Recognition and Fair Compensation for Frontline Home Care Workers—During COVID and Beyond

By: Dave Totaro, Chairman of the Partnership for Medicaid Home-based Care

Below, please find an opinion piece authored by Dave Totaro—Chairman of the Partnership for Medicaid Home-based Care (PMHC) and BAYADA Home Health Care’s Chief Government Affairs Officer. This was originally published in the Scranton Times-Tribune on May 10, 2020.

Our nation’s frontline healthcare workers have been recognized during the COVID-19 pandemic, arguably more than ever before—and rightfully so. These essential workers put their health and safety on the line in order to make sure that the most vulnerable populations are taken care of. But these workers—particularly the caregivers that keep these individuals at home and out of riskier settings like nursing homes—deserve more than cheers, front lawn signs, and complimentary cups of coffee. It is time that our federal and state governments fairly compensate these brave and compassionate workers for the sacrifices that they are making during this critical time through Hazard Pay—that is, temporary increases in hourly wages for workers who are risking the most yet earning the least.

Congress has passed three stimulus bills so far, and have done so quickly and commendably with an eye toward helping the economy and the unemployed. But these packages have not yet focused on compensation for those who are working—the essential employees that risk their safety to care for the many that can’t help themselves. And while many healthcare professionals within hospitals and institutions have been impacted, the federal government has not yet prioritized the caregivers that keep people healthy at home.

Congress is currently working on the fourth (and likely final) stimulus bill. This presents a vital opportunity to increase Hazard Pay for healthcare workers who put their safety on the line every day. While the first three stimulus packages have increased emergency funding for states, only a handful of states have used those funds to increase pay for frontline healthcare workers. Currently, there are three potential proposals that would serve to increase pay for these workers across the US—either of which would reward home care workers and incentivize many to begin or continue their career in a field that is much-needed during this time.

Home care workers—particularly home health aides—are largely females of color who are making slightly above minimum wage. Yet they are some of the most essential workers—caring for those who are unable to care for themselves. And not only is their job physically and emotionally tolling, but the prioritization of hospital care has made it increasingly harder for home care agencies to access personal protective equipment, such as masks, gloves, hand sanitizer, and gowns, for these workers. And, to top it all off, we are regarding them as heroes without considering fair compensation for their commitment and sacrifice.

Now more than ever, the potential dangers that go hand-in-hand with nursing home living are becoming a frightening reality and we as a nation need to consider the future of healthcare as our population continues to age. Nearly 20% of COVID-related deaths have occurred in nursing homes. Not only is in-home care the best way to ensure that the most at-risk populations—seniors and the medically fragile—stay as isolated as possible rather than be grouped in together, it also ensures that they are in the most cost-effective setting for their families and for the state and federal governments themselves.

COVID-19 has hit many Americans hard, and few are exempt from at least some negative consequences as a result. But it is clear that there are some who are risking more than others, and who are sacrificing their personal safety in order to keep others healthy and independent at home… both in times of crisis and times of normalcy. So while the recognition and support of frontline workers is certainly appreciated, it does little to truly show home care workers how valuable they are. Through the development of the fourth stimulus package, the federal government has the opportunity to meaningfully show at-home caregivers what they mean to America—both now and in the future. Home health care has been making headlines in recent media coverage.

In order to join those who are advocating for better home health care funding and policies on behalf of beneficiaries, their families, and frontline workers, contact us at advocacy@bayada.com

NJ PCA Beneficiary Keith Braswell: New Jersey Paraplegic’s Life Put on Hold When Home Health Aide is not Available

Many New Jersey seniors and adults with disabilities are able to stay safe and independent at home due to assistance from Home Health Aides (HHAs) under the state’s Personal Care Assistant (PCA) program

NJ Blog Takeover: Paraplegic Keith Braswell writes about his life with a severe disability – and how working with his aide through NJ’s Personal Care Assistant (PCA) program has helped him to live life on his own terms.

My name is Keith Braswell and a car accident in 2008 forced my entire way of life to change. I was left paraplegic and since then, I have been able to remain a vital, active member of my community thanks to the help of my home health aide, Quisela. As a 46-year-old adult, it can be tough for me to rely on someone else for everything from getting out of bed, bathing, eating laundry etc., but Quisela does everything she can to make sure that I feel safe and comfortable.

While Quisela is very reliable, filling all of my state-approved 40 hours of care without a day off, her choice to stay working as a home health aide is becoming more unrealistic by the day. This is because New Jersey’s Medicaid reimbursement rates under the Personal Care Assistant (PCA) program—the one that I and thousands of others like me rely on—don’t allow for aides to make a fairwage for the compassionate work they do. For example, in Newton, aides make minimum wage to slightly above minimum wage, and can often secure jobs with less required training, stress, and physical requirements at places like Walmart, Home Depot or Dollar General—all of which are located within the municipality or along route 206. This is especially true since NJ raised minimum wage in the beginning of year, while the Medicaid reimbursement rate remained stagnant.

I am beyond appreciative of how important Quisela’s vigilant and caring work is to my life, and I frequently go out of my way to make sure she is paid as much as possible, like booking my recent surgery around her vacation time to make sure that she wouldn’t lose any hourly pay. If I were to ever lose my aide, I would likely be forced into an institution which means losing what remains of my independence along with the quality of one-on-one care that I receive at home.

I humbly ask that the state legislature consider an increase in Medicaid reimbursement rates, so that individuals like myself can continue to choose to live independently at home. Many choices were taken away from me because of my injury, and losing this choice as well would be heartbreaking for myself and for thousands like myself across the state of New Jersey.

-Keith Braswell, Newton

About the NJ Blog Takeover: For the next few weeks, Hearts for Home Care will be featuring posts authored by NJ families affected by the state’s shortage of in-home nurses and home health aides to showcase the need for increased funding for New Jersey’s Private Duty Nursing (PDN) and Personal Care Assistant (PCA) programs. For more information on how you can get involved and let your elected officials know why increased in-home nursing availability is important to you, email advocacy@bayada.com.

Michelle Lino-Corona: New Jersey Paraplegic’s Life Put on Hold When In-Home Nursing is not Available

NJ Blog Takeover: Michelle, who is the sister of TBI Victim Brandy Lino-Corona, writes about her sister’s life after becoming severely disabled – and how working with nurses through NJ’s Private Duty Nursing (PDN) program has helped her family define their new normal.

Brandy’s family and caregivers surround her bed in her Absecon, NJ home

For the victims of traumatic brain injuries, access to reliable home health care can be the deciding factor that keeps people either permanently institutionalized, or at home with their loving families. My 17-year-old sister, Brandy, suffered a Traumatic Brain Injury (TBI) from a severe car accident in September of 2018. Since then, the state of New Jersey has authorized 16 hours of specialized nursing care per day for Brandy. This care allows her to stay safe at home, and allows my father, mother, and I to lead proactive, fulfilling lives outside the home. However, Brandy rarely receives all of her authorized hours due to New Jersey’s inequitable Medicaid reimbursement rates for their state-funded Private Duty Nursing (PDN) program.

The severity of Brandy’s injuries left her incapable of moving, eating and even breathing on her own. Nurses that work with her need to be up-to-date on life-saving techniques such as tracheostomy care, respiratory treatments, suctioning, monitoring vital signs, feeding tube care and feedings and administering meditations. Additionally, Brandy must be readjusted every two hours in order to combat her risk of skin breakdown and bedsores. This regularly poses as an obstacle when nurses miss their scheduled shifts as this task requires two people due to her size.

Like so many medically-complicated residents of New Jersey, my sister is at risk of institutionalization and/or hospitalization without the proper nursing care she requires. With potential caregivers persuaded by competitive wages and less physically and mentally taxing employment, eligible patients’ access to qualified healthcare professionals diminishes. New Jersey’s legislators need to consider the plight of their most vulnerable constituents and make the decision to increase Medicaid reimbursement rates. An increase in New Jersey’s Medicaid reimbursement rates would provide a second lease on life for Brandy and those like her, as well as instill a sense of hope for their families whose only desire is to be able to continue to care for their loved one in their own home.

-Michelle Lino, Absecon

About the NJ Blog Takeover: For the next few weeks, Hearts for Home Care will be featuring posts authored by NJ families affected by the state’s shortage of in-home nurses and home health aides to showcase the need for increased funding for New Jersey’s Private Duty Nursing (PDN) and Personal Care Assistant (PCA) programs. For more information on how you can get involved and let your elected officials know why increased in-home nursing availability is important to you, email advocacy@bayada.com

Home Health Care in the News

The New York Times recently published an article that highlights caregivers’ and home health care clients’ challenges

The looming home health care crisis has recently been making headlines. From Home Health Care News to the New York Times, industry leaders, home health aides, clients, and family caregivers have been sharing the same message: As Medicaid rates continue to stagnate, home health aides and nurses can’t make a fair wage. As a result, the industry is facing a worker shortage and clients’ access to care is being significantly threatened across the country. Below, please find links to recent media coverage on the issue, all of which present compelling data that point to an impending home health care crisis for the most vulnerable and medically fragile populations.

Home Health Care News, September 5: “Home Health Care Training Programs Popping Up As Caregiver Crisis Worsens”

New York Times, September 2: “On the Job, 24 Hours a Day, 27 Days a Month”

Thrive Global, August 30: “The Future of Healthcare: “First and foremost, reprioritize long-term care into the home setting” with David Totaro of BAYADA Home Health Care”

Vox, August 21:https://www.vox.com/the-highlight/2019/8/21/20694768/home-health-aides-elder-careHome health aides care for the elderly. Who will care for them?”

Everyday Health, July 27: “Demand on the Rise for Home Healthcare”

Home Health Care News, June 20: “Bayada Hits 1M Clients Served. Here’s Why Hitting 2M Will be More Difficult”

Home Health Aides’ Low Wages: Turning Public Awareness into Action

Home health aides keep hundreds of thousands of disabled adults and seniors at home and out of costlier settings. Low Medicaid reimbursement rates keep them from making a better wage, and it's up to state governments to address this issue.
Home health aides keep hundreds of thousands of disabled adults and seniors at home and out of costlier settings.

As home care clients, employees, caregivers, and family members, we know one thing for a fact: Home health aides do incredible, compassionate work that enable hundreds of thousands of residents across the country to stay at home and out of costlier, more infectious settings like nursing homes and hospitals. And we certainly know another fact: The work that aides do is invaluable, and it’s time that they begin to receive a fair wage for the hard work they do.

Low aide wages have recently made national headlines and the message is clear: We will need more and more home health aides as America’s population continues to age. But home health care providers are having trouble recruiting and retaining the quality, reliable workforce needed to keep up with the growing demand.

Recently, Hearts for Home Care advocate and BAYADA Home Health Care’s chief government affairs officer, Dave Totaro, submitted his opinion on the matter to STAT News, a media company focused on finding and telling compelling stories about health, medicine, and scientific discovery. He posed the question:

“To say that home health aides’ work is demanding is an understatement. They make it possible for 14 million Americans to stay in their homes and out of expensive and impersonal institutional settings like hospitals and nursing homes. Performing this necessary and in-demand work takes a physical and emotional toll, yet these individuals do it with compassion day in and day out.

So why do we treat home health aides as low-wage, low-value workers?”

The problem lies primarily in states’ low Medicaid funding for home care programs. Though states typically pay an hourly rate for providers who deliver home health aide services, these rates have largely been low for many years, or raised periodically, but at a rate too low to keep up with real costs of living and providing services. Because these rates must cover wages, training, benefits, new hire costs such as background checks and TB shots, and supplies, it is nearly impossible for home health care companies to take such a low rate and provide aides with a wage high enough to compete with industries like fast food and retail.

News coverage of the issue has been effective in bringing greater public awareness to the issue, especially as nearly all individuals will be touched by home care at least once in their lives, whether it be for themselves, a parent, friend, or other loved one. Now is the time to take awareness and turn it into action. Call your state legislator and let them know what home care means to you. Contact advocacy@bayada.com for information on what you can do to share your voice and support home health aides.

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.

ADVOCATE OPINION: The Impact of Home Health Care in my Life

UPDATE, January 11, 2019: After advocate Dimpal Patel sent her opinion piece to her local paper–the Gaston Gazette–they sent out a reporter who profiled Dimpal and the impact her home care services have had on her in greater detail! Great work advocating Dimpal!

BAYADA Home Health Care client and Hearts for Home Care advocate Dimpal Patel shares her view on home health care in an opinion submitted to her local newspaper.

Home care advocate Dimpal and her BAYADA nurse, Chastity.

I might sound like your typical local 23-year-old: I recently graduated from UNC Charlotte with a bachelor’s degree in marketing. I absolutely loved living independently on campus, and I love to play games and watch movies. But I am very different from most 23-year-olds you know because I rely on a trach and ventilator in order to survive, and it’s because of my home care nurses that I am able to grow and thrive independently.

My two BAYADA Home Health Care nurses—Chastity and Toni—have been with me for nine and six years each. They are like family to me, and they really are lifesavers. Without them, my parents would not be able to work and keep me at home, and I certainly would not have been able to experience college life. Chastity and Toni not only provide me with the skilled services that I need to survive, but they really are like best friends to me. I can’t imagine what my life would be without them—not only would it be without my two friends, but I’d likely be stuck in the hospital, a nursing home, or rely on my mom or dad to quit their job to take care of me.

My worst fear is that lawmakers cut Medicaid funding like they tried to do in Washington last year. If this happened, not only would I likely lose my nurses, but I’d be at risk of having to move into a nursing home. As someone who has experienced living independently and how it has allowed me to earn a degree and contribute to society, I ask that our state and federal legislators be mindful of what funding and service cuts can mean—not only to the state’s financially needy or to the elderly—but to 23-year-olds like me who want to continue living a full life.

-Dimpal Patel, Belmont, NC

Maryland’s Home Care Association Welcomes New Executive Director

During session, Maryland-National Capital Homecare Association selected a new Executive Director.  Dawn Seek, LPN, a longtime board member with a career in many aspects of home health care and durable medical equipment, was hired as the association’s sole full-time employee.  She met with Dave Totaro and Shannon Gahs from the BAYADA Government Affairs Office (GAO) team last week to discuss her vision for the association and plans to work together in the coming year.  Her plans include adding Maryland’s voice to the national conversation of the future of home health care, partnering with other organizations that serve our clients and employees in Maryland, building more substantive committees and planning meetings that have more immediately-actionable information for members.

Together We Get Results

Speaker Tim Moore, Vickie Deyton, Amber Mitchell, and Rep. Kelly Hastings at a legislative event

Legislative successes, like the NC Medicaid rate increase for nursing in 2015 and 2016 and the home health aide increase this past year, don’t magically happen.  Legislative successes start with an identified need — low Medicaid rates made it impossible to pay people what they are worth — and end with legislators supporting jobs in the community and keeping families together by investing in home health care.  Every step along the way our Hearts for Home Care Advocates carried our unified message to decision-makers. Our cumulative actions over the years, including home and district visits, legislative round tables with lawmakers, responding to calls to action, attending lobby days, etc., made all the difference.  Individually and collectively our shared voices got results.  Join us to be a Heart for Home Care Advocate.