Blog Takeover: My Family Hosted a Legislative Home Visit ─ You Should Too.

My name is Lisa Letterman and my son John was in a severe car accident in 2020, which left him paralyzed from the neck down, unable to walk, talk, or breathe on his own. As he was preparing to be discharged from the hospital, I unfortunately was not aware of any other long-term care option other than a nursing facility, so I made the difficult decision to send him to a facility in Virginia. But after a short time, it was clear that John’s health and quality of life were deteriorating, so I started researching other care options until I found home care.

After a long and stressful separation, John was finally able to return home to receive in-home care under North Carolina’s Private Duty Nursing (PDN) services. Since returning home with one-on-one nursing care, his condition has improved immensely. He no longer requires a feeding tube, he is now able to talk on his own and is even slowly making progress in regaining movement. However, there is a new hurdle that we face: trying to find enough nursing coverage for John. There is a critical nursing shortage that leaves families like mine struggling to care for our loved ones on our own, putting us in a constant state of exhaustion and concern when we can’t get coverage. I knew that something must be done to fix this shortage, so I started to advocate.

Our experience with a legislative home visit:

Recently, John and I invited our North Carolina Representative, Dudley Greene into our home (virtually), to show the importance of in-home nursing services and to advocate for better access-to-care. At first, I wasn’t sure what to expect from the virtual visit, but I can tell you it was an incredible experience that I believe other home care families should consider when wanting to advocate and make a difference.

Before the visit, BAYADA client services manager, Rachel Miller, handled the logistics. Once we agreed to opening our home, she handled everything from scheduling, practicing our call, and keeping us updated. When the 30-minute meeting began, it was like Rep. Greene was sitting in our home having a conversation with us. He could see all of John’s machines, medical routine, and he listened to the challenges we face. It was clear by the look on Rep. Greene’s face that he was truly understanding our situation in a way that no letter, email, or phone call could describe. We had his undivided attention for 30 minutes and in that time, we showed him the power of home care. After the visit was over, both John and I were impressed with how easy and rewarding the process was.

Top Left to Right: BAYADA CSM, Rachel Miller; BAYADA Government Affairs Manager, Cai Yoke; BAYADA Director, Kristen Church
Bottom Left to Right: North Carolina State Rep. Dudley Greene, BAYADA client & NC resident, John Letterman during the virtual home visit.

Why I advocate:

I advocate for home care because I can’t image what it would feel like to go through what John, and others like him, have had to experience and not have anyone around to speak up on your behalf.  I have seen John in every stage of his recovery: in the hospital, nursing home and then at home. It is because of PDN that John is thriving and living the quality of life he deserves. I want other families to have access to this same high quality, in-home care, but without better state-funding, that won’t be possible.

John Letterman with BAYADA nurse.

Why YOU should participate in a home visit:

Legislators like Rep. Greene determine the budget and funding for these types of programs, so we must do our part to educate them as best we can. I believe that legislators want to make a difference in their communities and help their constituents, but most are not aware these issues even exist. The more that decision-makers understand of the benefits of in-home care, the more advocates we have supporting our cause. Whether it’s a virtual or in-person home visit, these types of interactions with legislators give them a glimpse inside our challenging environment and help them understand the importance of in-home care ─ something that an email, letter, or phone call could never convey.

Advocacy Matters!

Despite the fact that many people in government and regulatory positions agree that home health care is a cost-effective, patient-preferred solution, it continues to be prioritized below institutional care. Not investing in home care will decrease the supply of qualified workers, increase turnover, and compromise the quality of home care services. At Hearts for Home Care, we help those that care about home care by enabling YOU to get involved at the capacity in which you’re able to do so.

Email us at advocacy@bayada.com or visit our website  in order to learn more about the home care advocacy community and find opportunities to get involved.

Pennsylvania Home Care Recipients Advocate for Better Access to Home Care

 Pennsylvania ranks seventh in the nation for the percent of its population that is 65 years of age or older1. As Baby Boomers continue to age and the population of older adults needing long-term care increases, the need for caregivers will continue to increase as well. Since COVID shined a light on major drawbacks of congregate living facilities like nursing homes and institutions, it is not just the elderly population that are choosing to be cared for at home. This is great news for the hundreds of thousands of individuals and families who prefer to age at home rather than in a facility. However, it also poses a major problem: there aren’t enough caregivers to take care of the current Pennsylvania population at home let alone the 29% growth that will occur by 2028, leaving a shortage of 73,000 home health aides2. This is due in large part to low state funding for Medicaid programs like Pennsylvania’s Personal Assistance Services (PAS) that cares for medically fragile individuals.

Stephen Hoppy from Luzerne County, PA with his home health aides

This is where our advocates come in. Home care recipients across the Commonwealth have banded together to help alleviate this growing caregiver shortage. Advocates like Stephen Hoppy from Luzerne County, PA are speaking out and helping raise awareness of the inadequate state funding. Stephen is approved for 20 hours per day of care from the PAS program, but since he cannot find enough caregivers to cover all those hours, he has been paying $500 per week out of his own pocket to help secure that coverage. Recently, Stephen was interviewed by FOX56 News about how the caregiver shortage has affected him.

“I am advocating because our healthcare system is compromised. There are plenty of people worse off than me that can’t get home care, which is unacceptable. These home health aides are medical professionals, and they need to be paid for their expertise and knowledge,” says Stephen.

COVID has only exacerbated this issue, with a mass exodus of health care workers no longer willing to risk their lives for a career that yields an average of only $12.40/hour. BAYADA Home Health Care has had to deny 40% of PAS cases in 2020 and 2021 because there were not enough caregivers to staff the cases. Teri Henning, the executive director of the Pennsylvania Homecare Association (PHA), says she’s hearing similar numbers from PAS providers across the board. “They simply cannot compete for the workforce,” she says. “Home health aides can earn more money doing similar work in other state home care programs, or in nursing homes, or even doing less physically- and emotionally-demanding work at Amazon, Target, or in fast food.”

“BAYADA Home Health Care has had to deny 40% of PAS cases in 2020 and 2021 because there were not enough caregivers to staff the cases.”

Pittsburgh resident, Maria Kolat with son Matthew

Home care advocate and mother, Maria, from Pittsburgh has also joined Hearts for Home Care’s advocacy efforts after experiencing these issues firsthand with her 22-year-old son, Matthew, who is developmentally disabled and requires non-stop supervision. Since COVID, their lives have dramatically changed—his schooling, his ability to receive psychological and medical care and—very significantly—his family’s ability to access the home health aide (HHA) care that Matthew needs and is qualified to receive. Maria and Matthew were featured on Pittsburgh’s local KDKA 2CBS station advocating on behalf of home health aides.

“Aides are leaving the caregiving field to work at big retail like Walmart and Amazon—or in fast food,” says Maria. “They can make $15 an hour or more there. When we see a revolving door of aides, Matthew can’t get the one-on-one care he needs, which puts him at risk.”

Home care advocates like Stephen and Maria give life to our advocacy efforts ─ their real-life experiences aren’t just numbers and statistics, but genuine struggles that thousands of Pennsylvanians endure every single day. They help tell the story so that legislators and influencers can fully grasp how their decisions are affecting their constituents and communities.

Home care advocates like Stephen and Maria give life to our advocacy efforts.

At the end of the day, when aides are not being drawn into working in home care, it’s Pennsylvania’s most vulnerable residents like Matthew and Stephen who suffer. PHA, home care providers, and advocates are asking the State to increase funding for the PAS program. Additional funding would put home care agencies in a better position to recruit and retain more HHAs, and thus ensure that PAS beneficiaries can continue to access the care they need to stay safe and healthy at home.

  1. https://www.leadingagepa.org/Portals/0/154869%20Long%20Term%20Care%20Statistics%20Book%20revised%20final.pdf page 14.
  2. https://mercer.healthcare-workforce.us/ +math

Advocacy Matters!

At Hearts for Home Care, we help those that care about home care by enabling you to get involved at the capacity in which you’re able to do so. Email us at advocacy@bayada.com or follow us on Facebook.com/Hearts4HomeCare in order to learn more about the home care advocacy community and find opportunities to get involved.

Home Care and Independence

Lee-Ann Quinn with son Zach. (PBN PHOTO/MICHAEL SALERNO)

My name is Zach Quinn and in many ways, I’m similar to other 22-year-olds that are around me: I love board games, video games, and movies. I love my family—even though my three little sisters get on my nerves sometimes. 

But I’m very different from just about every other 22-year-old I know in one big way:  I have Duchenne Muscular Dystrophy (DMD), and I rely on home health care services for nearly all of my daily activities. These nursing and certified nursing assistant (CNA) services allow me to be as independent as possible—and allow me to live, in many ways, like my non-medically complex peers. 

DMD is a degenerative neuro-muscular disease that causes the muscles in the body to weaken. DMD led to the loss of my ability to walk, and my needing a wheelchair. It has also led to the loss of lung function, which required me getting a trach and vent to breathe for me. I need to be medically monitored to stay independent, which is why I rely on home care in my daily life.

I wanted to write this blog post as a way to show the wider world that being disabled doesn’t make me—and others like me—so different, as long as we have the proper care in place. Home care allows me to maintain my independence. It takes a lot for me to do that, but it is worth it. I need nurses and CNAs to get ready every day. They help me get washed and dressed so I can get up in my wheelchair and start my day without my parents’ help. This makes it so I can hang out with my family, go out in my community, and be myself. I appreciate the life I have because of the care I receive from my nurses and CNAs, and it has changed my life.

Zach with his siblings and home care nurse, Jeff.

I truly believe that home care is the future of healthcare, and that so many more people could benefit from it if it was more readily accessible. Home care keeps disabled adults and seniors out of nursing homes and other facilities, and it keeps medically-complex children and adults like me independent in our communities. From a wider scope, this allows many people to grow up at home, go to school, contribute to the economy, and contribute to the community. Also, by keeping people out of costly places like ERs, hospitals, and long-term rehab and nursing facilities, it saves state budgets’ and families’ money. 

I truly believe that home care is the future of healthcare, and that so many more people could benefit from it if it was more readily accessible.

Another purpose of this blog post is to show what happens when things fall through. There is a huge gap in people’s ability to access home care, even if they and their families prefer to be at home. I’m no exception. I have had great nurses and CNAs leave the home care industry, which has led to my parents having to call out of work. They usually leave for better paying jobs—which is great for them, and often necessary so that they can support their own families. But it really affects me—it makes my care unpredictable for me and my parents, and makes it more difficult for them to count on care and know that they can sleep and work normally.

It also makes it a “revolving door” of caregivers in many ways. This has its own layer of problems, but in the end, the best way to prevent this is to ensure that caregivers like nurses and CNAs can make a sustainable wage and living in home care.  I studied Digital Media in high school, and I wanted to pursue a career in video game design. There are so many individuals in RI and across the US and the world who are able to live good lives, get jobs, and provide to the economy and community as long as good home care coverage is available. I don’t belong in a nursing home—I belong in my own home, and in a place where I can design video games!

Zach and family with Rep. Julie Casimiro during a home visit a few years ago.

But I can’t accomplish any of this without home care. We need to make sure that enough people want to work in home care—that it is a rewarding and compassionate career path. In my home state of Rhode Island, and in nearly every other state in the US, professional caregivers like nurses, CNAs, and home health aides are paid less than their counterparts in other settings—like hospitals. This keeps institutional care as more readily accessible to people who need long-term support. The federal government and state legislators must make sure that home care is a viable career by funding home care programs better. This would allow nurses, aides, and other caregivers to be paid a fairer wage—and would allow more of the workforce to enter home care. 

There will be a long time before we can say that home care is as accessible as care in other places. But this is one way to start.

After all, isn’t celebrating individual independence a huge and important part of our collective American culture?

Patient Recognition Week: February 1-7

In honor of Patient Recognition Week, Hearts for Home Care sends a warm and heartfelt thank you to the many patients and families that advocate every day!

Hearts for Home Care cannot be effective in changing states’ policies and program funding mechanisms without your stories. When those who are affected by home care—clients, their families, and their caregivers—share unique and personal stories, it creates real change. These stories illustrate to legislators how impactful home care is to their constituents, and why it is important that they create new laws and amend existing ones to maximize access to care for residents who need it most.

Advocating for yourself or for a loved one is rewarding. Sharing your voice can mean the difference between a legislator being unaware of home care’s impact, to their proactive support of home care. In honor of Patient Recognition Week, below are several real life examples of clients in advocacy action. Home care patients and families make all the difference. Thank you for all you do!

Delaware mom Kateri Morton has advocated for her son Joey in many ways, from being featured on local news station WMDT (47 ABC) to share how low state Medicaid rates have affected her ability to get all of Joey’s skilled nursing hours covered—to organizing a group of active moms to testify at upcoming state hearings on the issue! Not only have legislators heard her voice loud and clear, but now other DE moms have heard her and thereby gained the confidence needed to share their stories too.

Kateri’s advocacy on behalf of her son Joey has enabled state decision makers to hear about the importance of in-home nursing through many mediums—including print and broadcast media.

Durham, North Carolina’s Mr. Mendenhall is a 90-year-old armed service Veteran with Dementia. Due to his diagnosis and the accompanying physical limitations, he needs constant supervision and support—including assistance with everyday activities, such as dressing, eating, bathing, toileting, and moving around. Mr. Mendenhall lives at home with his wife, Margarite, of more than 50 years. She does her best to take care of her husband, despite her own medical challenges and limitations. While they both are frail, they are happy to be at home and together. They are able to stay at home through the home health aide services that he receives from his home health aide, Kashina, who comes in two hours per day to care for Mr. Mendenhall. Her caregiving services enables Mr. Mendenhall to remain as mobile as possible, as well as remain in his community.

Mr. Mendenhall (left) meets NC Rep. Hawkins while his wife looks on. They want to do what they can in order to show state and federal lawmakers how important home care is.

While you’d think that their advocacy work is limited, the couple recently participated in a home visit in which NC Rep. Zack Hawkins. This enabled Rep. Hawkins to see firsthand how home health aides help keep constituents costly and potentially infectious facilities such as hospitals and nursing homes. After Rep. Hawkins’s visit, he helped the family connect with the VA to address challenges they were facing. Rep. Hawkins said, “As a lawmaker, it is important we support seniors. 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.”

LaToya Martin is a super-mom who fearlessly advocates for her son Massiah. When she wrote an opinion piece for the Delaware Post, her powerful message led to many state legislators learning about how home care affects real people across the state. That message resonated not only with lawmakers, but also with moms and home care advocates from all parts of the US. Scary Mommy—one of the largest online resources for moms—even reshared her piece to the hundreds of thousands of readers that regularly access their site!

Mark Steidl is a disability rights advocate from PA to DC and beyond!

Mark Steidl of Pittsburgh, PA doesn’t let communication challenges stop him from sharing his voice. Diagnosed with Cerebral Palsy, he uses a Dynavox to communicate the importance of home care and the impact of his home health aides with his legislators! Mark and his mother travel to the state capitol in Harrisburg, and to Washington, D.C. at least once a year to take part in Hearts for Home Care lobby days—days in which dozens of advocates gather to make meetings with legislators that will be voting on home care-specific legislation.

In a conversation with Mark about his advocacy work, he said, “If I had been born in 1965 instead of 1995, my parents might have been told to send me to an institution instead of raising me at home with all the support I need. Times have really changed. Advocacy and new ways of thinking have created those changes. But much more needs to be done and much more can be done. We have to keep advocating for the changes and the opportunities we want.”

NJ mom Dana Insley testifies at a public hearing in Trenton.
Dana (second from right) is pictured with her family, including daughter Abi (second from left in white & pink)

New Jersey mom Dana Insley steps up to the plate for any opportunity to advocate on behalf of her beloved daughter, Abi. After 2+ years of fighting, Dana and her husband adopted Abi, who needs skilled home nursing to be able to live a safe, healthy life alongside her siblings and loved ones at home. When she isn’t taking care of her family, Dana thinks of many ways to advocate. She has testified at many state hearings for increased home care funding, regularly writes opinion pieces to share with news sources and legislators, and always makes time to share her family’s home care experience with the public. Abi didn’t only get a second chance at life, but she also got a mom whose voice advocates on behalf of all New Jersey children and families with special needs.

This is a mere glimpse into the wide world of patient advocacy. Thank you to the many, many home care clients and families that take the time to advocate in a variety of ways. From a brief video meeting with a legislator, to a home visit with your medically-fragile loved one, to writing to your local paper, sharing your story helps lawmakers see the importance of in-home care, and empowers you to act as a voice for the many who are unable to advocate for themselves. We recognize you and appreciate you. To get involved in advocacy in your community, contact advocacy@bayada.com today!

Client Spotlight: BAYADA NJ Client Jim Davies Turns Home Visit into an Opportunity to Fight for Nursing Coverage

BAYADA client Jim Davies (center, seated) hosted a home visit with Assemblyman Benson (upper left)

When BAYADA Home Health Care client Jim Davies received a notice in the mail last year that his insurance would be transitioning to another agency, he tried not to panic. After all, the letter stated there would be no change, he would still receive coverage for his home health care nursing and personal care home health aide services.

However, Jim was not convinced. The 66-year-old, who suffered a spinal cord injury as a result of a diving accident 20 years ago, is nearly paralyzed from the neck down. He relies on his nurses for his complex medical needs, which include wound care, range of motion exercises, mechanical transfers to and from bed, medication administration, catheter care, and care to prevent a serious complication called autonomic dysreflexia, which can lead to seizures, stroke, or even death.   

As a former sheriff and local fire commissioner, Jim is used to working collaboratively with others to make things happen. That’s why he immediately called a case manager at the insurance company, who reiterated what was explained in the letter, his home health care coverage would not change.

Coverage denied

Fast forward to the end of the year when Jim received another letter, this time from the new insurance company. Despite written and verbal assurance that his coverage would not change, the new company denied his home health care services, insisting Jim was stable enough and no longer needed nursing care.

Jim reached out to his BAYADA Mercer County Adults (MCA) office Director Meghan Hansen and Clinical Manager Sharon Wheelock who appealed the decision on his behalf, to no avail. That’s when they turned to BAYADA Government Affairs Area Director Louise Lindenmeier, who suggested Jim reach out to New Jersey Assemblyman Daniel Benson, a member of the state Health and Senior Services Committee.

Legislative home visit leads to positive change

“When I called Assemblyman Benson’s office, I wasn’t sure what the response was going to be, but I was pleasantly surprised,” says Jim. “The assemblyman made me feel that as his constituent, my problem was a major concern, and he owned it.”

Assemblyman Benson visited Jim and his wife of 40 years Rosemary at their home to witness, first-hand, the critical role home care nurses play in Jim’s health and well-being. During the visit, Assemblyman Benson also learned about the catastrophic medical consequences of stopping Jim’s nursing care and BAYADA’s unsuccessful efforts to appeal the denial from the insurance company.

Following the visit with Jim, Assemblyman Benson jumped into action. He joined BAYADA Managed Care (MCO) Director Pamela Soni, BAYADA Area Director for Pediatrics Managed Care (MCP) Stephanie Perna, and Louise for a meeting with the NJ Department of Banking and Insurance to discuss Jim’s case. In addition, he personally contacted the insurance company to negotiate the contract, resulting in a reversal of the denial. Thanks to his efforts, the issue was resolved within two weeks.

“It is really important to educate politicians on how insurance changes can impact their constituents,” says Jim, who encourages others in similar situations to reach out to legislators who may be more than willing to help. “Assemblyman Benson should be recognized for his prompt and professional response to my needs.”

Assemblyman Benson considered it a privilege to play a role in helping Jim. “It was my honor to work with Mr. Davies to ensure that he received the care he needs and deserves,” he says. “As legislators, it is our sworn duty to represent our constituents, and that means lending our assistance whenever possible, whether by simply cutting through red tape or elevating a situation to a higher level so that it is promptly addressed. I would encourage those in need to reach out to their elected representatives to learn what they can do for them.”

Want to Help Make a Difference: Register for Hearts for Home Care

Whether you can give a minute, an hour, or a day, there are many ways to get involved in advocacy. It can be as simple as sending a pre-written email to your local legislators, hosting a legislator in your home, or attending an event at a legislator’s office or your state capitol.To learn more, consider becoming a “Heart for Home Care” advocate. It only takes five minutes to register at heartsforhomecare.com. You’ll receive email updates about current issues and opportunities to make your voice heart.

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!

Thank You for Keeping Me Home: A Message from an Advocate

North Carolina advocate Ari A. during a trip to Washington, D.C.

We often think of advocacy as sharing our stories, our challenges, and asking for legislative support in addressing those challenges. But advocacy is much more multi-faceted: It’s about building relationships by cultivating legislative connections so that they become home care supporters for life, and it’s certainly about saying Thank You when the support pays off by resulting in a law or policy that is beneficial to the individual and to the home care community at-large.

Below, find a Thank You note written by North Carolina home care recipient and Hearts for Home Care advocate Ari A. Ari has been able to thrive and stay independent at home because of the skilled nursing services he receives under North Carolina’s Medicaid program. Recently, he wrote to Medicaid staff to thank them for resolving a critical issue that enabled him to continue these services. Medicaid staff are committed to improving health and well-being of North Carolinians, and their transactions are often behind the scenes and receive little recognition. Hearts for Home Care applauds Medicaid staff across the country for their commitment to helping individuals stay at home, and we applaud Ari for his sincere thankfulness of their work.

To All I Work with in NC DHHS and Medicaid,

Some of you I’ve known for years and some a short time. Through it all, the one and most important factor that has been consistent has been the capacity to care. Time and time again over the years I have had to get battle ready in order to keep my life-saving services. However, instead having to scale cold-hard hearts, impenetrable like a fortress, you invited me into your hearts. You consistently agreed to provide for my intensive care in my home instead of a medical facility; which essentially would have been leaving me out in the cold to die. Instead of fighting me you have been my allies, always being there for me when I needed you the most.

These truths became ever more apparent a couple weeks ago. For the past two years, my mom and I have been getting things ready to transfer my medications, physical therapy, and supplies to Medicare without de-stabilizing my PDN services under Medicaid. It has been a mind numbing, complicated process. We have been hyper-vigilant not to miss any details that could easily be overlooked. We recently turned in sensitive paperwork to the Department of Social Services (DSS) well before the deadline. On November 30 we spoke with the Director of Policy and Procedures for Medicaid Sandy Terrell about how to safeguard my PDN even more during the transition. Ms. Terrell told Saunja Wilson from PDN to double check if everything was in order by the end of the month. Thank God, Ms. Wilson decided to check right away. The sensitive paperwork we emailed to DSS was present, but hadn’t been pulled up yet even though my caseworker had the paperwork in her email. One of the Supervisors at DSS had also confirmed that we had it turned in. We were told email or fax was equally acceptable for documentation.

The breakdown was that this particular caseworker did not use her email for business and preferred to have documents faxed to her. My caseworker tried to alleviate a little bit of pressure off my mom and I by telling us to ignore the ‘Termination of Medicaid Services’ notice in the mail. Yet, the absolute terror that rose up from the pits of our stomachs when we received the notice was totally indescribable! Despite the paperwork being directly faxed to my caseworker, we still waited for the approval. Thankfully over a week later, the situation was taken over by one of the Supervisors at DSS. She rose to the occasion and kindly brought the matter to a close so that my mom and I could peacefully go on with our lives.

Frighteningly, the bottom line is that I am not exaggerating when I say my life would have been ‘Terminated’ if Saunja Wilson from PDN hadn’t been ‘quick on the draw’ to find the error. If Ms. Wilson had waited to check just two or three days later, I wouldn’t have been able to disregard the Termination notice and my life would have been ruined! I say again, Thank God for my champions in NC government. You always rises up out of the mist to do a heroic save! This is what the rest of America could be and should be as far as healthcare policy.

Frighteningly, the bottom line is that I am not exaggerating when I say my life would have been ‘Terminated’ if Saunja Wilson from PDN hadn’t been ‘quick on the draw’ to find the error. If Ms. Wilson had waited to check just two or three days later, I wouldn’t have been able to disregard the Termination notice and my life would have been ruined! I say again, Thank God for my champions in NC government. You always rises up out of the mist to do a heroic save! This is what the rest of America could be and should be as far as healthcare policy.

All of you keep doing a spectacular job and always keep your focus on the people you serve instead of the numbers, especially as NC transitions to Managed Care. If you ever need my help just let me know anytime!

Sincerely,

Ari A. Charlotte, NC

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!