Over the past several years, home care offices across South Carolina have struggled to stay sustainable due to low state Medicaid reimbursement rates for in-home nursing services. As more and more providers shut their doors, GAO and our advocates continued to fight towards a solution so that South Carolina’s most vulnerable residents could continue to access the skilled care they needed to stay at home.
After aggressive advocacy and a public affairs push throughout 2019, our concerted efforts are beginning to pay off! After more than a decade without a nursing increase, the state recommended a 15% increase, effective July 1, 2020. After further advocacy efforts focused on the urgent need for an immediate increase, including articles profiling affected families in the media, the SC Department of Health & Human Services (DHHS) issued the initial 5% increase be effective January 1, 2020. This 5% increase will generate nearly $230,000 in additional annual revenue.
BREAKING: DHHS is committed to including the remaining 10% to be effective July 1, 2020. If the provision is passed into law as planned, then PDN services will see a total 15% increase from 2019 levels (5% increase effective January 1, 2020, and an additional 10% targeted for July 1, 2020), resulting in nearly $690,000 in additional annual revenue.
Further increases are needed to ensure access to care for all vulnerable South Carolinians. These major steps forward would not have been possible without sharing our collective voices to showcase the importance of care in the home care and the need to regularly maintained viable reimbursement rates.
Thank you to all of our South Carolina offices, leadership, clients, and families that shared their stories and advocated for this important increase!
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.
On March 6, 24 energetic BAYADA employees and one BAYADA Assistive Care State Programs (ACSP) client gathered in South Carolina’s state capitol for a day of meaningful and heartfelt advocacy. The South Carolina Home Care and Hospice Association (SCHCHA) hosted its second annual Legislative Advocacy Day, and this year, a record-breaking total of nearly 60 advocates attended!
BAYADA’s advocates joined other attendees and walked the halls with a clear message: Investing in our Nursing Medicaid Waiver programs will save the state money and keep our medically fragile children, disabled adults, and seniors home with their loved ones and out of higher cost facilities. We care about home care, and so should you!
With their passionate message in hand, advocates spoke with over 50 legislators about the importance of home care. This year we were able to speak to all key lawmakers in both the House and Senate to ensure our message was heard by as many ears–and the right ears–as possible.
“Advocacy can’t be effective with only one person working towards a goal–one voice can only go so far! That’s why I am so proud to work in South Carolina, where so many of our office employees, field employees, and clients recognize the importance of sharing their voices too. The more impassioned people we have involved, the more of a difference we can make on behalf of all South Carolinians that rely on home care,” said GAO director Melissa Allman.
BAYADA employees were excited and inspired by the impact they made that day. Thank you to the many participants for the difference you make on behalf of all South Carolinians that rely on home care to stay independent in their communities!
By: Melissa Allman, GAO Director for South Carolina and Georgia
What a difference a year makes. This time last year I was just transitioning out of my role as Division Director for the Palmetto Division and into my new role directing our advocacy activities in South Carolina and Georgia. I didn’t know I was in for so much! As I reflect back on 2018, my thoughts go immediately to two things: First, the successes that we were able to generate for our staff and clients and secondly, the many BAYADA leadership, staff, and clients that shared their voices and helped us win!
This year not only were we able to achieve an 8.2% rate increase for all personal care Medicaid waiver services in South Carolina, but we made so much headway engaging our office staff, field staff, and clients. As one person running around in the state house, I can only do so much. It is your stories and your voices that truly have made our first full-time year in South Carolina a remarkably successful year.
Aside from our rate increase, South Carolina advocates hosted five home visits with state lawmakers, hosted two legislative roundtables, and Speaker Pro Tempore Tommy Pope attended a Hero Ceremony for his constituent—a home health aide from RHS. In addition, we attended several events to support our champions. Then-CLP Director, Haley Keisler was named South Carolina Home Care and Hospice Association’s (SCHCHA) 2018 Professional of the Year, and ROC client Mitchell H.’s mom and caregiver, Tammy Roberts, was recognized as the SCHCHA 2018 Caregiver of the Year.
Additionally, we were able to engage a record 25 Hearts for Home Care ambassadors and advocates to attend Lobby Day, where we connected BAYADA staff to lawmakers to share why our families deserve to be able to stay together through home care.
As I reflect back on the past year, my heart is full of gratitude for all of Georgia’s leadership, Ambassadors, and advocates. Your support and advocacy made all the difference! Not only were we able to generate a rate increase for private duty nursing (PDN) services under the Georgia Pediatric Program (GAPP) waiver, but we’ve made our voices heard and our industry and company better known in the state capitol. We are truly set up for a stellar 2019!
So far in 2019 we have already began meeting with Georgia’s House and Senate leadership and the Georgia Department of Community Health (GCH). We are seeking to further increase the RN and LPN rates under the GAPP program and gain enhancements for PDN waivers for the adult population under the New Options Waiver (NOW), Comprehensive Supports Waiver (COMP) and Independent Care Waiver (ICWP) programs. We will be seeking even further involvement from our GA advocates, and I am excited to see what we can accomplish together!
It was a true honor to work along side of you all, and I’m looking forward to working with you as we continue to raise awareness for our state’s most vulnerable children and adults. Thank you to the many advocates that made 2018 a success, and that will help pave the way for more successes in South Carolina in 2019 and beyond!
What is it important to continue hosting home visits in South Carolina from an Ambassador and Lawmaker Perspective?
USP CSM Kelsey Harris stated, “It’s important that service offices get involved in advocacy on behalf of our field staff and clients because supporting them in any way we can is at the center of what we do! I appreciate GAO’s continued efforts to raise awareness and rally troops around supporting homecare in South Carolina. We at USP can’t wait to meet many more legislators and government officials in our territory!”
Ali Genthner, Regional Director for WOW added, “The COA office continues to rave about how successful and impactful our home visit was from an office perspective, but also from a client, caregiver and lawmaker perspective. They are already planning who they want to go see next. Thank you to GAO for supporting our offices through the process.”
Representative Chip Huggins asked, “Are you planning to do home visits throughout the state of South Carolina? I would highly recommend doing so. Lawmakers need to hear and see the day in the life of a homebound patient. This has been very impactful, and I thoroughly enjoyed meeting Alexis and her family.”
Representative Richie Yow added, “Spending time with the family puts a different perspective on any situation. Its past time that we in South Carolina hold insurance companies accountable and do what we can do to ensure that families wanting to take care of their loved ones at home have the necessary equipment and support that they need to do so.”
GAO and four South Carolina service offices have been busy hosting lawmakers in home visits throughout the state. These visits show our state’s decision-makers the importance of home care, the impact it has on their constituents and all South Carolinians, and remind them to remember our stories and our clients when they vote on issues that affect the home care industry!
Upstate Pediatric Office (USP) Leads the Way for South Carolina Home Visits by Hosting Rep. Garry Smith in Pediatric Home Visit
The Upstate Pediatric Office (USP) led the way with South Carolina’s first home visit with Representative Garry Smith in Greenville. USP and Rep. Smith visited 20-month-old pediatric client Emma who had recently been discharged from her Medicaid waiver services. Luckily, after multiple hospitalizations that occurred during her discharge, she received reauthorization and was able to get her services back, which have since kept her healthy and out of the hospital. This home visit enabled Rep. Smith to see just how powerful and important these services are in keeping families together safely at home. Since his visit, South Carolina’s general assembly voted to increase the Children’s Personal Care reimbursement rate for Home Health Aide Waiver.
USP Client Services Manager Kelsey Harris, stated “It was so cool to have a legislator take time out of his schedule to see our processes in the office and how they lay the framework for the field employees and the care they provide. His investment of time in learning about our client and the difficulties the family faces is vital to the continued growth and success of homecare in South Carolina!”
Columbia Adult Nursing Office (COA) Hosts Impactful Visit with Representative Chip Huggins
The Columbia Adult Nursing Office (COA) recently hosted South Carolina’s second home visit with Representative Chip Huggins. GAO joined COA staff and the representative in a visit to client Alexis A., a 20-year-old anoxic brain injury client, and her parents in their Chapin home.
Alexis’s mother shared with Rep. Huggins the challenges she has had with the process of getting in-home care for her daughter. She stated, “This has been the most difficult process. I get many different answers and constantly get pushed around from one person to the next. I feel it would be in the state’s best interest to streamline the process for families like ours who don’t have the time to make multiple calls a day. I take care of Alexis 90 hours a week–at times I don’t even sleep because of her skilled needs. I don’t just advocate for higher rates for Alexis, but for our nursing teams, and for parents that experience a similar situation now or in the future.”
Impacted by his visit, Rep. Huggins stated, “I will do whatever I can to assist you and Alexis. That is what I’m here for.” Since the visit GAO has set up a meeting for August 14, 2018 to discuss the opportunities to improve the state’s home care waivers.
Upstate Adult Nursing Office (USC) Visits Vent Waiver Client with Senator Tom Corbin
The Upstate Adult Nursing Office (USC) hosted the third legislative home visit in Spartanburg. This visit was especially unique as Senator Tom Corbin and BAYADA adult nursing client Jeffrey B. bonded over several mutual connections. Senator Corbin attends church with a family Jeffrey had previously worked with. Additionally, they both also have a love for the Clemson Tigers and enjoy stories about the history of their community. Senator Corbin spoke with Jeffrey’s wife, Vonda Kay, about her challenges receiving home care services for Jeffrey. Vonda Kay explained how she cares for her husband 129 hours a week because he receives a limited 39 hours of private duty nursing.
She also shared with Senator Corbin the difficultly of obtaining reliable care—of the list of 15 providers that Jeffrey’s case manager gave her, BAYADA was the only agency that called her back. Senator Corbin, who has a son with autism, understands the struggles our families go through due to the low reimbursement. He stated, “Wow, when do you get rest? I understand home care is a cost savings to the state, and I’m willing to do whatever I can to support you and Jeffrey. I’m shocked at how much you have had to go through. I know we can work together to make some changes.”
GAO is planning to meet with Senator Corbin at the end of August to discuss further opportunities to assist our Vent Waiver clients.
Rock Hill Skilled Nursing Office (ROC) Host Home Visit with Representative Richard Yow
Our Rock Hill Skilled Nursing team (ROC) recently hosted Representative Richard Yow in a home visit with client Mitchell H. Mitchell is a 29-year-old who was in an automobile accident at the age of 23. At the time of the accident he had a 4- year old son. His son, Allen–now age 10–is a vibrant and active young boy who is very hands-on with his dad’s care. Having home care for Mitchell is not only important for his health, but also enables him to see his son grow up. Mitchell’s mom, who is his primary caregiver and biggest advocate, states, “Allen is Mitchell’s only motivation to keep moving forward. He wants to see his son grow, attend sports events, and just be there for him. Without Allen and being able to see him daily, he wouldn’t be with us today.”
Rep. Yow also shared stories of his own personal challenges he has with working with resources in the state. His father was in an automobile accident as well a few years ago, and the family continues to fight for his healthcare needs. Rep. Yow stated, “I know how challenging and stressful it can be. I also know I will do whatever I can to help you and Mitchell.”
Home visits like these really give elected officials a better understanding of how their decisions on key issues like Medicaid impact South Carolinians who are seeking to remain safely at home with their families. To find out ways in which you can participate in a home visit with a local legislator, or other ways you can advocate, email firstname.lastname@example.org.
BAYADA’s Government Affairs Office (GAO) is excited to announce its expansion into Georgia! BAYADA’s current footprint in Georgia includes two pediatric offices and one adult office, which employ 253 field staff and 28 office employees, and care for 131 clients combined. Expansion into the Peach State means that GAO can begin directly lobbying state lawmakers for better home care policies and reimbursement rates, and can begin to directly involve Georgia staff, clients, and families in advocacy efforts.
BAYADA had its first advisory council meeting with Georgia leadership on July 24th to discuss the issues that Georgia’s service office regularly face and how GAO can best support their needs. The advisory council is chaired by Chief Government Affairs Officer Dave Totaro and comprises of BAYADA leadership in the state, GAO Director for South Carolina and Georgia, Melissa Allman, and Area Director Lee Dobson. The advisory council meets regularly to determine legislative priorities, discuss progress towards our goals, and determine next steps.
Dahlia Division Director Tammie Craddock stated, “We are so excited to have the support of GAO so we can finally be the advocates that the adult nursing population in Georgia deserves! We know that the choices are limited for clients who age out of the Georgia Pediatric Program, but the need still exists. We are hopeful with the help of GAO we can generate a greater impact on lawmakers and assist families by providing more options for in home care after the age of 21.”
Be sure to check out GAO’s biweekly Heartbeat to see new updates on our progress in Georgia!
Thank you to all our Advisory Council Members for your input and participation! We are excited to work towards better rates and policies on behalf of all Georgia’s staff and clients!
South Carolina State Representative Garry Smith (R, District 27) visited a local family in his district to learn how his constituents and many South Carolinian families rely on home care to keep their loved ones together at home and out of more expensive settings. Rep. Smith is one of the many legislators that Hearts for Home Care advocates bring into home care clients’ homes to show them how federal, state, and local policies affect home care recipients and their families.
During his visit, Rep. Smith met 21-month old BAYADA Home Health Care client Emma Ferguson, Emma’s mother Gina, and Emma’s in-home BAYADA Nurse Danielle Rian. Emma was born with a Chronic Lung Disease of Prematurity, which causes Emma to experience severe breathing problems, pain, and other symptoms. At her young age, Emma has already had several surgeries and currently still requires use of a Gastrostomy-Jejunostomy (G-J) Tube to assist with her feedings and medication management throughout the day. At birth, state Medicaid authorized Emma to receive private duty nursing (PDN) services in her home so that Emma can remain safely and comfortably at home with her mother.
In March, Emma’s PDN services were terminated when Medicaid determined that her skill level no longer qualified her to receive care in her home. From March until May, Emma attended a local day care facility for children with complex needs so that her mother could continue to work. During this time, Emma was hospitalized on several occasions and required ventilator support due to respiratory illness. In May 2018, Emma’s mother Gina reapplied for PDN services, and Emma was able to start receiving care at home again. Emma currently receives 32 hours of PDN services in her home, and since the reauthorization, she has not been readmitted to the hospital.
Emma’s mother Gina stated, “I’m grateful Rep. Smith was able to visit our home to see how Emma and other medically-complex children can grow up and thrive with in-home nursing. These kids deserve some normalcy in their lives, and I have seen first-hand how much better she does when she can be with me at home rather than in an institution. She only receives 32 hours a week, and this allows her to receive the care she needs in the best place–her home–and allows me to be able to work to support my family.”
After the home visit, Rep. Smith said, “visiting sweet Emma and her family has opened my eyes to what home care means to my constituents and to the many South Carolinians who depend on Medicaid home care to stay with their families and out of higher-cost settings. I look forward to exploring ways we can help keep families together while at the same time effectively managing the state’s budget.”
“One-on-one nursing services have allowed Emma to remain safely at home under the Medically Fragile Children’s Medicaid Nursing Waiver. This program is an alternative to nursing home placement at a lower cost to the state,” said Melissa Allman, Hearts for Home Care advocate and Director of Government Affairs for BAYADA. “In-home nursing care helps minimize deterioration and can prevent costly hospitalizations as staff can address subtle changes in the medical condition before it becomes serious. I hope that more legislators continue to learn about how cost-effective these services are to the state, and how valuable they are in keeping South Carolinian families together.”
Home visits like this one really give elected officials a better understanding of how their decisions on key issues like Medicaid impact real people who are seeking to remain safely at home with their families. To find out ways in which you can participate in a home visit with a local legislator, or other ways you can advocate, email email@example.com.
On April 4, the South Carolina Home Care and Hospice Association hosted its second annual Legislative and Advocacy Day. This year, a record-breaking total of nearly 50 advocates gathered in South Carolina’s state capitol for a day of meaningful and heartfelt advocacy. Advocates, which included two home care clients, walked the halls with a clear message: Investing in the state’s Medicaid Waiver programs will save the state money and keep medically fragile children, disabled adults, and seniors home with their loved ones and out of higher cost facilities.
With their passionate message in hand, advocates spoke with over 50 legislators about the importance of home care. The highlight of the day was the recognition the home care advocates received on the house floor by Speaker Pro Tempore Representative Tommy Pope!
Advocates were inspired by the impact they made that day. Below, please find several quotes and pictures submitted by our advocates.
“It was an honor to participate in this year’s Advocacy and Legislative Day, to be a part of such an impactful team, and especially to bring my two boys with special needs to the event. It was a wonderful to be able show the representatives firsthand why we need higher Medicaid reimbursement rates in South Carolina.”
“Speaking with legislators about the need for higher Medicaid reimbursement rates in South Carolina was an amazing experience. We had a great turnout and I was especially pleased with all the love our fellow advocates gave us; their support was energizing– what a great group of people!” -Amy Ramey
“It was overwhelming to see so many people come together for a common goal. We advocated for something so important and I am so proud to have been a part of that!” -Jennifer Collier
“This was my first Legislative Day and it certainly will not be my last. It was truly remarkable for all of us to come together from different BAYADA backgrounds to make this day a success. I look forward to advocating for my company and my state in the future!”
“It was encouraging to see the growth of our advocacy group over one year and it is clear that Hearts for Home Care has the opportunity to be the biggest voice for home care in South Carolina.”
“It was truly a pleasure to connect with our South Carolina legislators to explain how our services can keep their constituents at home, explain the cost savings of home care versus hospitals and facilities, and connect legislators with our purpose and mission.”
“We believe Home Care is important to our communities, and I support the good work you do. Please let me know how I can help you.”
-SC House Ways and Means Health and Human Services Subcommittee Chairman Rep. G. Murrell Smith
“The South Carolina Legislative Day was a great opportunity to meet with legislators and talk to them about the importance of investing in home care… I can’t wait to see the impact that we have on laws affecting home care!” -Foster Krebs
“Over the course of the day I felt a strong sense of comradery, pride, and support when—no matter where I looked—I saw a colleague dressed in their finest red! It was great to be a part of something bigger than myself by advocating for those who need it most.”
“Legislative Day made it possible to get involved and support home care even though I had no prior experience. I enjoyed meeting everyone and learned so much. Thank you so much to my fellow advocates for all of your knowledge and support!”
THANK YOU to all of our advocates that participated in 2018’s Legislative and Advocacy Day!
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!