Home care has a distinct place in the future of US healthcare

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.

90% of America’s seniors say that they prefer to age in place…

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.

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.

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!

2019 National Ambassador of the Year: Shelby Myers

Advocacy became part of the culture at BAYADA Home Health Care a little over 10 years ago out of a need for a collective voice to speak on behalf of our clients, families, and field staff who are impacted every day by home care. As Chief Government Affairs Officer Dave Totaro, likes to say, “If you want to go fast, go alone. If you want to go far, go together.” And that’s what we did. We banded together a voluntary group of advocates within the company with the single purpose of acting as a voice for those in the home care community that may not have had the opportunity otherwise ─ they are our Hearts for Home Care Ambassadors. 

Our ambassadors serve as the liaison between the Hearts for Home Care advocacy team and their co-workers and home care community. Their primary responsibility is to develop and foster relationships with their direct-constituent legislators to spread awareness and advocate for better wages for field staff, more approved hours for clients, and the overall governmental investment in the home care industry. Year after year, our ambassadors go above and beyond to ensure legislators are aware of the crucial importance of home care for so many families across the country. 

A few weeks ago, Hearts for Home Care presented the 2019 National Ambassador of the Year award to Shelby Myers for her role as a dedicated, passionate, and influential ambassador. As an ambassador in New Jersey, Shelby’s advocacy efforts were abundant ─ She developed her own platform to share client and employee stories through a podcast, Clayton’s Voice, she arranged home visits in which she invited legislators into the home of a client to showcase the everyday process of care, she arranged legislative roundtables with office staff and key decision makers, and she also met with many legislators individually advocating on her own.  For these reasons and many more, Shelby was the clear choice as the 2019 honoree.

Shelby Myers:

“This award is truly a culmination of efforts by so many individuals. Although I humbly accept it, by no means am I the primary recipient – that honor should be given to the families I was privileged to represent. Their powerful and sometimes heartbreaking stories, were the driving force behind legislation in New Jersey. I have no doubt that their voices were echoed in the ears of our lawmakers as they were voting on important home care legislation. Our role as ambassadors is essential to the well-being of our clients, families, and the compassionate field staff that takes care of them. Hearts for Home Care offers something that many of them have lost – hope. H4HC shifts the impossibility of their situation to a probability of hopeful change. Not only can we evoke change legislatively, but we empower families by showing how even the smallest of voices can create the largest of changes ─ I truly held this privilege in the highest regard. As Emerson so eloquently expressed in his description of success, “To know even one life has breathed easier because you have lived. This is to have succeeded!” I feel enormously blessed and grateful for every family I met, every story I heard, and every hand I held this past year. Additionally, I want to thank all of the BAYADA employees who gave me the opportunity to meet their clients and families, to the Hearts for Home Care team for the advocacy experiences you foster to elicit change, and to all of my mentors – thank you for changing my life.”

Advocacy Essential to Clearing Up New Jersey Home Care Funding Uncertainty

New Jersey Troy Singleton meets with home care advocates from BAYADA - Personal Care Assistant (PCA) program funding and minimum wage
Hearts for Home Care advocates share the importance of home care with NJ Senator Troy Singleton

The COVID-19 pandemic has brought about changes in almost every facet of society. Impacted most severely has been our aging and elderly populations. The home care community has certainly felt the shock wave from this pandemic across all aspects of client care and operations, but in the hardest hit states such as New Jersey, the fate of home care looms.

As New Jerseyans continue to adapt to and understand the effects of this virus, one of the key takeaways has been the value and safety that New Jersey’s Personal Care Assistant (PCA) program provides. The PCA program allows New Jersey residents to stay independent, safe, and healthy in their homes. Simultaneously, this level of care diverts these often infection-prone clients from more congested group settings and nursing home placements, while saving the state tens of thousands of dollars a year per individual.

Currently, the PCA program faces funding uncertainty on the horizon as New Jersey is set to increase the state minimum wage to $12/hr. on January 1. However, the state has yet to permanently commit to adequate increases in PCA funding. State funding covers not only personal care assistant wages, but also training, benefits, and supplies. Compounding this issue, COVID-19 has driven up the costs across all fields of business including expensive PPE and adequate compensation for our frontline workers that provide this vital service.  

What is the solution? Well, as Dr. Seuss once said in The Lorax, “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.” Advocacy is the solution. It is evidently clear how essential home care is to so many medically fragile individuals − it is the saving grace that allows these residents to stay safe, healthy, and happy in the place they feel most comfortable. However, many decision-makers are not always aware of how crucial a program like PCA is to their constituents.

This is where advocacy plays such a significant role in raising awareness around the value of home care. Personal stories from clients, families, and employees highlight the compassion and care that the PCA program provides, while best contextualizing the benefits of the program to legislators. If you, or someone you know has been benefited from home care, please reach out to your legislator and urge them to support adequate funding to the PCA program. It is imperative that the state addresses this funding shortfall so that agencies can continue to attract and retain the high-quality home health aides that keep elderly and medically fragile New Jerseyans well-cared for in the comfort of their own homes.

Home Health Aides Deserve Better Wages! If Done Right, Mandatory Minimum Wage Increases Will Help

Home health aides provide a lifeline to millions of Americans, but low wages make it difficult to recruit and retain enough to keep up with the demand. If done thoughtfully, mandatory minimum wage increases can help support these valuable workers

It’s undisputable: Home health aides provide a lifeline to millions of Americans that need assistance living where they want to be—at home. But low wages often disincentivize home care workers from staying in the field. The problem lies in Medicaid reimbursement rates: Home health aides rely largely on state-determined Medicaid reimbursement rates for their wages, and those rates have stagnated well below the cost of living—and many states have not addressed this in years.

Luckily, many states have proposed increasing the mandatory minimum wage. And while many businesses often oppose such measures—many home care industry leaders have come out in support of it because they recognize the importance of aides in helping keep people at home and earning a fair wage for doing so. But we must ensure that minimum wage increases are done with the recognition that many home care programs rely on state funding to pay their workers. And if that funding isn’t increased in tandem with mandatory minimum wage increases, the state could unintentionally be putting vulnerable residents at risk.

Simply put, if Medicaid reimbursement rates for home care services are not increased at all, or at a rate too low to cover new minimum wage standards, then many home care providers will need to consider whether they can afford to keep their doors open. If providers do decide that they cannot remain sustainable and do decide to forgo providing Medicaid-based home care services, then the real loser is the millions of Americans that rely on that provider to live independently at home. Down the line, this could result in more people who can live at home with help from a home health aide into being forced into nursing homes.  

“People want to live at home. And it’s the most cost-effective option for states. Home health aides are the backbone of our industry and we absolutely support wage increases for our workforce, but states need to be thoughtful in their approach to protect the many seniors and individuals with disabilities that rely on home and community-based services. We are working with state legislatures to make sure that they understand the relationship between rates and wages, and the potential risk to vulnerable residents who need home care,” says BAYADA Chief Government Affairs Officer Dave Totaro.

So far this year, 18 states have started the year with higher minimum wages than the year before. If you live in a state where the minimum wage is set to increase, then you have a unique opportunity to advocate and tell your legislators about the importance of home care and of paying home health aides a living wage. Contact advocacy@bayada.com to find out ways you can play a role in ensuring that home care is accessible to the many that want to stay at home, and that home care workers continue to be attracted to a field that helps them do just that.