South Carolina Families Suffer as Reimbursement Rates Stay Stagnant for Over a Decade

Home care clients like Rashad (right) can stay at home with skilled nursing care, but a lack of state funding is making it more difficult for many South Carolinians
Home care clients like Rashad (right) can stay at home with skilled nursing care, but a lack of state funding is making it more difficult for many South Carolinians

The facts are clear: Home care is less expensive than hospital or other institutional care. Plus, it enables medically complex children and adults to remain at home amongst their loved ones. But because the State of South Carolina has not increased reimbursement rates for skilled nursing home care services since 2008, families are finding it increasingly harder to access the skilled, high quality care that they need to stay as independent as possible in their communities.

State funding for home care has not been increased in more than a decade. At the same time, hospitals and other facilities have been steadily able to increase wages. Even more so, nurses can make more in home care in surrounding states. Now, home care providers find that they can compete for less than a quarter of all the nurses available in South Carolina. When agencies face such recruitment and retention struggles, home care recipients and their families suffer.

When there are less home care nurses available, families find that they experience missed shifts, which can not only create undue stress and chaos as loved ones must miss work, lose out on sleep, and forego other necessary activities—but it also puts the client in danger. For those who need skilled nursing care, missed shifts can mean dangerous consequences, including trips to the ER and unnecessary hospitalizations.

Even more so, many major home care providers have already left South Carolina because of the low funding for home care. Stagnant rates that are more than a decade old make keeping their doors open unsustainable. As more and more agencies leave the state, the harder it is for families to access care. Simply put, if the State does not take action to increase funding for home care, South Carolina’s most medically complex and vulnerable families will have few options for care.

South Carolina’s concerned families are making their voices heard: They are reaching out to their legislators and media to share their message: Increase funding for home health care so that families can access the high quality, reliable care that they need to be where they want to be: At home.

To find out how you can get involved in advocacy, contact us at advocacy@bayada.com today.

Delaware Hearts for Home Care Advocate Shares Heartfelt and Impactful Story with Legislators!

Recently, a Delaware pediatric licensed practical nurse (LPN), Charlene Chappell, signed up for Hearts for Home Care and wanted to get involved. And did she come out in full force!

After sharing powerful and heartfelt testimony in Dover, DE’s Legislative Hall about the impact she makes on families and the challenges low Medicaid rates bring to nurses who want to provide one-on-one care to families at home, Charlene listened to a radio show where host Joel Olsteen spoke about “an itch you just can’t scratch.”

That got Charlene thinking about more advocacy. Charlene said, “I feel that the majority of men and women that serve as elected officials have no clue what’s required of a family when they have a child that has special needs and is differently abled! They don’t understand that nurses need to be attracted to home care so that families can rely on this care to keep their medically-complex children at home.”

That inspired her to write the below story and send it to all Delaware legislators. Read Charlene’s powerful story below!

My Itch!

I have an itch! Mo matter how hard I try to let someone know, I can’t.  I’m 8 years old and I can’t tell Mommy where I itch! I can’t reach my itch! Its 2:30 in the morning and Mommy has fallen asleep in the chair next to my bed because she had to work today and then take my sister to her dance lesson. When she finally arrived home she threw some dirty laundry in the washer, and cooked dinner. After dinner she put the wash in the dryer, and then she loaded the dishwasher. She came in my room to check on me and feed me. Off she went to make sure my sister had done her homework and was in the shower. Oh no, an alarm is going off! Here comes Mommy. I wish I could tell her how much I love her for all she does and about my itch. She looks so tired. It’s almost 8:00 pm. The phone is ringing. Hurry Mommy before they hang up!

I can hear Mommy on the phone. “What! Oh no, please tell me it’s not true. I’m so tired tonight. I don’t know if I can stay up all night with him but I must. I have to make sure he’s ok on his ventilator and his medications are given at the right time, so he doesn’t have a seizure, and that the tube feeding is running properly. He has to be repositioned every two hours so his skin doesn’t break down. I have to check his diaper too. Well… thanks for the phone call.”

Oh no. Mommy just found out my favorite night nurse called out tonight, and the rest of forever. The agency is going to try and find a replacement as soon as possible, but that may take some time. Nurses aren’t as anxious to get into home health care nursing because they can make more money at a hospital. Mommy is going to miss work because she will have to stay up with me as Daddy’s gone from home with his job right now. Mommy may lose her job. I’m so sad my nurse left. She really knew me and she knew when I had an itch. She would gently scratch me all over till she found it, like Mommy does. She understands my cues and my facial expressions as I can’t talk, or walk, or move because of my illness. 

I heard Mommy talking to the lady at the agency about the nursing shortage in home health care. She told Mommy that the money provided for reimbursement by Medicaid, not Medicare, has not increased in 13 years! The last time there was an increase in Medicaid was in 2006! I wasn’t even born then! She also told Mommy that the companies are running out of their own funds to supply the raises the nurses deserve. God bless the nurses that do work in home health care, for a lesser wage then they deserve, and take care of not only me but my mommy and Daddy too. Without them my Mommy and Daddy would not get the proper rest, would have to quit work to care for me. It would not be a good thing for my family. We would all suffer. I don’t want to go anywhere but here in my room. What if we can’t find a new night nurse? Where will I go? I overheard the doctors and nurses at the hospital talking last time I was admitted for a bad seizure and they said that all children do better in the home setting for getting well once they can leave the hospital. They are less likely to get sick again from a disease they acquired while in the hospital, and all of us are more comfortable in our own bed!

I hope my story has helped you to understand why we need to increase the Medicaid budget. Not Medicare, but Medicaid. Mommy told me that some people get confused so that’s why I will say it one more time. Please increase the Medicaid funding for home health care nurses.

Thank you for reading this. Mommy thanks you as well as all the other children and their parents that require specialized home health care nursing.  And yes, Mommy found my itch!

Thank you, Charlene, for sharing your creative and passionate story with Delaware’s legislators. We must all share our voice to make an impact, and your advocacy highlights your deep commitment to your clients’ care.

Hearts for Home Care is seeking to advocate for higher reimbursement rates for skilled nursing services in Delaware so that nurses can be better attracted to home care, and so families that need this care to stay together at home can more easily and reliably access it. For information on how you can get involved, contact us today

Two Workgroups Formed to Explore Changes in the State Medicaid Reimbursement Model

Recent conversations with MCC Waiver Administrator Michelle White have revealed that the time is right to explore making significant changes in the nursing reimbursement model.  GAO has formed two workgroups to analyze and evaluate options to address Medicaid policy and its reimbursement model for nursing.

First, we’ve formed a BAYADA technical expert group representing the relevant practices and leadership to help inform BAYADA’s recommendations.  The second group is a larger provider workgroup within the SC Association for Home Care & Hospice. As a SCAHHC Board member, I have been asked to co-chair this workgroup to draft industry recommendations.  BAYADA will draw from its internal workgroup to inform the conversation with the industry and Medicaid.  This is a great opportunity to address the challenges and recommend a unified solution to DHHS that can be a win-win for providers, the state, and ultimately- clients.

Thank you to the SC Advisory Council and the workgroups! I look forward to working with you to develop recommendations that will lead to better outcomes for our staff, clients and their families!

Advocacy Efforts in Massachusetts Gaining Publicity

Submitted by Rick Hynick, Director, Client and Family Advocacy (GAO)

As advocacy efforts continue to progress toward a State Medicaid rate increase for nursing services, to help individuals with complex medical needs, excitement around the movement throughout Boston and much of the state is starting to build.  On July 30, the Boston Globe featured a lead article about one of the families most effected by the matter.  The article showed how this family has not had nursing coverage in more than 100 consecutive days because of the low Medicaid reimbursement rates.  Two days later, WGBH-TV of Boston ran an on-air piece featuring the Mom from the Globe article and another Mom who is a leading advocate showing the urgency that the 900 plus Massachusetts families needing home care nursing services are facing on a daily basis.

MassHealth Announces Second Rate Increase In The Face Of Budget Deficit

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

Last week, Chief Government Affairs Officer Dave Totaro, Boston Pediatrics Director Emery Hughes, and other industry leaders and families gathered together to meet with MassHealth.  MassHealth had asked for the meeting, in regards to the Continuous Skilled Nursing (CSN) program.  During the meeting, MassHealth stated that they recognized that low reimbursement rates were a major problem within the program.  They have planned to increase the rates by 2.25% effective July 1, 2017.  This is the second reimbursement increase we have been notified about within three months.  The organizations working to increase this rate were pleased with this movement but recognized that this is a fraction of what is needed to stabilize the rates.  We look forward to continuing our efforts to increase the CSN rates by a total of $15 per hour.

Supporting Home Care at the Rhode Island State House

Submitted by Rick Hynick, Director of Client and Family Advocacy

On Tuesday, April 11, a crowd of people gathered at the state room in the Rhode Island State House to thank those in our state government who support the many children, adults, and their families who rely on home care. The gathering was part of an event planned on behalf of BAYADA and the Rhode Island Partnership for Home Care.

“We’re here today to thank those legislators who have listened to your conversations and heard your challenges, and have become steadfast supporters to make your lives and the lives of your children better,” said BAYADA Chief Government Affairs Officer Dave Totaro. Dave and other representatives from GAO partnered with Rhode Island Skilled (RIS) pediatrics Director Ashley Sadlier and her staff to make the event a success.

State Representative Gregg Amore was presented with a 2017 Legislative Advocacy Award for his tireless work to back the needs of his constituents and the many other residents of the state who use home care services on a daily basis. Senator Hannah Gallo was also recognized but could not be present. Additionally, Lieutenant Governor Daniel Mckee spoke about the important role home care plays in the lives of many Rhode Island residents.

Mr. Mckee and Rep. Amore continued to discuss the positive impact of home care, to the great interest of our clients and their families who were present in the audience. These families—the very people who rely on having nurses to provide clinical care to their loved ones—can offer firsthand testimony as to why home care is so vital.

Eric Olson—the father of client Liam and a long-time home care advocate—explained that the nurses who work with his son have such a connection with him. They understand that many of Liam’s movements are actually the way he communicates what kind of care he needs from moment to moment. He went on to explain that, without the close connection that the nurses have with his son, Liam would not be where he is today. With their help, he has thrived, despite his dependence on many mechanical devices. Eric went on to underscore how important it is that the families work with the elected officials, as they have the ability to make positive change.

“Our goal today was to bring enough of these voices together so we can start to make a difference.  Not just for families in this room, but for all families who want to keep their loved ones at home,” Dave said.  Side by side, BAYADA and the Rhode Island Partnership for Home Care provide significant support to the goals of legislators and families who depend on home care. We are working together for a better tomorrow for all home care services in Rhode Island.

Working on a Solution for the Retro Rate Increase

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

GAO, working collaboratively with the Association for Home & Hospice Care (AHHC) and Matt Wolfe, AHHC’s legal counsel, continues to work with Medicaid Director Dave Richard and key lawmakers, including Senators Ralph Hise and Tommy Tucker, and Representatives Nelson Dollar and Josh Dobson to resolve a technical issue with the retroactive rate increase for CAP-C nursing. As you may recall the General Assembly appropriated funds last session to increase the nursing rate by 10% effective July 1, 2016. The Department is supportive and is seeking a solution with the Centers for Medicare & Medicaid Services (CMS). GAO will keep you informed as things develop.

Expanding Our Reach Through A NC Home Visit

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

When freshman NC Representative Andy Dulin expressed an interest in home health care, Charlotte Personal Care (CPC) Hearts for Home Care Ambassador and Client Service Manager Shayla Jemmott, and Clinical Manager Deborah Batts jumped into action. They hosted a home visit with CJ, a 24-year old young man with cerebral palsy, and his family. CJ’s mom explained how the three hours per day of certified nursing assistant services allows her to work and gives them a sense of peace knowing CJ is happy and healthy. Rep. Dulin asked great questions and was surprised to learn that the aide rate, at $13.88, is only $0.44 cents higher than back in 2001. He indicated he is willing to help us garner support for the increase.

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Representative Dulin with CJ

A Day in the Life of a Massachusetts Mom/Advocate

Submitted by Rick Hynick, Director, Client and Family Advocacy

On February 27, several BAYADA employees, home health care family members and others working toward getting a patient bill of rights passed, gathered at the state house in Boston to meet with legislators.  Lisa B. was en-route with her son, an adult home care client in his early 30s, and his son’s nurse.  Their goal for the day was to speak with different elected officials about the need for a rate increase for continuous skilled nursing services and to advocate for a patient bill of rights that is making its way through the legislative system toward becoming a law.  Just four miles from the state house, Lisa and the nurse saw that her son’s medical condition had changed and they quickly pulled their van over near the outskirts of a public park to help him.  He was struggling to breath due to a mucous plug.  In addition to this, he had lost control of his bowels.  As they pulled off the road, it happened to be near where an undercover police officer was working.  Startled by their presence, the officer approached them.  It took a bit, but Lisa and the nurse were able to clear the plug and get him back to a normal status.  They also changed his clothing and got everything back to normal.  The police officer was so motivated to help the family that he provided them with a police escort to the state house.  As a result of their dedication to the greater cause of helping people with special medical needs, they were still able to meet with senators and representatives and discuss the importance of home care nursing and the patient bill of rights from the perspective of the family.

Home Visit Shows Need For Home Care To NJ Legislator

Submitted by Tara Montague, Manager, NJ Client and Family Advocacy (GAO)

Through the efforts of Hearts for Homecare Ambassador and Director Rose Sample, State Senator Nilsa Cruz-Perez made a visit to the home of Cherry Hill Pediatric client, Lindsay H. The Senator had the opportunity to meet Lindsay and her mother, Debbie, as well as some of the Pediatric Cherry Hill office staff and Susan Stout, one of the nurses who helps to take care of Lindsay.

According to Rose, both the client’s mom Debbie and nurse Susan were just blown away by the Senator’s compassion and concern.  The Senator and Lindsay’s mom connected on a number of levels.  Senator Cruz-Perez thanked everyone repeatedly and said it made her week to be there.  In follow-up from the meeting with Lindsay’s mom, Debbie shared that, “She seemed like a wonderful and sincere person, and I feel so fortunate to have had the chance to get to know her and share stories.”

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Senator Nilsa Cruz-Perez, our client’s mother Debbie H., Rose Sample, Clinical Manager Kara Leahy (pink jacket), Nurse Susan Stout, and our client Lindsay H.