States Struggle to Recruit and Retain In-Home Nurses Due to Low Reimbursement Rates… But Advocacy Can Help

Home health care companies around the country struggle to recruit and retain enough qualified workers to support the growing number of children, adults and seniors that want to be cared for in their own homes. Recruitment and retention issues stem from a number of reasons, including the nationwide nursing shortage, low US unemployment rates, and inadequate Medicaid reimbursement rates that leave home care providers in a position where their wages cannot compete with those of other settings and industries.

BAYADA Home Health Care was recently featured in a Wall Street Journal article for the company’s efforts in solving for this by recruiting nurses from Puerto Rico to fill open nursing positions in Minneapolis. The island’s unemployment rate, currently at 10.8% is much higher than that of Minneapolis, which is currently listed at 2.4%.

A 2.4% unemployment rate is low even compared to the US rate, which is currently at a 17-year low of 4.1%. This low unemployment rate is compounded by the fact that in many states, Medicaid reimbursement rates are too low for home care providers to be able to recruit and retain workers, who can be paid a higher wage in other settings, like hospitals, and industries, like fast food and retail.

And it doesn’t end with a lack of workers for home care providers. This lack of caregivers can lead to an access to care issue in which individuals who can be cared for at home are left with no option but to receive care in a hospital or institution. Finding qualified caregivers is often cited as home care providers’ top challenge, and future estimates show that demand for in-home care will continue to grow due to the aging of baby boomers at alarming speeds.

What can you do to help? Share your voice. Reimbursement rate review and adjustment decisions are generally made in state capitols when legislators determine that such a need exists. This need must be communicated to legislators so that they understand the pressing nature of the issue and what could happen to the state’s Medicaid population if the issue is not addressed.

We can help you reach your legislators to let them know what increased reimbursement rates mean for you and your community. And if you would like to make an even bigger impact, consider meeting your lawmakers in-person at our Lobby Day. We take care of the scheduling and preparations- all you need to do is show up and share your voice. Upcoming Lobby Days are as follows:

Minneapolis, Minnesota: 3/6/18
Dover, Delaware: 3/14/18
Columbus, South Carolina: 4/4/18
Harrisburg, Pennsylvania: 5/22/18
Raleigh, North Carolina: 5/30/18
New Jersey: District office visits 4/20-5/4/18
Maryland: TBD

Contact Rick Hynick to find out what you can do to advocate, whether it be sharing your personal story, contacting your legislators, or participating in an upcoming state Lobby Day!

Advocacy Key to Getting Hospitalized Children Home

Increased wages for pediatric home nurses can bring more hospitalized children back home to their parents.

ThinkAdvisor recently published an article about numerous cases across the country in which hospitalized children are cleared to return home but cannot due to the severe shortage of home care nurses.  This means that these children must live in the hospital or other institution until they can get the nursing care they need at home. This lack of available skilled nurses has created a huge financial and emotional strain on these children’s parents and families.

So where are these nurses? Making higher wages in other settings and industries. Even though home nursing is almost always less expensive than hospital care, private insurance rarely covers the service and Medicaid pays very little for it. This leaves few nurses willing to work for these low wages, especially when they can receive higher pay in other settings or other industries entirely.

But it doesn’t have to be this way! Increasing the reimbursement rate for in-home nurses is possible, and increased wages increase parents’ access to in-home nursing care for their child. In Pennsylvania, for example, BAYADA home health care employees, clients, and clients’ family members advocated for a pediatric nursing rate increase and received a $5 per hour increase. BAYADA saw open hours for the program decrease by nearly 50% for one of our largest payors.

A parent coalition in Massachusetts successfully advocated for increased reimbursement rates after over a decade of stagnant rates. But in Massachusetts, the increase still is not enough—parents say that the wages remain too low to attract and retain enough home nurses for their state’s medically complex pediatric population.

In Pennsylvania, Massachusetts and in other states around the nation fighting an in-home nursing shortage, advocacy is the key. It’s important that we raise our voices about this issue so that legislators can understand what home care means to parents of medically complex children.

If you are interested in finding out what you can do to help bring these children home, let’s chat! Shoot an email to advocacy@bayada.com.

Educating New SC Legislator Rep. Nancy Mace about Home Care

New South Carolina representative Nancy Mace was sworn into office this past month. When new legislators are sworn in, it is important that we educate them about the importance of home health care and how it has enabled thousands of South Carolinians to stay at home with their loved ones. This is especially true for Rep. Mace-   Since she will be serving on the House Medical Committee, which oversees regulatory issues for the home care industry, it will be important for us to educate her on the challenges our relatively new offices are facing.

Rep. Nancy Mace recently won the special election for House District 99 in Charleston and Berkeley counties and is the first woman to ever win this seat. As a former business owner of a small public relations technology start-up, she understands the grit and determination needed to get a business off the ground. We are hopeful that her business experience and committee membership will spur her to become a legislative champion for our issues.

Legislative meetings are most effective with real life stories from constituents. If you are interested in joining me to meet Rep. Mace and tell her about what home care means to you and your clients, let me know!

Equalizing Access Legislation Approved in PA House Health Committee

Submitted by Laura Ness, Director, PA Government Affairs (GAO)

On November 21, the House Health Committee met and unanimously voted to approve HB 1829. HB 1829 allows individuals to be presumed eligible for home health care. This practice is currently allowed for nursing homes but is not extended to home care. Because of this, Pennsylvanians often go without the help they need or are unnecessarily placed in a nursing home. The legislation approved included two amendments, which changes the name “presumptive eligibility” to “deemed eligibility”. It also extends this process to allow adult day centers to do presumptive eligibility as well. We are very pleased with this outcome. Next the bill will go to the House Appropriations Committee. The Government Affairs Office (GAO) is working to set up meetings with Appropriations Committee members to ask them to support this legislation.

New NJ Governor Elected!

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

On November 7, voters elected nominee Phil Murphy to serve as the state’s 56th Governor starting this January through 2022.  Governor-elect Murphy chose Assemblywoman Sheila Oliver to serve as Lieutenant Governor.  Assemblywoman Oliver served as Speaker of the Assembly for four years.  All 120 of the legislative seats were also up for election.  The democrats increased their majorities in both houses where they will control the Senate 25-15, and the Assembly 52-28.  BAYADA is looking forward to the new administration to support home health care and help us deal with the many challenges of managed Medicaid, access to care, and increasing wages for our field staff through higher reimbursement under Medicaid and waiver programs.

 

DHS Secretary Testifies at Recent ACA Repeal Hearing

Submitted by Laura Ness, Director, Government Affairs (GAO)

Pennsylvania Department of Human Services Acting Secretary Teresa Miller was called to testify recently at the US Senate Committee on Finance during the Graham-Cassidy bill proposal.  This proposed legislation would have a traumatic impact to the home care industry.  Not only would it have limited health care coverage for millions of Americans it would have also block granted Medicaid which would limit Pennsylvanians access to home care services.

Because of our advocacy efforts and the advocacy efforts of others, the bill was removed from consideration.

There have been many action alerts this past quarter each one more important than the last. Thank you for taking the time to be a heart for home care and taking action!

Photo credit: PA Department of Human Services
DHS Acting Secretary Miller testifies in front of Senate Finance Committee Photo credit: PA Department of Human Services 

 

 

U.S. Senate Aging Committee Staff Spends Day with BAYADA

Submitted by Laura Ness, Director, Government Affairs (GAO)

Recently, Samantha Koehler, policy aide to the U.S. Senate Special Committee on Aging for ranking member U.S. Senator Bob Casey, and Vicki Hoak, Executive Director of the Pennsylvania Homecare Association, spent the day in Philadelphia with BAYADA Home Health Care.  During her time with us, Samantha spent time learning about the inner workings of our service office and went on two home visits, one to an assistive care state programs client and another to a hospice client.

During Samantha’s visit, we discussed the most recent issues to impact home care in Pennsylvania including the institutional bias that still exists, the challenges with the recent proposal to block grant or institute per-capita caps to Medicaid, and the harmful proposed home health groupings rule.

Samantha loved getting to spend some time with Ms. Lenora E. and her aide Kimyatta J. Ms. E has been a BAYADA client for over a year and gets nine hours of care a day.  She is served by the Philadelphia Corporation of Aging (PCA) office. She also met Florence G., a 101-year-old heart patient who can remain at home with her daughter because of the care we deliver. She loves her Clinical Manager Faith Brown almost as much as she loves her children, grandchildren, great-grandchildren, and great-great grandchildren. Grace is served out of the Pennsylvania Media Hospice (PMH) office.

A big thank you to the PCA and PMH staff for hosting Samantha!

Executive Director of PHA Vicki Hoak, BAYADA Aide Kimyatta J., BAYADA Client Lenora E. and Policy Aide Samantha Koehler sit and discuss home care.

Progress on Transforming Medicaid

Submitted by Lee Dobson, Area Director, Government Affairs (GAO)

Ten months into her new job Secretary of Health & Human Services, Dr. Mandy Cohen has been working to move her Medicaid Transformation plan forward. She hired an implementation guru from Missouri, Jay Ludlam as the Assistant Secretary for Medicaid Transformation to lead the process. Medicaid’s hope is to address the physical and behavioral health of North Carolinians. The goal is to improve overall health by creating an innovative and well-coordinated Managed Care environment that addressed the whole-person. The program design calls for three state-wide commercial plans and up to twelve provider-led entities (PLE) as regional plans.  The department’s aggressive timeline will release request for proposals (RFP) in early 2018, with a targeted transition in 2019, pending CMS approval.  BAYADA has been invited to participate in stakeholder discussions as Medicaid develops their Pre-paid Health Plan (PHP) model. Our goal, related to home care, is to ensure level of services and provider adequacy remains central in the program design and waiver application. GAO has involved technical experts from across our various practices to ensure our feedback is sound and supports BAYADA’s overall mission.