As Drawbacks of Nursing Homes are Recognized, It’s Time to Recognize Home Care as the Future

Medicaid Home Based Care
Home health aides help keep many families together at home.

Whether you are a professional or family caregiver, home care recipient, or otherwise, you know why home care is safer, more patient-preferred, and less costly than institutional care. Home care provides vulnerable seniors and adults with disabilities with one-on-one care that enables them to stay safe and independent in their own communities. While its benefits—and the inherent drawbacks of institutional care—are evident to us, home care is still not widely recognized as a long-term solution. This is because nursing home care is still often seen as the “default” option for those that need consistent care, particularly under Medicaid.

But tables are beginning to turn: As the COVID-19 pandemic has shed light on the dangers of nursing home care. With recent reports citing that a staggering 40% of COVID-related deaths have occurred in nursing homes, people are more widely recognizing home care as the long-term care setting of the future.

Home care saves state Medicaid programs money and helps vulnerable Americans stay out of costlier and more infectious settings like hospitals and rehab facilities. It enables more than 8.3 million Americans to remain healthy at home, thanks to the 3.2 million compassionate and dedicated frontline direct care workers, including home health aides and personal care assistants, that keep these at-risk populations safe, independent, and out of riskier institutional settings.

In a post-COVID world, home will become recognized much more widely as the care setting of the future. With the US’s aging population growing quickly, and with families’ recently-discovered reservations about placing their loved ones in a long-term care facility, it is important that governments across the country take steps to make sure that the home care industry grows proportionately along with the demand for it. This includes: Increasing state and federal Medicaid rates for home care services so that providers can raise wages and allow more caregivers to be recruited to the home care workforce; Rethinking outdated laws and regulations that allow vulnerable populations to more readily access nursing home care; and instituting built-in protections for Medicaid-based agencies, such as relief funding for extraneous costs that occur during an emergency like COVID-19.

A “Home First” mentality would allow for individuals to stay safe at home and away from group settings that encourage virus spread. Now more than ever, the potential dangers of institutional care are becoming a frightening reality and we as a nation need to consider the future of healthcare as our population continues to age, and as more medically-fragile and disabled individuals are able to live independently. By updating laws to prioritize home care, we have the opportunity to create a meaningful, cost-effective and common-sense change to healthcare for the post-COVID future.

If you are ready to advocate for home health care, please contact us at advocacy@bayada.com.

2020 Legislative Priorities: An Exciting & Anticipatory Year for GAO States & the National Home Care Industry

2020 is gearing up to be a monumental year for BAYADA’s Government Affairs Office (GAO). GAO directors and Chief Government Affairs Officer Dave Totaro have worked diligently with BAYADA leadership to agree upon this year’s legislative priorities. Check out GAO’s state-by-state priorities below! To find out more about your state’s issues and how you can get involved, see the list of state GAO directors and associates within the article.

FEDERAL
Chief Government Affairs Officer Dave Totaro
Federal Affairs Associate Victoria DeLone

#1: Support PQHH and NAHC to pass the Home Health Payment Innovation Act

  • Eliminates behavioral assumptions to set reimbursement rates and limits changes in reimbursement to +/- 2% in any year
    • BAYADA impact: $12-15 million
    • Practice: Home Health

#2: Support the passage of the Home Health Care Planning Improvement Act

  • Allow non-physician providers to certify a patient’s eligibility for coverage – including face to face requirements
    • BAYADA impact: TBD (awaiting score from CBO)
    • Practice: Home Health

#3: Introduce and pass the Home Care Access and Savings Act (H-CASA)

  • Modernizes the Medicaid program through quality, efficiency, and integrity improvements
    • BAYADA impact: Policy only
    • Practices: ACSP and SNU

NORTHEAST REGION
Area Director Louise Lindenmeier (NJ, RI, NY, MA)
Director Ashley Sadlier (RI, NY, MA)
Associate Marissa Fogal

NJ

#1: Secure increase for PCA to offset minimum wage increases in 2021 by $3 per hour

  • BAYADA impact: $7.2 million
    • Practice: ACSP

#2: Increase the state fee for service rate for RNs and LPNs by $10 per hour in Private Duty Nursing and set a minimum rate floor for managed Medicaid.

  • LPN increase of 26.3% from $38 per hour to $48. RN increase of 20% from $50 to $60.
    • BAYADA impact: $19.1 million
    • Practice: SNU

#3: Pass legislation to mandate commercial insurance to cover PDN

  • Impact: Potential savings of $50-70 million for state Medicaid dollars
    • Practice: SNU

NY

#1: Gain NYC Department of Education’s Request for Proposal to achieve status of “approved vendor” to provide school nursing services in the New York City boroughs

  • BAYADA impact: $429,000
    • Practice: SNU

RI

#1: Pass legislation to ensure clients turning 21 have continuity of care 

  • BAYADA impact: $1.1 Million
    • Practices: SNU and ACSP

#2: Defend Cost of Living Adjustment (COLA) for Medicaid Home Care/Hospice rates

  • Governor has proposed an additional 5.9% increase for skilled nursing and CNA services in the 2020-2021 budget, effective 7/1/2020
    • This proposal must still go through the legislative decision-making process, with the final budget set to be signed by the end of June 2020. GAO will continue to monitor its progress and advocate for this increase
    • CNA Current Average: $25.51 à $27.02 (+$1.51)
    • LPN Current Average: $47.79 à $50.61 (+$2.82)
    • RN Current Average: $54.20 à $57.40 (+$3.20)
    • BAYADA impact: $219,791
    • Practices: SNU and ACSP

#3: Secure an increase for Medicaid FFS reimbursement rates

  • 16.3% increase from $25.52 to $29.67
    • BAYADA impact: $431,912
    • Practices: SNU and ACSP

#4: Secure a rate floor for Managed Medicaid rates so they cannot be below the set Medicaid FFS rates

  • BAYADA impact: $163,000
    • Practices: SNU and ACSP

MID-ATLANTIC REGION
Area Director Laura Ness (PA, DE, MD, IN)
Associate Director Rob Lattin (DE, MD, IN)
Senior Associate Maggie Tracy

DE

#1: Secure an increase for PDN LPN and RN reimbursement rates

  • 21% increase from $46.14 to $56.01 for LPNs, and 21% increase from $51.50 to $62.51 for RNs
    • BAYADA impact: $5.3 million
    • Practice: SNU

MD

  • Protect the yearly rate increase for LPNs providing private duty nursing.
  • BAYADA impact: Unknown
  • Practice: SNU

PA

#1: Secure an increase for Personal Assistance Services under Community Health Choices

  • 8% increase (dollar amount depends on MCO)
    • 2019 goal was a 10% increase, and a 2% increase was secured. Thus, the 2020 goal is to obtain the remaining 8%
    • BAYADA impact: $3.2 million
    • Practice: ACSP

#2:  Pass legislation to allow Deemed Eligibility for home care

  • BAYADA impact: Unknown
    • Practices: ACSP and AN

#3:  Eliminate the requirement for nurses to call home health aides every two weeks

  • BAYADA impact: Unknown
    • Practice: PED

SOUTHEAST REGION
Area Director Lee Dobson (NC, SC, GA, MO)
Director Melissa Allman (GA, SC, MO)
Senior Associate Lindsey Wright

GA

#1: Secure a 6% increase for all Medicaid nursing services

  • BAYADA impact: $426,862
    • Practice: SNU

NC

#1: Secure an increase for nursing under Medicaid’s PDN Program–

  • 13.6% increase from $39.60 to $45
    • BAYADA impact $8.4 million
    • Practice: SNU

#2: Secure an increase for aide wages under Personal Care Services, Community Alternatives Program, and CAP for Children

  • 18.6% increase from $15.60 to $18.50
    • BAYADA impact: $1.89 million
    • Practice: ACSP

SC

#1: Secure a 10% PDN rate increase, effective July 1, 2020

  • The state recommended a 15% increase effective July 1, 2020. After further advocacy efforts focused on the urgent need for an immediate increase, DHHS issued the initial 5% increase, effective January 1, 2020. DHHS is committed to including the remaining 10% to be effective July 1, 2020. If the provision is passed into law as planned, then PDN services will see a total 15% increase from 2019 levels (5% increase effective January 1, 2020, and an additional 10% targeted for July 1, 2020).
    • BAYADA impact: $690,000
    • Practice: Skilled Nursing

#2: Secure 24% for RN and 35% for LPN increase for Medicaid nursing waivers

  • BAYADA impact $1.16 million
    • Practice: Skilled Nursing

#3: Secure a 10% increase for Personal Care Waivers

  • BAYADA impact: $158,000
    • Practice: ACSP

GRASSROOTS ADVOCACY & PUBLIC AFFAIRS
Grassroots Advocacy Senior Manager Mike Sokoloski
Public Affairs Senior Manager Alisa Fox

Grassroots Advocacy: In 2020, the GAO Grassroots Advocacy team is seeking to further enhance the Ambassador program by creating a new “Senior Ambassador” role in order to have seasoned advocates guide and mentor newer advocates. Senior Ambassadors will also be able to attend special and strategic events in order to hone their skills and to advise GAO on issues their office(s) see. If you would like to learn more about the Ambassador and/or the Senior Ambassador program, or how you can get involved in advocacy, contact the Grassroots Advocacy team at msokoloski@bayada.com.

Public Affairs: Following the success seen in 2019, BAYADA has expanded its public affairs program to open up resources for smaller states that may benefit from a public affairs campaign. In first quarter, BAYADA has employed three campaigns thus far: A campaign to increase PDN and PCA rates in New Jersey, a campaign to further increase PDN rates in South Carolina, and a campaign to create regulations in Rhode Island to ensure that medically-complex children aging out of the pediatrics program can continue to seamlessly access care. Other states that may soon be seeing public affairs campaigns are: Florida, Indiana, Massachusetts, Missouri, and Pennsylvania.

Public Affairs: BAYADA’s First Full Year of Full Time Public Affairs Efforts Secures Media Attention and Contributes to Legislative Wins!

BAYADA’s public affairs program has generated public and legislative awareness about home care, its importance in communities across the country, and the issues clients and families face accessing care due to low state reimbursement rates.

BAYADA has used public affairs efforts throughout the past several years. That is—in states where GAO and state leadership knew that increased public awareness and engagement would reinforce a strong lobbying message, GAO deployed these efforts, which resulted in increased legislative & regulatory pressure on BAYADA’s key issues. This was particularly true where BAYADA, home care recipients, and the industry needed rate increases to stay sustainable and to be able to recruit and retain enough caregivers to meet clients’ demand.

2019 was the first year that BAYADA invested in a full-time public affairs program. Here, public affairs staff executed several state-specific campaigns to further BAYADA’s legislative agenda, as well as an “umbrella” campaign to highlight the challenges seen regularly on the national home care and home health care front.

GAO enlisted public affairs firm Regan Communications Group (RCG) full-time to put clients’ and caregivers’ stories in the spotlight. No easy task, especially as media and newsworthy issues tend to change minute-by-minute, RCG regularly delivers by getting GAO’s legislative message out via broadcast, print, and non-traditional media outlets. As a result of full-time public affairs efforts in 2019, state governments heard us loud and clear, and often made policy changes in order to help alleviate the issues BAYADA staff, clients, and families faced.

Below, see a list of media that BAYADA’s GAO was able to gain through its partnership with RCG in 2019:

Federal/Industry-Wide

Home Health Care News: Immigration Reform, Minimum Wage Increases Top of Mind for BAYADA

Home Health Care News: Medicaid legislation introduced in Congress

STAT News: Health aides’ low wages threaten home health care, a necessity for millions

Modern Healthcare: More middle-income seniors face financial insecurity

Home Health Care News: Industry Insiders: Don’t Overlook CMS’s Dual-Eligibles Directive

Home Health Care News: Immigration “Pathways” Vital to industry’s future

Home Health Care News: BAYADA Hits 1M Clients Served. Here’s Why Hitting 2M Will be More Difficult

Modern Healthcare: Nursing home staffing levels often fall below CMS expectations

Everyday Health: Demand on the Rise for Home Healthcare

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

Delaware

Delaware Public Media: Advocates call on state lawmakers to raise Medicaid reimbursement rates

Delaware State News: BAYADA Pediatrics director awarded national honor for advocacy work

Indiana

RTV 6: Hoosier families want more resources for home health care

WTHR 13: Gasping for Care: Indiana families desperately seek care amid home nursing shortage

New Jersey

NJTV & NJ Spotlight: Shortage of Home Care Nurses on Horizon

My Central Jersey: NJ’s shortage of private duty nurses taking toll on families

NJ 101.5: A home health care nursing shortage is looming in NJ

NJ Star Ledger: Prefer to age at home in N.J.? It will soon be even harder | Editorial

Pennsylvania

Bucks County Courier Times: BAYADA Home Health Care’s Langhorne office recently nominated Melissa Husted, of Morrisville, and Winnie Gittens, of Philadelphia, for the Pennsylvania Home Care Association’s 2019 Direct Care Worker of the Year Award

PennLive/Patriot News: Advocates call on lawmakers to make home-based care services more accessible for seniors and disabled

Generocity: BAYADA transitions from for-profit to nonprofit to save its mission-driven culture

Pittsburgh Post-Gazette: An old refrain: Better wages, conditions a must for direct care workforce

PennLive/Patriot News: An opportunity to do the right thing for vulnerable Pennsylvanians: Raise home health aides’ wages

WXPI & WPGH: Lack of home health care aides impacting local patients

Pittsburgh Post-Gazette: Increase funding for home care providers

Pittsburgh Tribune Review: Donna Pierantoni: Home care crisis’ impact on disabled adults, seniors

Rhode Island

Valley Breeze: Aging Out: Local family says vulnerable son fell through state’s cracks

Valley Breeze: Family frustrated after near-miss on losing care hours

Providence Business News: Anxious R.I. families await decision on special medical coverage

South Carolina

Post & Courier Gazette: Lowcountry home health care experts speak on the need for more workers in the field

Summerville Journal: Helping Mason: Family of Police Officers with Sick Child Loses Home Nurse Right Before the Holidays, need to raise Medicaid Reimbursement Rates in SC for 2020

Grassroots Advocacy: GAO Ambassador Program Completes an Expansive and Record-Breaking 2019!

Southeastern Ambassador Academy 2020: BAYADA’s Hearts for Home Care Ambassador program has been growing steadily each year

Each year, more and more of GAO’s efforts are successful due to the increase of our collective voice: That is, the united voice of our clients, families, employees, and industry partners. GAO staff can only do so much alone—it is our Hearts for Home Care (H4HC) Ambassadors and advocates who help to bring the message to legislators loud and clear.

And our Ambassador program continues to grow every year. In 2019, 335 BAYADA employees and caregivers served as Ambassadors—a 28% growth over 2018! Not only is the Ambassador program growing and expanding each year, the culture of advocacy is growing across the company. That is, Ambassadors are increasingly getting their coworkers and clients involved in advocacy efforts, and BAYADA and the home health care industry as a whole are seeing how their voices help make a significant impact.

In 2019, GAO saw a major expansion of the Ambassador program. Traditionally, each GAO state director would host an annual Ambassador Training day. After extensive research and development, GAO expanded and enhanced the program by hosting seven revamped on-site Ambassador academies, ten 30-minute educational Ambassador zoom sessions, and eight on-boarding sessions for new Ambassadors. Additionally, GAO developed the curriculum for, and hosted, the first-ever Advocacy Bootcamp during the National Association for Home Care and Hospice (NAHC) annual conference in Seattle, Washington. Here, GAO taught and trained other providers on BAYADA’s “best-in-the-industry” grassroots advocacy program.

The Ambassador program continues to grow every year in number and in recognition. In 2019, BAYADA’s grassroots and Ambassador programs were recognized as one of the most impactful in the entire home care industry. In 2019, Ambassadors continued to lead home visits, legislative roundtables, and office visits with legislators.

THANK YOU to all our Ambassadors
We would not be successful without you!

GAO SC: Much-Needed PDN Rate Increase Helps Keep SC Medicaid Skilled Nursing Offices Open!

GAO Director Melissa Allman and SC office employees, field employees, and clients & families made all the difference in ensuring that medically-fragile residents could continue to access home care

Over the past several years, home care offices across South Carolina have struggled to stay sustainable due to low state Medicaid reimbursement rates for in-home nursing services. As more and more providers shut their doors, GAO and our advocates continued to fight towards a solution so that South Carolina’s most vulnerable residents could continue to access the skilled care they needed to stay at home.

After aggressive advocacy and a public affairs push throughout 2019, our concerted efforts are beginning to pay off! After more than a decade without a nursing increase, the state recommended a 15% increase, effective July 1, 2020. After further advocacy efforts focused on the urgent need for an immediate increase, including articles profiling affected families in the media, the SC Department of Health & Human Services (DHHS) issued the initial 5% increase be effective January 1, 2020. This 5% increase will generate nearly $230,000 in additional annual revenue.

BREAKING: DHHS is committed to including the remaining 10% to be effective July 1, 2020. If the provision is passed into law as planned, then PDN services will see a total 15% increase from 2019 levels (5% increase effective January 1, 2020, and an additional 10% targeted for July 1, 2020), resulting in nearly $690,000 in additional annual revenue.

Further increases are needed to ensure access to care for all vulnerable South Carolinians. These major steps forward would not have been possible without sharing our collective voices to showcase the importance of care in the home care and the need to regularly maintained viable reimbursement rates.

Thank you to all of our South Carolina offices, leadership, clients, and families that shared their stories and advocated for this important increase!

GAO MD: 30% Increase to All Home- and Community-Based Services through 2025!

Client and family advocacy helped to bring MD’s dire need for a rate increase to the Baltimore Sun’s front page

Due to GAO’s advocacy efforts and that of our clients, employees, and industry partners, the Maryland legislature voted to increase Medicaid reimbursement rates for all home- and community-based services by 30% over the course of six years! In addition to traditional lobbying and grassroots advocacy efforts, the skilled nursing unit collaborated with GAO to deploy a public affairs campaign that led to home care clients’ stories being published in the Washington Post and Baltimore Sun, thus further showing legislators and the public the dire need for a Medicaid rate increase.

This monumental increase will enable BAYADA to compete for approximately 50% of the state’s LPNs, who are currently more attracted to hospitals and other settings where wages are higher. This in turn will enable BAYADA to better fulfill its vision of serving millions of people worldwide.

GAO anticipates that, as a result of this increase, the skilled nursing unit will open an office in 2020.

GAO PA: 2% Increase to Pennsylvania’s ACSP Practice to Help Vulnerable Residents Access Care

HHAs Antwain and Markeeta Lewis were featured in the Pittsburgh Post Gazette to bring public and legislative awareness to low PA PAS rates

Throughout 2019 GAO, Pennsylvania office & field employees, clients, and industry partners banded together to secure a 2% increase for Personal Assistant Services (PAS) under Pennsylvania’s Office of Long-Term Living (OLTL), effective as of January 1, 2020.  This increase will result in an additional $700,000 in annualized revenue, as well as an additional $625,000 in operating surplus and will predominantly affect our Assistive Care State Programs (ACSP) offices.

In addition to increased revenue for Pennsylvania’s ACSP offices, this rate hike will also benefit the state’s most medically fragile and vulnerable adults and seniors. GAO anticipates that service offices will be able to recruit and retain more home health aides and fill more shifts that are currently going uncovered. 

In addition to traditional lobbying and advocacy efforts, GAO and state ACSP service offices worked together on an aggressive public affairs campaign that resulted in several articles regarding BAYADA clients’ struggles with accessing care, and opinion pieces authored by Clinical Managers (CMs). This campaign further added pressure to the state legislature to begin to solve the access to care issue. In 2020, GAO is seeking to increase the PAS rate even more—an additional 8% to reach a 10% total increase over 2018’s reimbursement rate for PAS services.

GAO RI: Annual Cost of Living Adjustment (COLA) Increase Secured for 2019-2020; Additional 5.9% Proposed for 2021!

BAYADA staff and clients were instrumental in gaining public and legislative awareness on home care issues in Rhode Island. Here, client Brandon Stone (right) is pictured with mom Sherry (lower left) and nurse Jessica (center)

In 2019, GAO and industry advocacy led to the successful renewal of the Cost of Living Adjustment (COLA) of 1.9% for Medicaid reimbursement rates for Certified Nursing Assistant (CNA) and Skilled Nursing services. This adds an additional $232,941 to BAYADA’s annual revenue, and $26,535 to the company’s annual operating surplus.

The first-in-the-nation COLA adjustment was included in 2018 state legislation as a result of the advocacy efforts of GAO, client and employee Ambassadors and advocates, and Rhode Island industry partners, as well as a public affairs campaign that led to local print and broadcast media coverage on the need for regular rate reviews to ensure that reimbursements for home care services were adjusted annually to keep up with real costs of living and conducting business.

By continuing to advocate for the renewal of the COLA increase every year, then Rhode Island service offices will be able to—at their discretion—increase field staff wages, thereby increasing caregiver recruitment and retention rates and enabling clients to experience less missed shifts.

BREAKING: Due to GAO, BAYADA, and industry advocacy, RI Governor Raimondo has already proposed a 5.9% increase for skilled nursing and CNA services in the 2020-2021 budget! If successfully passed through both chambers in the state house, effective July 1, 2020, this increase will add $219,791 to BAYADA’s yearly revenue, and $65,937 to BAYADA’s annual operating surplus.

Thank you to our RI staff and clients for your continued commitment to advocacy on behalf of all of Rhode Island’s caregivers, and the medically fragile and vulnerable populations!

GAO NJ: $2 Per Hour Increase for Personal Care Assistance (PCA) Services

BAYADA staff, along with GAO area director Louise Lindenmeier center) spoke with many NJ legislators, including NJ State Senator Kristin Corrado, about the need for higher reimbursement rates for our clients.

Throughout 2019, GAO and New Jersey home care clients, employees, and industry partners battled the state government on the state’s minimum wage increase. BAYADA has been a staunch supporter of an increased minimum wage, as home health aides’ roles are vital to the community and require compassionate, excellent, and reliable workers. However, GAO and other advocates worked to show legislators and stakeholders why a Personal Care Assistant (PCA) Increase was necessary for providers to be able to continue to recruit and retain these valuable workers.

Advocates’ efforts resulted in a much-needed $2 per hour increase to the PCA rate—but the battle wasn’t quite finished yet. The legislature had also included language that would require 100% of the increase to be passed through directly to aides’ wages. While such a mandate was admirable in spirit, in practice it would have the potential to crush the state’s home care industry as a whole. After additional advocacy from GAO, staff, and industry partners, this pass through was successfully eliminated in December 2019.

In 2020, one of GAO’s primary goals in New Jersey is to continue to battle for further increases to the state’s PCA rate so that BAYADA can continue to pay wages to recruit and retain quality aides as the state’s mandatory minimum wage continues to increase. 

GAO Federal: Advocacy Spares BAYADA’s Home Health Practice $11 million Annually

GAO’s 2019 Federal Affairs Team with Senator Tom Carper (D-DE)
  • BAYADA GAO’s federal affairs team supported both the Partnership for Quality Home Healthcare (PQHH) and the National Association for Home Care and Hospice (NAHC) in lobbying both Congress and the Centers for Medicare and Medicaid Services (CMS) to reduce the reimbursement cut mandated by the Patient Driven Groupings Model (PDGM) from 8.36% to 4.06%.  This reduction in the rate cut, effective January 1, 2020, saves BAYADA more than $11 million in annual gross revenues.  While the industry was successful in having the reimbursement cut reduced by more than 50%, it still faces further cuts based on behavioral assumptions.  This partnership of BAYADA and national associations will continue into 2020 with the goal to eliminate any further cuts made based on assumed behaviors and limiting future reimbursement cuts and increases to 2%.  
  • BAYADA led the Partnership for Quality Home Health’s (PQHH) first annual Home Visit Program by providing specific guidelines so that the industry continues to be consistent in its efforts to educate legislators on the value of home health.  Each quarter BAYADA was represented in several tactics (office visits locally or in Washington D.C., action alerts, town halls, comment submissions) that essentially led to the reduced reimbursement cut, and led a federal home visit in Florida with Congressman Vern Buchanan (R-FL). BAYADA continues to be recognized for our grassroots efforts on a national level within the industry.
  • GAO, along with the Hospice Action Network (HAN), lobbied MedPAC and successfully reversed MedPAC’s recommendation to cut hospice reimbursement in 2020 by 2%, saving BAYADA a potential revenue loss of nearly $1.5 million in 2020.