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.

NJ: GAO Hits the Road to Meet with Service Offices Across the State

GAO Director Louise Lindenmeier (center) meets with the PAS office to learn about their struggles recruiting and retaining quality aides

Every year, the Government Affairs Office (GAO) travels the state to connect with our service offices about our legislative priorities and the importance of advocacy. Not only do these visits give us the opportunity to share the work we do to improve the state of home health care in New Jersey, but they also give us the unique chance to hear about the challenges you all often face in attempting to deliver the compassionate, excellent, and reliable care that our clients deserve.

Throughout our visits so far, we have been able to celebrate our collective successes and accomplishments. In 2018, our GAO Ambassadors and service office employees attended a number of district office visits and legislative receptions, and participated in phone banks, letter writing campaigns, and action alerts all in support of accomplishing legislative priorities that support our nurses, aides, clients, and families. Without your partnership and collaboration, we would be unable to deliver on our promise to act as the voice for BAYADA and its clients and employees.

GAO gets groovy with the PER office!

In addition to celebrating last year’s successes, we have worked together to identify ongoing challenges and to form our 2019 legislative priorities and strategies. As we’ve formed these priorities, it is clear that our grassroots efforts and your continued commitment to advocacy will be integral to achieving our goals.

Thank you to the many offices who have made the time to meet with us. In 2019, we will continue our outreach effort to accomplish our goal of meeting with 100% of our New Jersey service offices. If you’d like to learn more about our road show, our 2019 legislative priorities, or getting more involved in advocacy at BAYADA, contact advocacy@bayada.com.

NC Legislative Update: Looking Back, Planning Forward

Last month the GAO Advisory Committee met to evaluate our 2017 efforts and to plan for 2018. The Advisory Committee is made up of representation of every practice in NC as well as representation from CMO and GAO. Below is a summary of their findings and the priorities for 2018.

2017 Legislative Accomplishments
With your help we accomplished the following:

• Secured an increase for Medicaid aide services under the Personal Care Services (PCS) Program and the Community Alternatives Program for Children (CAP-C) from $13.88 to $15.52, effective August 1, 2017, and to $15.60 effective January 1, 2018. BAYADA impact: $300K annually. These increases will allow us to hire and retain more quality staff.
• Protected Certificate of Need (CON) and prevented its elimination from health care. Also prevented the Continuing Care Retirement Communities (CCRCs) from operating a home health agency without a CON. The CCRCs were seeking a carve-out from CON statute. Four separate bills were filed to eliminate this statute. BAYADA impact: Protected 5 service offices that serve Medicare clients. This issue is likely to re-surface in 2018.
• Secured a 7.5% tax exclusion for health care services on all revenue.
BAYADA impact: All 54 NC service offices will save a collective $12.6M annually.

2018 Key Legislative Priorities:

• Amend the Community Alternatives Program for Disabled Adults (CAP-DA) budget neutrality language to allow the aide rate to be increased from $13.88 to $15.60 to align with the PCS and CAP-C rate increases effective Oct. 1, 2018, by Q4-2018.
• Secure a $1.40 increase for all Medicaid aide services from $15.60 to $17.00 effective Jan. 1, 2019, by Q3-2018.
• Prevent the elimination of Certificate of Need (CON) for home health or hospice by Q3-2018.
• Ensure that the Medicaid Transformation waiver includes a rate floor provision and language that ensures access to quality care and minimal administrative burden by Q4-2018.

Lotus Ladies Connect with the Republican Women of the PA House of Representatives

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

Government Affairs Office (GAO) Senior Associate Alisa Borovik, Senior Manager Emilie Bartolucci and I spent an evening at the Pennsylvania Homecare Association headquarters near Harrisburg with house republican Representatives.  During the event, we had the opportunity to thank our current sponsors of our presumptive eligibility legislation and discuss the need to increase the personal assistant services rate for our aides.  The event was well attended by over 10 republican legislators.

Government Affairs Office Completes Harrisburg, PA Office Blitz

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

This week, Chief Government Affairs Officer Dave Totaro and I met with more than 15 different legislators and staff in Harrisburg. The intent was to follow up from our lobby day to answer any additional questions and concerns they may have regarding the personal assistant services (PAS) increase and the pending presumptive eligibility language. Although it is a tough budget year, legislators understood our need to increase the PAS rate and pass presumptive eligibility. In the coming weeks, the Government Affairs Office (GAO) plans to follow up with all legislators as they begin budget negotiations.

Pennsylvania Office of Developmental Programs Restructures Rates

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

The Deputy Secretary of the Office of Developmental Programs (ODP) Nancy Thaler released a statement that she would establish one statewide rate for services and that all rates would go up.  This is a welcomed move as it also supports our legislative priority of establishing one statewide rate and increasing the personal assistant services rate to $20.58.  We plan to ensure our legislative champions know about this move in our upcoming meetings.

GAO Makes Progress on Rate Increase During Meeting with Senator Scott Wagner

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

On April 6th BAYADA Leaders, including Practice President David Baiada, Chief Government Affairs Officer Dave Totaro, Assistive Care State Programs (ACSP) Practice Leader Eric Thul, Crocus Division Director Kevin Kuzmick, PCA Director Donna Russell-Kane, and I  met with Senator and Gubernatorial Candidate Scott Wagner.  This meeting was a result of a previous meeting that Dave Totaro and I had with Senator Wagner introducing the need to increase the personal assistant services (PAS) rate under the Office of Long-Term Living (OLTL) by an average of 10%.

The meeting took place in the BAYADA PCA office. We discussed the ACSP business, its challenges and advantages, as well as the wage issues associated with the program.  Senator Wagner also heard first-hand about what it’s like to be a home health aide from PA Department of Aging’s Direct Care Worker of the Year, BAYADA aide Anne Pannone. 

The conversation was productive, and Senator Wagner understands the value of home care and the cost savings it can provide to the Commonwealth. He has agreed to help us in our legislative priority of increasing the PAS rates and would also like to spend a day in the field with Anne to see the work first-hand.

We look forward to continuing to work with Senator Wagner.

Ambassador Spotlight: Proctor’s Immediate Passion for Advocacy is Palpable

 Submitted by Mike Sokoloski, Grassroots Manager (GAO)

Less than a week after the PA Ambassador Training, Mechanicsburg Pediatrics (MBP) Client Services Manager Candice Proctor made it clear that she was going to be at the forefront of our grassroots advocacy charge throughout the Commonwealth.  Candice reached out to State Representatives Rothman and Mehaffie and had her first legislative visit scheduled with State Rep. Mehaffie two weeks to the day following our training.

During the visit, Candice spoke to Pennsylvania’s pressing issues for BAYADA: an increase in the PAS rate and Equalized Access for constituents of the Representative looking for Home Care as an alternative to long-term institutionalized care.  As a follow-up, Candice invited him to attend a home visit in his district.

Rep. Rothman was a guest speaker at our PA Ambassador training. Candice took her advocacy efforts to the next level with this particular opportunity, having the Representative join her on a home visit! During the home visit Representative Rothman met Sophia, one the MBP office’s longtime clients. The visit was a success!. Not only does Representative Rothman now have a greater understand of the wide breadth of home care, but it has also affected him personally. Rep. Rothman said, “Sophia’s personality profoundly impacted me…It was an important visit.”

Recently, Candice was able to attend a House Democratic Caucus Meet & Greet in Harrisburg.  She was able to advocate and network with the Democratic leadership team and get an idea of how they work collaboratively with all interested parties, stakeholders, and constituents to help move Pennsylvania forward.  Candice hasn’t slowed down.  She is currently working with clients and families to participate in upcoming Advocacy Days in Harrisburg.

None of this would have been possible without the help and support of her office director Kim Auchey and the entire MBP team.  Advocacy is a group effort that is clearly alive and well in the MBP office!  Thank you for your support and commitment to advocacy at BAYADA.

Legislative Roundtable and Ambassador Relationship Leads to Action in PA

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

Recently, Community Liaison and 2016 BAYADA Ambassador of the Year Mike Sokoloski hosted a roundtable with PA Representative Aaron Kaufer.  BAYADA started building a relationship with Representative Kaufer before he was elected to the General Assembly.  As a result of our relationship, Representative Kaufer took an interest in our issues early on and learned more about the state’s human services programs.

During the roundtable, we spoke about our need for increased reimbursement rates for personal assistant services under the Office of Long-Term Living and the need to equalize access to home and community based service by allowing presumptive eligibility*.  Equalizing access was an issue of great interest to Representative Kaufer, and since the roundtable, the Government Affairs Office (GAO) has been in touch with the Representative multiple times to determine next steps in the process.

GAO looks forward to working with Representative Kaufer and others to ensure presumptive eligibility is allowed for home health care in the state.

*Presumptive eligibility: Individuals can be presumed eligible for Medicaid services while their full application is being processed.  Presumptive eligibility grants greater access to care and allows the individual to receive medically necessary treatment.