Client and Family Advocacy – Hearts for Home Care

BAYADA’s 2018 Legislative Accomplishments and 2019 Goals

BAYADA’s Government Affairs Office (GAO) staff continue to push forward on our goals in our major states and in Washington, DC. We’ve worked hard to leverage our staff, clients’ and families’ voices to elected officials and legislative leaders, and we are excited to keep moving ahead for Medicaid rate increases, better policies, and more staff and client engagement throughout 2019. Below, read about our recent accomplishments and upcoming goals.

Federal

2018 Major Accomplishment – In 2018, BAYADA’s Government Affairs Office expanded resources to support federal affairs and home health. We recently rejoined the National Association for Homecare & Hospice (NAHC) and expanded our involvement in national associations. We also have increased our advocacy efforts in Washington D.C. as David Totaro and Lindsey Wright are now registered as federal lobbyists and continue to meet with legislators on Capitol Hill.

2019 Major Goal – At the federal level, our major goal is to pass legislation that counteracts the Patient Driven Groupings Model (PDGM). PDGM is the new Home Health Prospective Payment System CMS finalized on October 31, 2018. While PDGM has some positive effects on the home care industry, we seek to counteract the portion of the rule that will decrease Medicare payments to home health providers by 6.42% based on the use of “behavioral assumptions” beginning January 2020.

Impact: Successful passage of one of the three bills (H.R. 6932/S. 3458; S.3545) that have been introduced into Congress would counteract the “behavioral assumptions” by requiring Medicare to implement adjustments to reimbursement rates only after improper behavioral actions by home health agencies are actually observed affecting Medicare spending rather than assuming those improper activities will occur. Successful passage of any of these bills as currently written would ensure greater stability in the new payment model, thus ensuring the sustainability of BAYADA’s Home Health offices and ensuring that Medicare clients would not see a disruption or cancellation in services.

Delaware

2018 Major Accomplishment – In Delaware, we were successful in building the momentum necessary to bring home a rate increase in 2019. GAO engaged office and field staff in advocacy and saw seven BAYADA employees provide testimony to the Joint Finance Committee. We also educated legislators in both chambers including committee chairs and leadership in both Chambers.

2019 Major Goal – Our major goal in Delaware is to increase Medicaid Reimbursement for RNs and LPNs by 21.4%.

Impact: Delaware clients currently see 6.8% of prescribed hours go unserved and another 7.5% of hours where the nurse is working overtime, both up from the year before. We anticipate that this increase will enable BAYADA and other providers to recruit and retain the skilled nurses needed to meet the demand and fill the gaps needed to remedy both the missed shift rate and the overtime hours served.

Georgia

2018 Major Accomplishment – 2018 was the first year that Georgia saw a full-time GAO presence. Our advocacy efforts secured us a more than 6% rate increase for private duty nursing (PDN) services under the Georgia Pediatric Program (GAPP) waiver.

Impact: The PDN rate hike increased reimbursement rates for RN services by 6.3% and for LPN services by 6.5%, effective July 2018. This increase allows BAYADA to recruit and retain the nurses necessary to provide Georgians across the state with the services they need to remain at home with their families.

2019 Major Goal – In 2019, our major goal in Georgia is to build upon our 2018 accomplishment and add $3 to both the RN and LPN reimbursement rate for private duty nursing (PDN) services under the Georgia Pediatric Program (GAPP) waiver.

Impact: This increase would allow BAYADA to better recruit and retain the skilled nurses that we need to keep up with the demand in Georgia.

Maryland

2018 Major Accomplishment – In Maryland, we successfully passed legislation to mandate a Governor-appointed task force charged with looking into Maryland families’ access to home health care. At the behest of the task force, the Maryland Department of Health revealed data showing that on average, 17% of prescribed skilled home nursing hours go unserved.

Impact: The successful creation of this task force and the revealed data were the first steps we needed to accomplish before we could begin to advocate for our 2019 goal: Increasing reimbursement rates for LPN skilled nursing services by 24.6%. If achieved, BAYADA would be able to deliver pediatric skilled nursing services to the many families in Maryland that are currently struggling to access the care they are authorized for.

2019 Major Goal – Increase Medicaid LPN rate a further 24.6%.

Impact: If achieved, this rate increase would open the market to enable BAYADA to deliver pediatric skilled nursing services to the many families in Maryland that are currently struggling to access the care they are authorized for. We anticipate that this increase will enable BAYADA and other providers to recruit and retain the LPNs needed to meet the demand, and that the 17% missed shift rate would decrease as families access more of the hours they need.

New Jersey

2018 Major Accomplishment 1 – In New Jersey, we were able to secure a 9% rate increase for the state’s personal care assistance (PCA) program. Additionally, our advocacy efforts resulted in a “rate floor” bill, which ensures MCOs cannot reimburse providers at a lower rate than mandated by the state.

Impact: This increase ensures that BAYADA can continue to serve current clients without fear of disruption by MCOs’ varied reimbursement practices and better ensures the sustainability of the state’s PCA program. A sustainable program will allow BAYADA offices to take on new clients, thus enabling more families across the state to access the personal care services they deserve.

2018 Major Accomplishment 2 – Our advocacy efforts resulted in the passage of the “Parking Placard Bill,” which will allow nurses, therapists and aides to park on restricted street parking, municipal lots and overtime at meters to render home care when it is implemented in April 2020.

2019 Major Goal – In 2019, our major goal in New Jersey is to increase the Private Duty Nursing (PDN) fee-for-service rate for both RNs and LPNs by $10 per hour.

Impact: If achieved, this increase will allow BAYADA to compete for a larger share of the state’s RNs and LPNs that are currently attracted to hospital and institutional settings where wages tend to be higher. As we gain the proper number of nurses to meet the demand, we will also likely see a decrease in missed shifts.

New York

2019 Major Goal 1 – In New York, our goal is to achieve the “Approved Vendor” status from the New York City Department of Education (NYC DOE). This will enable BAYADA to provide pediatric nursing services in the New York City schools.

Impact: If BAYADA achieves approved vendor status, we will be able to provide in-school care to children whose parents would like a BAYADA nurse to accompany their child to school but currently cannot do so. The ability for BAYADA nurses to work with a child at home and at school is critical to providing continuity of care for medically fragile children and their families.

2019 Major Goal 2 – Our second major goal is to pass legislation to increase New York’s Medicaid fee-for-service private duty nursing (PDN) reimbursement rates by at least $20 per hour.

Impact: If we succeed in generating an increase to the PDN fee-for-service rate, BAYADA will be better able to recruit and retain the high-quality nurses needed to provide skilled care for medically fragile individuals in New York. Increases will ensure that home care providers can adequately compete with other settings and surrounding states and Medicaid beneficiaries can continue to access home care services.

North Carolina

2018 Major Accomplishment – During this two-year budget cycle, our advocacy efforts resulted in rate increases in three Medicaid programs: Personal Care Services (PCS), Community Alternatives Program for Children (CAP-C) effective July 2018, and CAP for Disabled Adults (CAP-DA) effective January 2019.

Impact: This increase allows for us to continue to provide in-home aide services to 1,244 medically fragile children, disabled adults, and seniors across North Carolina who need care, and enables us to create jobs in the community while keeping families together in their homes.

2019 Major Goal 1 – The first major goal for the upcoming two-year budget cycle is to secure a $5.40 increase for nursing under Medicaid’s Private Duty Nursing (PDN) Program.

Impact: This nursing increase will allow BAYADA to recognize our staff with better compensation across North Carolina and help us better hire and retain the compassionate, high-quality staff that our clients and their families deserve.

2019 Major Goal 2 – The second major goal for the upcoming two-year budget cycle is to secure a further $1.40 increase for aide services under Medicaid’s Personal Care Services (PCS) Program, the Community Alternatives Program for Disabled Adults (CAP-DA) and CAP for Children (CAP-C).

Impact: This aide increase will allow BAYADA to recognize our staff with better compensation across North Carolina and help us better hire and retain the compassionate, high-quality staff that our clients and their families deserve.

Pennsylvania

2018 Major Accomplishment – In Pennsylvania, our advocacy efforts led to the unanimous passage of the Hospice Drug Disposal Bill, which was signed into law by Governor Tom Wolf in June.

Impact: This new law allows hospice and home health nurses to help families dispose of unused narcotics following a patient’s death or discharge. This is important to our Hospice employees because they felt that families needed help and support in disposing of unused drugs. The law shows that the home care industry is doing our part to curb the opioid epidemic in Pennsylvania.

2019 Major Goal 1: Secure a 10% increase for personal assistant services (PAS) for programs under the Office of Long Term Living (OLTL).

Impact: This will allow us to increase compensation for our home health aides and better recruit and retain the caregivers necessary to keep up with the demand in Pennsylvania.

2019 Major Goal 2: Pass legislation allowing for deemed eligibility within home care services.

Impact: This is landmark legislation which will help shift the balance from favoring institutions, such as nursing homes, which are currently allowed to deem a person eligible for Medicaid-based institutional care after a cursory review of their financial application. If passed, this would extend this practice to home care providers, which currently must conduct a full review of a person’s application before delivering services. Because a full review can take months, passage would help ensure seniors will have access to home care when they need it and will help divert individuals from the costlier option of institutions.

Rhode Island

2018 Major Accomplishment – In Rhode Island, our advocacy efforts helped secure two rounds of Medicaid increases, which range from 10% to 70% for home care services delivered by CNAs, LPNs, and RNs. This landmark increase includes the first-in-the-nation annual Cost of Living adjustment (COLa), which will provide additional increases to those rates every year based on the Bureau of Labor Statistics’ Cost of Medical Services annual adjustment.

Impact: As a result of these significant increases, BAYADA and other home care providers can increase nurses’ and CNAs’ wages and better compete for a larger segment of Rhode Island’s workforce. We anticipate that better recruitment and retention will also result in increased access for Rhode Islanders who are currently authorized for home care services but are experiencing missed shifts or cannot find the adequate number of caregivers they need to remain safe at home.

2019 Major Goal 1 – In Rhode Island we are seeking to secure a 10% high-acuity skilled nursing modiﬁer rate for RNs and LPNs in all Medicaid-contracted home care services provided to tracheostomy/ventilated clients.

Impact: This rate differential will ensure that nurses who receive specialized training to care for clients with tracheotomies and ventilators receive a higher pay rate. This will enable BAYADA to better recruit and retain these specially trained nurses and thus ensure the continuity of care for these medically-fragile clients.

2019 Major Goal 2 – Our second 2019 goal is to collaborate with industry partners to submit legislation ensuring the Medicaid Home Care/Hospice COLa is included in the SFY 2020 budget.

Impact: Many states’ reimbursement rates have stagnated and have not been addressed for decades. Obtaining a COLa will protect Medicaid reimbursement rates from falling behind the cost of living and ensure that Rhode Island’s rates do not stagnate as they have elsewhere. This will better ensure we can compete with other health care settings to have the caregivers necessary to meet the demand.

South Carolina

2018 Major Accomplishment – 2018 was the first year that South Carolina saw a full-time GAO presence. Our advocacy efforts secured us an average 10.5% rate increase for all personal care Medicaid waiver services.

Impact: The in-home personal care rate increases brought the personal care (PC) rate up 8.%, the enhanced personal care (EPC) and adult attendant care (ATDC) rates up 8.2%, and the respite care (RC) rate up 17.25%, each effective July 2018. This allows BAYADA to provide aide services to vulnerable South Carolinians across the state and enables us to keep families together at home.

2019 Major Goal – In 2019, our major goal in South Carolina is to secure a 24% increase for RN services within the Medicaid nursing waiver program and a 36% increase for LPN services within the same program.

Impact: Currently, home care providers can currently only compete for approximately 10% of RNs and 25% of LPNs in the state. A successful increase for both RNs and LPNs would allow us to attract a greater share of available nurses in the state and serve more vulnerable South Carolinians in need of skilled nursing home care services.

Hearts for Home Care Kicks Off 2019 with Two Heartfelt Visits with New Jersey Clients

Last week, Hearts for Home Care members and BAYADA employees Dave Totaro, Tara Montague, and Alisa Fox traveled to northern New Jersey to meet two home care clients and their caregivers to learn more about how home care has impacted their lives and how they advocate on behalf of themselves and their loved ones.

Meeting Addy and Gloria

*Photo: DOV client Addy R. and her HHA Gloria have an unbreakable bond*

First, the team stopped by a BAYADA service office in Dover, NJ to meet the staff and learn about the struggles the office regularly faces in recruiting and retaining home health aides. Per staff member Helena Anton, challenges lie primarily within staunch competition in the area and finding the high-quality and compassionate caregivers that “you can tell are put on this earth to care for others,” as Helena puts it.

“Smaller home health care companies can usually pay the caregiver more in wages because we put that money into benefits, training, and supplies. But the real problem is that Medicaid reimbursement rates are so low that these caregivers—no matter what company they work for—aren’t making enough. That’s why we need to advocate to make sure the state sees how low wages are impacting so many New Jerseyans that are able to live and their communities and thrive with home care,” added Helena.

After the discussion, the Hearts for Home Care advocates met home care client Addy and her aide Gloria. The crowd was nearly brought to tears by Addy’s story regarding the challenges she has been able to overcome with her “teammate”—which is what she calls Gloria.

“I was extremely touched by Addy’s and Gloria’s relationship. Not only is it clear how much Gloria has impacted Addy’s daily life and her sense of self-worth, but the way that Gloria talks about Addy’s influence on her own life is incredible. You can tell that Gloria was truly put on this earth to be the nurturing, compassionate caregiver that she is,” said Tara Montague.

Recently, Addy and Gloria visited Senator Steve Oroho to share their story and to advocate for better state home care policies. “Helping people is important. And it’s important that those who help others get the help that they need too,” Addy told the group. Addy recommitted to continuing to advocate for herself and for others who are impacted by home health care. “I want to share my message with legislators. It’s my way of giving back,” she said.

Lili and Emma Welcome Advocacy into Their Home

*Photo: Lili and her nurse Barbara share a high five*

Next, Dave, Tara, and Alisa traveled to Morristown to visit home care client Liliana “Lili” and her mother Emma in their home. As a single mom, Emma relies on home nursing so that she can keep her full-time job and keep Lili at home. She told us that her service office team works hard to ensure that every one of Lili’s shifts are covered. She also shared about times when that coverage wasn’t so steady: “Our routine and our comfort level is only as good as today…When Lili’s main nurse Liz retired, we had a few months where we didn’t know what tomorrow would bring.”

Lili benefits from New Jersey’s private duty nursing (PDN) program, which allows for children and adults with skilled care needs to live at home. Without this program, it is unlikely that Lili would have been able to grow up with her mom and graduate from school as she did. The PDN program’s rates need to be raised in order to better attract more nurses to home care, as most can currently make a higher wage delivering skilled care in a hospital or nursing home. One of Hearts for Home Care’s major advocacy goals for 2019 is to educate legislators on the need for a rate increase and to secure one on behalf of all New Jersey home care clients, families, and nurses.

Like Addy, Emma is committed to ongoing advocacy to ensure that nurses see home care as an attractive employment option, so that other families can receive the home care that they need too. In recent years, Emma has hosted state elected officials in her home. “Seeing our daily routine and how important it is for Lili to have a nurse at home is the most impactful way for an assemblyman or senator to understand home care,” said Emma. “As a mother of someone who is able to stay home due to in-home nursing care, I see it as my duty to advocate…Not just for Lili, but for those in the state who are struggling to get the nursing they need.”

“It’s our clients’ and families’ voices that make the biggest impact on our state and federal elected officials’ decisions about home care. Because of advocates like Addy and Emma, legislators better understand the impact home care has on their communities,” said advocate Dave Totaro, who also serves as BAYADA’s chief government affairs officer.

There are plenty of ways to advocate, even from home! To find out ways that you can make an impact, contact us at advocacy@bayada.com. Together, we can share our voices to make 2019 the best year for home care yet.

NC: SHE, GAS, and RAN Offices Demonstrate Advocacy by Building Relationships and Sharing Clients’ Stories

*Sen. Alexander (back left) visits BAYADA client Rusty (front left) and his nurse, Vikki (front right) with BAYADA staff Cheryl, Jillian, and Rusty’s mother (back right).*

GAO can’t do it alone, and in North Carolina we are proud to have so many employees that understand the impact of sharing their voice on behalf of all our staff and clients!

SHE and GAS Host Impactful Home Visit

Last month two offices, SHE and GAS, teamed up to host a home visit with newly elected Senator Ted Alexander. Our BAYADA team of advocates, including MIM Division Director Joe Seidel, GAS Clinical Associate Cheryl Reading and GAS Client Services Manager Jillian Fernald, as well as the client’s long-time nurse Vikki, spoke passionately about our services and the challenges we face in care delivery.

The visit was a grand success! The importance of home care and the work you do every day was certainly not lost on Sen. Alexander, whose wife and daughter are both nurses: “Our goal,” he explained, “is to keep families where they belong, together and at home.” These types of interactions lay the foundation for support of our legislative asks because the decision-makers see first-hand the impact home care has on families.

RAN Builds Relationships in a Different Way

*BAYADA Ribbon Cutting Ceremony with Senator Wiley Nickel*

Last month, the RAN office hosted a ribbon cutting ceremony to commemorate the grand opening of our new state-of-the-art simulation lab and training center. This was no regular ribbon cutting ceremony where the office invited current and prospective nurses to tour and see-in-action the simulation lab. We took the opportunity to educate lawmakers on the scope and breadth of what is possible in the home by inviting Senator Wiley Nickel to welcome the group. We also included Ed Troha, Vice President for the NC Chamber, who has four nurses in his family, to speak about the importance of the training center in job creation.

Additionally, former Senior Chairman for House Appropriations Nelson Dollar issued a proclamation to show his strong and constant support for home care. This center allows BAYADA to train nurses using real life scenarios that helps develop confidence, competence, and builds career-building skills to home health care nurse. Increasing awareness among legislators and other community leaders on the benefits of home care helps garner support as we work toward our legislative goals.

Thank you to the many North Carolina staff and families that regularly share their voices in advocacy! To find out how you can get more involved, contact GAO Director Lee Dobson today!

Why Client Advocacy Matters

BAYADA client Carly (front) is pictured here with NJ Assemblyman Anthony Bucco (right) during a legislative home visit, which served to familiarize the assemblyman about how home care affects his constituents. Carly and her mother Christina (left) also testified at a legislative hearing in Trenton about the need for increased Private Duty Nursing (PDN) rates.

Client advocacy matters more than that of home care industry professionals. While home care professionals can share facts and figures about home care with legislators, it is clients’ stories that truly paint the picture of what home care means to legislators’ constituents.

Whether a home care client is an infant, senior, or any age in-between, it is very likely that the nursing or aide services that they rely on is from a Medicaid or Medicare program. What this means is that government officials are the ones making the decisions on care regulations and reimbursement rates rather than those who are regularly affected by home care. Home care providers must accept these rates and regulations and provide care to the best of their abilities based on what the government has set forth rather than on what is actually best for clients and their families.

Home care employees regularly see that many of the government reimbursement rates for home care are low and have not been increased in years. This has a domino effect in that if providers can’t bring more revenue in, they can’t pay higher rates to attract more staff to care for current clients or for new clients who will need care in the future.

Many areas of our country are starting to age and will need caregivers to allow people to live in their homes instead of in facilities, yet projections indicate fewer people want to be professional caregivers due to the industry’s low wages. Additionally, more nurses are choosing employment in other types of settings, which makes it difficult for many home care clients to have adequate nursing coverage because facilities such as hospitals can pay nurses a higher wage.

As elections come and go, we see changes in our government leaders and with these changes come the possibility of healthcare policy changes. These changes can be sudden and unpredictable, and these changes often threaten funding cuts to important programs such as Medicaid or Medicare. Any funding cuts to these programs would be devastating to home care providers and to program beneficiaries.

The interesting thing is that the representatives and senators who we vote for at the state and federal level make these decisions, and few of them have strong healthcare backgrounds. In addition, it is their job to represent all of the people from their respective districts to the best of their abilities. While provider employees can share their voices through legislative meetings, clients’ and their family members’ advocating and sharing their stories matter most.

Clients who benefit from home care and their family members have their own special stories to tell. As the end users of nursing and aide services, clients and family members have the first-hand knowledge of how the Medicaid and Medicare programs are working and what could be done to improve them. Clients names, faces, and shared stories paint a far more detailed picture of home care than industry professionals can with facts and figures. When legislators vote on issues related to home care, clients stories are better-remembered, and legislators are much more likely to vote for favorable home care policies with these in mind.

“I’ve been an advocate for my wife, who is 100 percent dependent, for 16 years,” said Mike Pollock, the husband of a client who advocates to protect home care for his wife and all who need services. “Thanks to Medicare and Medicaid and BAYADA, I’ve been able to care for her at home. Although Medicare and Medicaid are excellent resources, they have their issues. An excellent resource for solving these issues are our elected officials,” Pollock said. “In fact, elected officials are the only people capable of fixing issues that arise within Medicare and Medicaid. But they can’t help if they don’t know what we as family caregivers are dealing with every day. Never hesitate about reaching out to them. It’s been my experience they are eager to help,” Pollock concluded.

By putting advocacy into action and connecting our clients to their elected officials, there is a far better chance that Medicaid and Medicare will be protected and grow with the needs of our clients. Please email me at rhynick@bayada.com for more information related to client and family advocacy and what you can do to help protect and strengthen the home care industry in your state and at the federal level.

NJ Client & Family Advocacy Manager Shares Her Own Client Experience During Recent Home Visit

Submitted by Tara Montague, Manager, Client and Family Advocacy, NJ (GAO)

I had the pleasure of hosting Carol Murphy, Assembly candidate in Legislative District 7, for a home visit to meet my daughter Mary. As a 20 year long client of Mt. Laurel Pediatrics (MLP), Mary is the epitome of what home care can help families to achieve and we wanted Ms. Murphy to experience that first-hand. Clinical Manager Chantel Denny and Administrative Coordinator Brooke Fitzpatrick discussed some of the challenging staffing issues that occur due to low reimbursement rates and difficulty attracting qualified nurses. Registered Nurse Stacey Sutton shared some of the varied tasks that she performs in order to keep Mary healthy and safe at home and at school. Ms. Murphy made a commitment, if elected to work with us to make home health care nursing a more attractive career option in the state.

Photo: Tara Montague, Client Mary, Carol Murphy

Summer Legislative Home Visits were a Success!

Submitted by Louise Lindenmeier, Director, Government Affairs (GAO)

Client and Family Advocacy in NJ are picking up speed. In the third quarter of 2017, we participated in four home visits with local legislators. This brings our totals for 2017 to nine home visits, one legislative round table, and one client district visit.

Hearts for Home Care Ambassador, Allison Nulton invited NJ state legislator Senator Thompson to a home visit for one of her clients from the TRP office.

District 6 Assemblywoman Pamela Lampitt visited with 14 year old Mt. Laurel Pediatrics client Juan M and his mother, Carmen.

Assemblyman Michael Patrick Carroll from District 25 visited the home of 20 year old PED client Lily Kaplan in Morristown.

Dawn Moeller, mom to PED clients Zak and Tyler, invited Senator Cardinale into their home to share what it’s like to have not one, but two children who are medically fragile and require nursing care.

We have two visits already scheduled during the upcoming fourth quarter and a couple more pending.

If you’re interested in setting up a home visit for one of your clients, please contact Louise Lindenmeier or Tara Montague and we will be happy to assist you.