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!

NC: Legislature Kicks Off 2019, Former Home Care Champion Nelson Dollar Joins Speaker’s Staff


Former Representative and home care Champion Nelson Dollar joins Speaker of the House Tim Moore’s staff as Senior Policy Advisor

Lawmakers returned to Raleigh on January 9 for the 2019-2021 long legislative session.  We expect to see some changes in committee assignments and leadership, especially in the House Appropriations for Health & Human Service (HHS), with the election defeat of Chairman Nelson Dollar.

Dollar–the former chairman of the House Appropriation Committee—has transitioned from the public sector to a senior policy advisor to the Speaker of the House Tim Moore. Dollar has been a home care champion for years and was named BAYADA’s Legislator of the Year in 2016 and 2018 for his efforts. He was instrumental in securing much needed Medicaid reimbursement rates increases for nursing and aide services. He has also been instrumental in protecting from elimination the Certificate of Need (CON) process for our Medicare offices.  His expertise and knowledge on complex issues at the statehouse will serve North Carolina well. As you may recall, Dollar lost his seat by 884 votes last November to Democrat Julie von Haefen.

While we are sad to see our former Champion lose this leadership position, there are other home care Champions that we anticipate seeing in key roles. We expect to see Representatives Donny Lambeth and Josh Dobson as co-chairs of HHS. Further, we anticipate Senators Ralph Hise and Joyce Krawiec in chair positions serving the Finance and/or Health Committees. All four legislators are well-versed in home care and the challenges our clients and staff regularly face throughout North Carolina due to our collective advocacy efforts. This puts BAYADA in a great position to move forward with our next round of asks.

Our major reimbursement priority this session is to increase the Medicaid private duty nursing (PDN) rate from $39.60 to $45.00 over the course of two years. This increase is necessary to help us recruit and retain the high quality, compassionate nurses we need to care for the many North Carolinians that need skilled care to stay at home.

Sharing your voice is key to achieving our goals: Be sure to look for opportunities to advocate as we seek to support our clients and staff. Of note, please save the date and be sure to look out for communications regarding our Legislative Day, which will be held in Raleigh on May 1.

New Hearts for Home Care Member Showcases Advocacy at Home!

Left: Gaston Gazette reporter chats with Dimpal and her BAYADA nurse Amy.
Center: Dimpal’s long-time nurse Chastity helped Dimpal live on campus and graduate from UNC Charlotte!
Right: Dimpal’s nurse Toni has been by her side for nearly a decade.

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 us recently.

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.

For more information on how you, your colleagues, or your clients can share your voice in advocacy, please email advocacy@bayada.com or sign up to join Hearts for Home Care today!

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

Combatting the In-Home Caregiver Crisis: What Can We Do?

North Carolina family meets with their state legislator to discuss the importance of home care in their lives.
North Carolina family meets with their state legislator to discuss the importance of home care in their lives.

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 PostBoston 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.

To learn more about Hearts for Home Care and to register, please visit our website, follow our Facebook and Twitter, or email us at advocacy@bayada.com today.

Rate Increase Secured from Partners Behavioral Health–Work Continues

Great news for our NC Habilitation offices that operate under Partners Behavioral Health, a Local Management Entity/Managed Care Organization (LME/MCO) that oversees Medicaid’s Innovation Waiver in western North Carolina. After more than of a year of advocating for rate parity for like services, Partners announced yesterday rate increases for community-based services. The Community Living & Support rate will see a 9% increase, bringing it to $20.28 effective August 1, 2018.

This much-needed increase will allow BAYADA to hire and retain more qualified professionals and take care of more individuals at home and in the community. While this is a great step forward, our work is not done yet. BAYADA, along with our Hearts for Home Care advocates, will continue to push towards more rate increases so that we can ensure that North Carolina has enough high-quality caregivers to meet the growing demand for home care services. Our field staff deserve better wages, and our clients and all of those who wish to remain at home in North Carolina deserve better access to quality services.

Thank you to all our advocates who supported this increase through your input and your contact with legislators. We truly are #StrongerTogether.

North Carolina’s Efforts Towards Medicaid Transformation Continue to Move Forward

The General Assembly passed two bills, H. 403  and H. 156,  which work together to clarify the implementation of the Standard and Behavioral Health/Intellectual-Developmental Disability (BH/I-DD) Tailored Plans and the licensure requirements for Prepaid Health Plan (PHP) managers under Medicaid Transformation.

In a historic move, legislators voted to move Medicaid recipients with mild-to-moderate behavioral health needs under the Standard Plan for Medicaid services. Individuals with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability, US DOJ settlement consumers, or individuals who have survived a traumatic brain injury are the defined population that will fall under the Tailored Plan.

The BH/I-DD Tailored Plan will begin one year after the Standard Plan with the LME/MCOs as the lead plan managers working with another PHP to offer the physical healthcare services for Tailored Plan Medicaid recipients for four years after that. The timelines incorporated in these bills push for North Carolina to complete the transition to the Standard and Tailored Plans as well as moving other specialty populations under managed care within five years of CMS approval.

GAO and our internal advisory workgroup continues to provide feedback through stakeholder involvement to ensure access to quality care as North Carolina moves toward Managed Care. If you have any questions about this process or the future of Medicaid in our state, please email me at ldobson@bayada.com.

12.37% Rate Increase for Community Alternatives Program for Disabled Adults (CAP-DA)

Great news for BAYADA clients and the many North Carolinian disabled adults that wish to remain at home with the help of in-home caregivers! The Medicaid CAP-DA program will see a rate increase from $13.88 to $15.60, effective January 1, 2019.  This increase brings parity between the three Medicaid aide programs, Personal Care Services (PCS), CAP-C for Children and CAP-DA for disabled adults.

This much needed increase will  enable BAYADA to hire and retain more quality caregivers to serve the many adults with disabilities in North Carolina. Thus, our service offices that serve CAP-DA eligible clients will be able to staff the necessary cases and keep families together and keeping clients whether they want to be – at home.

BAYADA’s Government Affairs Office (GAO), collaboratively with the Association for Home & Hospice Care, worked behinds the scenes with both Medicaid and key lawmakers to ensure this provision was adopted this session. Additionally, we made great strides towards this increase during our 2018 Legislative Day in which several client advocates came to share their stories with lawmakers and talk about the necessity of such increases. Thank you to those who came and shared their voices! We will continue to fight for higher rates to ensure that all North Carolinians will be able to access high-quality, reliable in-home care.

 

Unusual Adjournment Grants Republican Super-Majority One Last Session in November

This year has proven to be anything but normal at the General Assembly. Instead of adjournment with sine die, which indicates that no future business schedule this session, the Republican majority passed House Joint Resolution 1101, which calls back lawmakers on November 27.  This political power move gives the Republican super-majority one last session no matter what happens on election day.

Despite this unusual legislative session, BAYADA managed to accomplish the following legislative priorities:

  • Secured a 12.37% aide rate increase for CAP-DA, effective Jan 2019
  • Protected Certificate of Need from elimination for our Medicare offices
  • Secured a 9% rate increase from Partners Behavioral Health for our Habilitation offices, effective August 1, 2018

Thank You to our many ambassadors and advocates that helped us achieve these goals. We could not have done it without your passionate voices coming together to support all of North Carolina’s home care employees and clients.

Ambassadors Spring into Action! NC 2018 Ambassador Training Day

GAO and our North and South Carolina Ambassadors met in Charlotte, NC on March 14th for a day packed with thoughtful discussion about the scope, significance, and impact of our advocacy efforts. Whether they discussed legislative priorities, advocacy strategies and techniques, or the relationships that drive the work they do, our Ambassadors made it increasingly clear that they are passionate and prepared to be the voice for their clients, for their client’s families, and for themselves.

Among the day’s highlights was a visit from Representative Carla Cunningham, a former hospice nurse who represents North Carolina’s 106th district. Representative Cunningham has been a staunch advocate for health care, mental health, seniors, women, and children. Representative Cunningham offered our ambassadors a window into the legislative process and encouraged them to be dedicated, prepared, collaborative, and respectful. We were joined also by Wilburn, who has been a BAYADA client for 11 years. Wilburn spoke of the deep connections he shares with his caregivers and with the people he has met in his own advocacy efforts.

Our ambassadors are ready to move forward and be the competent, dedicated, and reliable voices that BAYADA needs to ensure that Wilburn and all our clients receive the care they deserve. It only takes one action, taken by only one person to make a difference. You can be that person today. Email advocacy@bayada.com to see how you can get involved!