, challenges, and hardships they and their families must confront due to chronically low reimbursement. We have shared these powerful stories directly with legislators to educate them on the value of home care. It is important they recognized the need for adequately funding the Medicaid, including the Private Duty Nursing (PDN) and Personal Care Services (PCS) programs, and the various Community Alternative and Innovation Waivers.  Introducing lawmakers to their constituents who are most directly affected by the decisions they make is an excellent way to share their stories and make an impact.

See below to meet several of our client advocates! If you are interested in becoming more involved in advocacy, or have a client who is interested in sharing their story, please contact advocacy@bayada.com.

NC Client Spotlight: Meet five BAYADA clients that have engaged in advocacy this quarter!

North Carolina Legislative Day 2019 Photo Gallery

Tour of NC: Offices Celebrate Successes, Look to Future Goals

Every yearour Government Affairs Office (GAO) makes an in-person outreach to our service offices, traveling throughout the country to connect with staff about advocacy at BAYADA. This past month, GAO visited approximately 20 offices in North Carolina, from the mountains to the low country, to provide a legislative update, share advocacy information, and hear directly from staff on issues that matter most to them and our clients.

In conversations with staff, we had the opportunity to share our operating model, which utilizes a three-pronged approach in achieving our legislative goals: direct lobbying, supporting our champions, and grassroots advocacy. While GAO works to lobby our elected officials to educate them about issues impacting the home care industry, we rely on the efforts of our employee advocates to support our legislative champions through PAC contributions and to participate in grassroots efforts, such as hosting a home visit or responding to a legislative action alert.

As an Ambassador, I’m proud of the work that we do to be a voice for those who may not always have the chance to advocate for themselves. Advocacy has taught me that there are so many things we can do, big and small, to make an impact on the people we serve.

—Michele Hoke, Hearts for Home Care Ambassador and HHI Client Services Manager

These efforts truly add up, whether you attend a lobby day, host a home visit, respond to an action alert, or simply register as an advocate on the Hearts for Home Care website. With the help of our client and employee advocates in NC, together this past session we:

  • Secured a much-needed rate increase for aide services
  • Ensured an increase from Partners Behavioral Health
  • Protected certificate of need (CON) for our Medicare offices

The impactful grassroots efforts from our Ambassadors and advocates through home visits, legislative roundtables, and our annual Legislative Day make a difference!

Beyond sharing the power of advocacy, this trip gave GAO the opportunity to reconnect with staff and listen to learn more about the issues that matter most to clients and employees. As we traveled from office to office, we heard of all the wonderful things our offices are doing, the special relationships you have with each other and with our clients, and the persisting challenges our offices face in providing compassionate, excellent, and reliable care at the current reimbursement rates. We look forward to working together to ensure our legislators understand and address these challenges.

Collaborating like this to make sure we are being the best advocates we can be is so important to the work that we do. The more we work to get our clients and field staff engaged in advocacy, the more we can ensure their voices are being heard and represented.

Bryan Borchard, RAN Director

Quotes from our Advocates: The Power of Advocacy and PAC by the Numbers

Election season is in full swing and our legislators are busy rallying support from organizations and constituents in their districts. BAYADA staff and members of our Political Action Committee (PAC) have taken full advantage of these opportunities to connect with our legislators by attending legislative receptions in their communities.

These events, whether they are fundraisers, dinners, or meet-and-greets, give BAYADA an opportunity, beyond our direct lobbying and grassroots efforts, to engage with the legislators who are making laws that that affect our clients, employees, and the home health care industry in general.

Our NC PAC membership is 126 (33%) of eligible employees with a retention rate of 99%. The NC PAC Board has distributed year-to-date $14,050 to 25 home care supporters. Further, the Board has approved another $30,625 to be distributed to some 42 lawmakers and candidates within the next two months. As a non-partisan PAC, we distribute proportionally to members from both sides of the isle–52% Republican / 48% Democrat–and focus our limited funds on members who are in a leadership position, or a relevant committee (health, appropriations, aging, insurance, etc.), AND who are supporters of home care.

See below to hear directly from our PAC members and legislators about the importance of getting involved in the legislative process.

Timothy Peterkin with Senator Joyce Waddell


I really enjoyed getting involved and meeting Senator Waddell. She really wants to help. Sharing our stories gets the point across and helps lawmakers understand home care. It is worthwhile for us to advocate.

Timothy Peterkin, Area Director (GP)


Paige Downing, Rep. Cynthia Ball, Ryan Halas

If you think that lawmakers understand or know everything on which we are voting, you are wrong. We, as lawmakers, can’t know everything. We rely on people and organizations we know and trust, like BAYADA, to help us understand the issue. It is great to be able to get feedback from experts on issues before we cast our vote.

Rep. Cynthia Ball

While this is my first time attending an event with BAYADA, it is not my first time getting involved in advocacy. I was pleased to learn that BAYADA has a strong advocacy program and is working with lawmakers to ensure they understand the importance of home care.

– Ryan Halas, Client Services Manager (DRP)

Adam Brooks with Rep. Bill Brawley

It is vital we connect with our elected officials. They make decision that impact our ability to serve clients in their homes. These events allow us to building relationships locally and to share The BAYADA Way with them. It was worthwhile for me to attend and represent BAYADA.

– Adam Brooks, Director (MAG)


As I’m campaigning across the state I’ve attended numerous events for various members, I’ve seen BAYADA everywhere. Your red stands out! Thank you for supporting our efforts to improve North Carolina.

–   Speaker of the House Tim Moore

Attending PAC events is a chance to market BAYADA and our services in a different venue. Theses PAC events are worthwhile and allow us to showcase the scope of services and the need we’re filling for clients.

–   Trip Smithdeal, PAC Board Chairman

Amy Boardwine, Keeley Tharpe, and Rep. Jeffrey Elmore

This PAC event gave us the opportunity to thank Rep. Elmore for his strong and constant support. Educating our legislators at events like these is so important in making sure our legislators truly understand the challenges that our employees, our clients, and their families face on a daily basis.

Amy Boardwine, Director (FHP)

Ryan Halas, Paige Downing, Lee Dobson, and Rep. Gale Adcock

I enjoyed the PAC legislative breakfast. I would definitely go again. It is super important, especially for my office which relies on Medicaid, for lawmakers to hear from us. We need their support if we are to get a rate increase.

Paige Downing, Client Services Manager (SPR)

As lawmakers, we need to hear directly from our constituents. Demystify the process. Sharing your story is an excellent way to advocate.

 – Rep. Gale Adcock

Thank you to the many other PAC members, including Stephanie Zananiri, Timothy Peterkin, Melissa Zuzolo, Paulette Troy, and others who made the time to connect with our legislators and to advocate on behalf of our clients and employees. If you want to join our PAC or have questions about how you can get involved, contact advocacy@bayda.com.

Medicaid Enters a “Period of Silence” as Medicaid Reform Moves Forward

In 2015, the North Carolina General Assembly enacted legislation (Session Law 2015-245), directing the transition of Medicaid from predominantly fee-for-service to a managed care structure.  The North Carolina Department of Health & Human Services (DHHS) seeks to implement Medicaid Managed Care (MMC) in such a way that advance high-value care, improves population health, engages and supports providers, and establishes a sustainable program with predictable costs.

As our state works toward implementation, the North Carolina Department of Health & Human Services (DHHS) has released the Medicaid Managed Care (MMC) Prepaid Health Plans (PHPs) request for proposals (RFP) and the department has entered a “period of silence” until contracts are awarded through a competitive bidding process. This period of silence has been implemented to avoid unfair advantage to any one submitter and is expected to last until contracts are awarded this month.

While the Centers for Medicare & Medicaid (CMS) has not yet approved the state’s request to implement Medicaid Managed Care (MMC), that approval is expected. The state continues to move forward with MMC with a phased-in approach, targeted for early 2019. DHHS has awarded Maximus Inc. the enrollment broker contract for the state.

GAO and our internal advisory workgroup continue to provide feedback to Medicaid to protect and ensure access to quality home care as North Carolina moves toward Medicaid Managed Care.

If you have any question or concerns about Medicaid reform, contact  me at ldobson@bayada.com.

CMS Proposes Program Integrity Demonstration in North Carolina

The Centers for Medicare & Medicaid Services (CMS) has issued a second proposed rule for a 30-day public comment on the Home Health Pre-Claim Review Demonstration. This demonstration seeks to prevent and identify fraud, waste, and abuse in the Medicare home health services through either pre-claim or post-payment review.

The proposed rule calls for a demonstration in five states starting on December 10, 2018 in Illinois. The other states slated to be phased in every 60-90 days include Ohio, North Carolina, Florida, and Texas, with the option of expanding to other states. Providers will have three options: 100% pre-payment review, 100% post-payment review, or a 25% rate reduction and up to 100% reviews by the Recovery Audit Contractor.

Leaders from the Home Health Practice, along with GAO, have submitted formal comments calling for CMS to evaluate and release results from the previous program integrity (PI) demonstration before initiating this new demonstration, and to develop a targeted review approach to PI efforts. BAYADA wants to be a strong partner in rooting out fraud, waste, and abuse, with complete transparency.

Offices should pay close attention to their documentation to ensure referral paperwork, nursing and therapy notes clearly paint the medical necessity picture.  Areas of focus include appropriate documentation pertaining to:

  • Face to face
  • Homebound status
  • Therapy SMART goals
  • Skilled service needs

Questions should be directed to MAG Regional Director Richard Hopson at rhopson@bayada.com.

Advocacy Efforts Persist Despite Unusual Legislative Session

Although the General Assembly typically adjourns legislative session by end of June or early July, this year has proven to be anything but normal. Instead of adjournment with sine die, which indicates no further business is scheduled this session, the Republican majority has called back lawmakers after November’s  mid-term elections. Beyond campaigning, lawmakers continue to hold committee meetings to move legislative business forward. Despite this unusual legislative session, the Government Affairs Office (GAO) continues our efforts to educate legislators on our home care priorities.  Building relationship never stops–in or out of session.

Looking ahead, the GAO Advisory Council–comprised of NC leadership representing every practice–is scheduled to meet on October 23 to identify BAYADA’s legislative priorities for 2019. While rate increases are top priority, the Advisory Council will consider other issues that impact our ability to deliver quality care to clients in their homes. If you have an idea or concern regarding legislative or regulatory issues that impact BAYADA, we’d love to hear from you!

Thank you to our ambassadors and advocates who continue to advocate on behalf of BAYADA’s clients and employees. If you’d like to learn more about our goals, or would like to get involved in advocacy, contact advocacy@bayada.com.