States are beginning to make key changes to increase families’ access to home care
The COVID-19 pandemic has increased people’s awareness of the US healthcare system’s dependence on institutional care, and the potential dangers that come with a reliance on congregate healthcare settings. Nursing homes and hospital are a necessary part of the healthcare continuum, but COVID has undoubtedly increased the public’s appetite for—and governments’ understanding of—accessible home care.
COVID may have a long-term effect on healthcare policy, as it has shifted the spotlight to the inherent benefits of home-based care. Home care is cost-effective: It costs governments, insurance companies, and individual families less to provide care in the home than in a hospital or facility. It’s also patient preferred: 90% of America’s seniors say that they prefer to age in place, and families with medically-fragile children and adults know their loved ones do better when they are in their own home environments.
Home care advocates—state and national home care associations, providers, home care employees, and clients & families—have been advocating for better funding and better policies for home care for years with mixed success. In general, across the US, funding for home care programs continues to lag behind funding for services delivered in facilities like hospitals and nursing homes. But in this first post-COVID budget season, advocates have seen successes!
We’ve moved the needle: Several states increased their Medicaid funding for home care programs. The New Jersey legislature increased funding for home care by $2 more per hour, and for skilled nursing home care by $10 more per hour. Additionally, Delaware increased funding for skilled in-home nursing by 15%, and Georgia, Indiana, Missouri, and Pennsylvania have increased funding for private duty nursing by 10% or more. Thank you to these states for recognizing the importance of home care.Increased funding will help thousands of children, seniors, and adults with disabilities and medical complexities access the home care they’ve been struggling to access due to caregiver shortages that have plagued the nation.
Other states have increased funding for home care at smaller increments, including Minnesota and Vermont. While any increase is appreciated, there is still work to do in these states and many others: Increasing funding, and reviewing it regularly, is essential in ensuring that caregivers’ wages can remain competitive as costs of living continue to rise year by year. If home care funding is raised now, but then ignored for years to come, then families that need home care will be back to the same situation they were in pre-pandemic: Struggling to find the care they need to stay safe and healthy at home.
On behalf of the home care community, thank you to the many legislators and decision-makers who have supported home care this year!
On March 28, our annual North Carolina Hearts for Home Care Ambassador Symposium took place, where we provided tools and resources to our volunteer Ambassadors. The training focused on a variety of topics, including leading a legislative meeting and building relationships with lawmakers.
addition to special guests former Representative Bill Brawley, Senior Healthcare Campaign Director of MomsRising Felicia Burnett, Association for Home
& Hospice Care’s VP of Government Affairs Tracy Colvard, and Staff Attorney with Charlotte Center for Legal Advocacy
Louise Pocock, the shining star of the Symposium was client Dimpal, who inspired
all of our Ambassadors with her story of her journey into advocacy.
Beyond detailing the specific challenges she and her family face as a result of low state Medicaid reimbursement rates, Dimpal also described the ways in which home care and her nurses have changed her life and granted her independence:
“Without my nurses, I wouldn’t have been able to go to college and to live a full life. Without them, I’d likely be stuck in a hospital or a nursing home,” said Dimpal.
It was this gratitude for her nurses that propelled Dimpal to share her story and to advocate for others who rely on the state’s Private Duty Nursing (PDN) program to survive.
To hear more about Dimpal and the importance of advocacy, you can watch her full speech here. You can also read about her nursing care in the Gaston Gazette after a reporter came to her house to learn more about how her nurses impact her everyday life.
Special thanks to our Hearts for Home Care Ambassadors
for volunteering their time and talents advocating for our staff and clients!
Great things happen when we advocate together! After years of
advocacy from BAYADA, our partners, and many parents and home care employees, the
Maryland General Assembly recently passed two pieces of legislation that collectively will increase all Medicaid
home and community-based services reimbursement rates by more than 30% over
the next six years. Though initially met with opposition from Governor Larry Hogan,
the Maryland General Assembly heard our voices and overwhelmingly voted to
override his veto of one of the bills.
The first bill, the state’s annual budget, provides a rate
increase of 3% that will go into effect July 1, 2019. The second bill, also
effective July 1, 2019, contains an amendment which will increase reimbursement
rates by 4% each year between July 1, 2020 and July 1, 2025.
Currently, Marylanders who rely on in-home nursing care have only
83% of their authorized hours filled, meaning that families struggle to fill
their medically complex loved ones’ skilled home nursing care nearly 20% of the
time! We have found that Medicaid rates have stagnated below the cost of living
and below wages seen in other settings—such as hospitals and facilities—and surrounding
states—and that families were struggling to fill these hours. We are hopeful that
these access-to-care issues will be alleviated as providers will be able to
recruit and retain nurses within the home care industry, and that more of Maryland’s
most medically complex will be able to stay safe where they want to be—in their own homes.
This was a true team effort led by BAYADA and the Maryland National-Capital Area Home Care Association (MNCHA) and including MNCHA member providers, several individual families, parent advocacy organizations and disease-specific advocacy organizations. Special thanks to JoAnn Saxby, Patrick O’Malley, Eddie Dyer, Patty Watson, and Susan Ingallswho all played important parts in making this happen and to BAYADA Delaware employees Mandy Brady, Kristyn Kelsch, and Taylor Kosinski who went above and beyond to advocate in their sister state. Mike Sokoloski, Tara Montague, and Nicole Onofrio were instrumental in supporting two Town Halls and Legislative Day, and Alisa Fox coordinated timely articles in The Baltimore Sun, The Washington Post, and on WDVM TV in Western Maryland. Maggie Tracy managed countless logistical hurdles and supported direct lobbying and grassroots efforts.
Thank you to everyone who played a role in this major achievement! Advocacy cannot succeed if only one voice is heard, and your advocacy has contributed to the well-being of so many Marylanders in need of home care.
For more information on this increase, or how you can get involved in advocacy in Maryland, please contact Shannon Gahs at firstname.lastname@example.org.
On April 9, more than 300 home care advocates—clients,
families, caregivers, and employees—joined the Pennsylvania Homecare Association
(PHA) at the state capitol in Harrisburg. Advocates met with hundreds of the
state’s representatives and senators to deliver an important message: Home care
is important to me, and it should be important to you too.
Check out pictures from the legislative reception, the kickoff rally, legislative day meetings, and the PHA press conference! Care about home care and want to share your voice? Check out heartsforhomecare.com or email email@example.com to find out how you can get involved in advocacy today!
Every year, the
Government Affairs Office (GAO) travels the state to connect with our service offices
about our legislative priorities and the importance of advocacy. Not only do
these visits give us the opportunity to share the work we do to improve the
state of home health care in New Jersey, but they also give us the unique
chance to hear about the challenges you all often face in attempting to deliver
the compassionate, excellent, and reliable care that our clients deserve.
Throughout our visits so far, we have been able to celebrate our collective successes and accomplishments. In 2018, our GAO Ambassadors and service office employees attended a number of district office visits and legislative receptions, and participated in phone banks, letter writing campaigns, and action alerts all in support of accomplishing legislative priorities that support our nurses, aides, clients, and families. Without your partnership and collaboration, we would be unable to deliver on our promise to act as the voice for BAYADA and its clients and employees.
In addition to
celebrating last year’s successes, we have worked together to identify ongoing
challenges and to form our 2019 legislative priorities and strategies. As we’ve
formed these priorities, it is clear that our grassroots efforts and your
continued commitment to advocacy will be integral to achieving our goals.
Thank you to the many offices who have made the time to meet with us. In 2019, we will continue our outreach effort to accomplish our goal of meeting with 100% of our New Jersey service offices. If you’d like to learn more about our road show, our 2019 legislative priorities, or getting more involved in advocacy at BAYADA, contact firstname.lastname@example.org.
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
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!
Oftentimes, when we hear the word “advocacy” we think about
attending a BAYADA-sponsored lobby day in a state capitol or visiting a
legislator’s local office to ask him or her to support or oppose a piece of
legislation. While both those options are in fact forms of advocacy, they’re
not the only ones.
North Carolina client Dimpal Patel recently joined Hearts for Home
Care, a program that BAYADA’s Government Affairs Office began to get
clients, families, staff members, and the community at-large more engaged in legislative
advocacy. She expressed that she wanted to get involved, but as an individual
with a trach, vent, and wheelchair, she would need a lot of assistance
traveling to advocate in person.
The Hearts for Home Care team immediately encouraged her to
reach out to her local paper by submitting a short opinion piece about her
thoughts on home care. She shared an insightful
take on how her nurses enabled her to live on campus and graduate
from UNC Charlotte, as well as how important Medicaid is for her and so many
others that rely on home care.
The Gaston Gazette received her piece, but instead of
publishing it, they sent a reporter to Dimpal’s home to get a better look at
how home care impacts her life first-hand. The reporter spoke with Dimpal and
her nurse, Amy, about the importance of legislators’ mindfulness of continued
Medicaid funding—and her
story made the paper’s front page!
“I’ve always wanted to get more involved in advocacy because
I think it’s important that our state and federal decision makers hear our
voice and understand how important home care is in our communities… but I was
always worried because I can’t get to the state capitol or to legislative
hearings as easily as others can. I’m grateful that Hearts for Home Care has
given me the tools to help me begin my advocacy journey from home,” Dimpal told
Home care by its very nature often helps those with limited
mobility to live a full life and remain at home. That’s why the Hearts for Home
Care team developed a robust menu of advocacy activities—so that anyone who
wants to get involved in advocacy can! Reaching out to legislators via
traditional media or social media, calling into a town hall, sending a
newspaper clipping or an email are just a few of the many ways individuals can
advocate from their own home.
In today’s world elected officials and regular individuals
alike are bombarded with messages, from advertisements on the bus to a long
social media newsfeed, all the way to robotic phone calls and junk mail. It’s
important that we take a step back to cut through the noise to deliver our
advocacy message to state and federal decision makers: Home care is important to me, and it should be important to you too.
GAO continues to grow and strengthen our Ambassador program. Symposiums and other engagement activities are currently underway–don’t miss your chance to get involved!
Government Affairs Office (GAO) launched the Hearts for Home Care Ambassador
program nearly ten years ago, we envisioned that each service office would have
a designee who would essentially act as the GAO liaison for that office. How
much we’ve grown! Today, our Ambassadors
go above and beyond to be the voice for our staff and clients, and they truly exemplify
the leadership and excellence qualities that have grown to be associated with
the Ambassador program.
In 2018, GAO
committed to a more robust and centralized grassroots program, including a
stronger dedication to the Ambassador program. In 2019, under Grassroots
Advocacy Manager Mike Sokoloski’s leadership, the program is set to have its
strongest year yet. This year we will be sharing a new “Ambassador Dashboard”
that will help our advocates stay engaged and track their progress, create more
30-minute advocacy Zoom trainings, and bring our top-performing advocates on an
exclusive Ambassador Awards trip to Washington, DC in May!
Additionally, one of the most exciting changes we have underway is our newly-revamped state-by-state Ambassador Symposiums. Our Ambassador Symposiums are newly designed and structured to train rookie Ambassadors while simultaneously energizing more seasoned advocates. This year we are partnering with outside organizations and bringing in more legislative and client guest speakers to truly show attendees the impact that strong advocacy has in making meaningful changes for our staff and clients.
So far in 2019,
we have held our first Ambassador Symposium in Newark, DE for both our Maryland
and Delaware Ambassadors. Here, DE Senator and Majority Leader Nicole Poore
came to share her passionate story about how she initially became involved in
advocacy for her child, and how she now sees her role as being an advocate for all
her constituents. Throughout the spring, we will continue to host Ambassador Symposiums
in New Jersey, North Carolina, South Carolina, Georgia, New York and Rhode
Island. Whether or not you’ve attended in the past, be sure to check out
what being an Ambassador is all about during our upcoming symposiums!
As our Ambassador
program continues to grow, we are seeking new Ambassadors from all service and
support offices, and are seeking greater involvement from field staff, clients,
and other organizations. It is vital that we join together as Hearts for Home
Care to strengthen our collective voices in support of home care. Our
Ambassadors serve as the forefront of our advocacy program, and truly make the
difference in educating local legislators about home care and its impact on clients
For more information
about the Ambassador program, upcoming Symposiums, or home care advocacy in
general, contact me today!
2019 Ambassador Symposium Schedule*
SC – 2/20 at the
state capitol in Columbia
GA – 2/21 at the
state capitol in Atlanta
PA – 2/28 at the Hilton Garden Inn in Harrisburg
NJ – 3/13 at the New
Jersey Learning Center in Pennsauken
NC – 3/28 at the North Carolina Learning Center in Charlotte
NY – TBD
RI – 4/9 at the Capitol in Providence (morning of Advocacy Day)
*Please note that the DE/MD Symposium
has already occurred, but it’s not too late to become an Ambassador if you are
interested! Contact Mike
Christine’s advocacy efforts led to the ultimate win: a new law that will benefit families!
Pennsylvania Hearts for Home Care Ambassador Christine Detweiler has always been a diligent advocate, but recently, her efforts have proven that home care employees can truly go beyond the call of duty for clients and staff by serving as their voices in our state capitals.
“Home care is important to so many Pennsylvanians, and many aren’t as readily able to meet with legislators to share their stories,” said Christine. “I see advocacy as an extension of why I do what I do as a home care employee: We need to make sure we get out there to be a voice for those who don’t have one!”
Christine has been progressively adding more interactions to her advocacy portfolio—Over the past year-and-a-half she focused on meeting legislators in their district offices, and in the past few months she has hosted multiple home visits. Home visits are the most impactful way to demonstrate the importance of home care to legislators because it gives them a chance to see firsthand how clients receive services. To say Christine’s home visit resonated with Pennsylvania state Representative Marguerite Quinn is an understatement.
A few months ago, Christine led the representative on a home visit with five-year old client Gideon M. who suffers from Spinal Muscular Atrophy (SMA). His mother shared their heartwarming story and opened up about their family’s challenges and Gideon’s ever-growing needs. Her story impacted the representative so deeply that shortly after the visit, Rep. Quinn emailed Christine to further assess the family’s needs and determine how she could help them obtain a transportation cart that would make Gideon’s care easier. The outreach didn’t stop there.
Rep. Quinn recently reported to Christine that she has arranged for a builder to come into the family’s home to build custom doors to create a private area for Gideon downstairs. She also reported that she contacted a rotary to find out if the family can be provided with a generator so that they do not need to constantly worry about their home’s power going out. It is truly remarkable how Christine’s efforts have impacted her client and his care.
In addition to her efforts for Gideon’s family, Rep. Quinn introduced a bill that would add SMA screening to the newborn screening list to help diagnose this disease before a child is even born. After introducing this legislation, Rep. Quinn encouraged the state Newborn Screening Advisory Board to support the measure. As a result of her continued efforts, this past month Secretary of Health Dr. Rachel Levine signed the recommendation.
The Hearts for Home Care Team can’t be prouder of the impact that Christine has made! Her passion and tenacity has reached the hearts of many legislators, and she is truly making a name for herself in Harrisburg as a tireless advocate!
Whether you worry about your aging parents’ ability to remember to take their medication on time or you have a medically-complex child that requires 24-7 skilled nursing care, families that rely on home care across the country are feeling the squeeze: There just aren’t enough quality in-home caregivers, and it is quickly becoming a crisis. While more of the general public is beginning to understand the negative impact this is having on our communities, there is much more to be done to mitigate the impending consequences. Together, we can advocate to combat this looming access-to-care crisis.
We’ve read the articles and we know the facts. Home care is the most cost-effective and patient-preferred healthcare setting for individuals and families who want to remain at home. This is true for older Americans who wish to age in place to parents who believe their child should live at home and not be raised in costly institutional settings. Moreover, demand for in-home caregivers will be continue to increase as baby boomers age and better treatments for chronic illnesses and disabilities continue to become more widely available.
If home health care is in high demand, why are we still facing a shortage of available workers? Home care providers struggle to recruit and retain enough quality caregivers to keep up with the growing demand. Because many insurance companies still do not cover in-home healthcare services, many home care providers rely on government reimbursement rates to cover provided services. That is: When a patient is prescribed and authorized for in-home care, the state reimburses the home care provider for delivering that service. The provider relies on that reimbursement rate to not only pay the direct care worker’s wages, benefits, supplies, and training, but also to cover wages and costs for the workers needed to coordinate and supervise in-home staff.
While rates vary widely depending on the service and the state the care is delivered in, there is a dominant trend that contributes to providers’ inability to keep up with demand: State governments’ reimbursement rates are too low to attract and retain the proper, high-quality workforce necessary to deliver this care. And there are several competitors at play: Hospitals and other institutional settings like nursing homes are able to pay workers more because one caregiver can deliver multiple services to multiple people during one shift, so institutions are able to rely on multiple reimbursements to cover employee wages and costs. Additionally, the home care industry faces competition from non-healthcare industries like fast food companies and retailers, which can often pay workers at competitive rates and offer more consistent schedules and other benefits.
While home health care offers one-on-one care to vulnerable individuals at a lower cost, these reimbursement rates have stagnated and fallen past the cost-of-living across many states. Some states, have not addressed reimbursement rates for decades, putting home care providers at even more of a disadvantage when competing for labor. For example, California has not increased its reimbursement rate for Medicaid home nursing services for nearly two decades. Even the most compassionate home care workers who enjoy the personalized nature of home care are leaving the industry for better-paying jobs in neighboring states and in other settings and industries.
Who can resolve this issue? By and large, state governments are responsible for making decisions that affect home care, including reviewing reimbursement rates and adjusting them so that home health care providers can attract the workforce necessary to keep vulnerable state populations at home. While the rates vary in each state, one thing is consistent across state lines: legislators, who are responsible for making these decisions, are under great pressure to keep state budgets in line while making the necessary expenditures to all of the departments, industries, and populations that need the government’s financial support. All too often, other industries’ voices are heard louder, and home health care continues to fall by the wayside.
Is there any good news? Yes: People are beginning to see the problem. Public awareness of the importance of home care and of the impending access-to-care crisis is becoming more widespread. People care about the issue now more than ever before, and people across the country are beginning to realize that, even if it doesn’t affect them now, home care will impact their lives in the future.
Reports, studies, and articles have made information about the home care industry and the widening labor gap more available. Mercer Health Provider Advisory recently created an interactive map that visually depicts the deficit of home health aides and other healthcare workers in specific states and across the US through 2024. Articles have come out in the Washington Post, Boston Globe, Baltimore Sun, and in local news outlets in South Carolina and Rhode Island, among other states.
And the other good news is evident to many: Home care is simply the right choice. Many legislators are aware of home care’s cost-saving potential, especially as home care keeps people out of costlier institutional settings and prevents ER stays and hospital admissions. And while they may understand the advantages that home care offers families in general, not all legislators realize the impact home care has on the families that they directly represent as public officials.
Public awareness isn’t enough. Action is necessary. Studies, reports, articles, and direct lobbying efforts from home care providers and state and federal associations and partnerships have raised the public’s and legislators’ awareness of home care as a service. However, lawmakers’ awareness of home care issues have not yet spurred them into taking action to address stagnating reimbursement rates and providers’ inability to compete for a fair share of the labor market. We must leverage our collective voices by truly showing legislators what home care is, how it impacts us, and what happens if families can’t access care. Legislators must change laws and policies to reprioritize home health care for their constituents.
What can you do? Join the movement. As individuals, we are responsible for telling our elected officials what is important to us and what those we elect to office should prioritize and champion. Advocating for home care is easy: Call your state and federal representatives and senators to request a meeting to discuss home care, or even simply send a letter, an email, or even a Facebook message or Tweet to let them know about what home care means to you. The Hearts for Home Care platform was specifically created to help members of the home care community learn about opportunities to get involved in home care advocacy. There are plenty of ways big and small to get involved, the most important thing is that we share our voices with one unified message: Home care is important to me, and it should be important to you too.