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Whether it’s Medicare, Medicaid, Medicare Advantage (MA) or private pay, home care and home health leaders are both navigating tricky payer environments in their respective sectors.
MA penetration continues, as do cuts to traditional Medicare payments in home health care. In home care, billing rates have recently risen on the private-pay side, while Medicaid payment continues to be inconsistent.
Regulations, too, are constantly changing.
Michael Johnson, chief researcher of home care innovation at Bayada Home Health Care, has guided successful home health operations over the years despite payment challenges. Village Caregiving CEO Jeff Stevens, too, has expanded his business while dealing with payment volatility.
The two were on the latest episode of HHCN+ Talks for a wide-ranging conversation that covered payment, efficiency, regulation, technology and much more.
HHCN: Before we get going, we’d love a background on yourselves and your organizations. Jeff, let’s start with you.
Jeff Stevens: Hey, everybody. My name is Jeff Stevens. I am one of three co-founders, and currently serve as the CEO of Village Caregiving. We are a privately held home care agency. We don’t do home health care. We operate out of our headquarters in West Virginia. We’ve been around for a little over a decade, and we’re in 20 states right now. We’ve had a lot of success and growth over the years.
We’re a purpose-driven company. It’s really important to us. We’re all about culture, providing a great place where people love the work that they do, so that they can go out and provide the best services to the clients that we have.
HHCN: Mike?
Mike Johnson: Glad to be here. Thanks for the invitation. I’m with Bayada Home Health Care. I’ve been with the organization 16 years now, last 10 as the practice president for home health. Led the hospice practice for a couple of years, and I’m now stepping into a brand new role as the chief researcher to try to help continue to build the evidence base for the value of what we do here at Bayada.
Bayada is a family-owned organization started by Mark Baiada 49 years ago. It’ll be 50 years in January. We’re excited, we’re coming up on our 50th anniversary. We’re very mission-driven in this organization. The Bayada Way is our guiding light. One of the things it says is we want to be here in 100 years.
As Mark and the family were trying to figure out how to make that happen, one of the things they realized was in the U.S., organizations that last longest are not-for-profit. In 2019, they took the organization from a for-profit and turned it into the largest not-for-profit home-based care provider in the country, which allows us to take our time, be a little bit more thoughtful, and continue to build and invest in a culture like Jeff talked about, where people are excited to come to work. The stuff we do is hard. It’s not getting any easier. The environment you work in is important. I’m glad to be here.
HHCN: Let’s start with taking stock of the current landscape, the payment landscape that is, in both home health care and home care. Mike, let’s start with you. This is a very broad question, but what makes today’s home health care payment landscape difficult for providers?
Johnson: I have one word, uncertainty. I’ll give you five reasons why I think that’s the case. First, we’re sitting, again, with a proposed payment cut from CMS, which we’ll talk a little bit more about. ‘Continue to do good work, be innovative, and we’re going to pay less.’ We’re just finishing our first year in home health under the Home Health Value-Based Purchasing (HHVBP) Model.
All organizations should have gotten their performance from last year. It’s a potential 5% of all your Medicare revenue bump or 5% detraction. Trying to budget now with that in mind provides some challenges. For those that have been following it, already after the first year, they’re changing the way it gets measured, and they’re adding a discharge function score in 2025.
The reason I bring it up is it’s the first time that Medicare is going to calculate what they expect the discharge function to be. You now have a metric that you have to meet, and how you report their performance is going to be measured, not against your judgment, but CMS’ regression analysis.
Third, audit scrutiny. I can’t speak enough to it, particularly in the hospice industry, but in home health, that leaves a lot of uncertainty, and it seems like everybody’s painted with the same brush. The fourth is the one you probably think about first, staffing. How do we have enough staff? We continue to get more referrals. Our referral rate continues to skyrocket, but our conversion rate is going down because we can’t keep up with that. That’s a good problem to have, but we need staffing.
At Bayada, we actually are looking at minting our own, and so we just are kicking off our first Bayada Scholars cohort. It’s a nursing program with Thomas Edison State University in New Jersey and Cooper Health System. It’s an accelerated BSN program. As providers, we’ve got to start thinking about how we mint our own. In the meantime, how do we retain and recruit?
The final one is probably the obvious one, which is just the political environment and the election coming up because it’s going to be a new environment no matter who wins, and that’s always a level of uncertainty. Those things, you have to be comfortable being uncomfortable if you’re going to work in home health care, and that’s just as true today as ever.
HHCN: That’s very well put Mike. Jeff, on your end, before you go over the payment landscape in home care, would you mind breaking down what your payment mix looks like just so we understand how much of that is Medicaid, private pay, VA, et cetera? Then after that, explain what the dynamics are like in each, whether billing rates are rising, private pay, home care, what reimbursement environments look like state by state with Medicaid.
Stevens: We’re in 20 different states and the payer mix is a little bit different everywhere we are. Our goal is to be equally diversified and say yes to everything. That’s part of our purpose is that we want to provide home care to anyone, anywhere they’re at, regardless of who’s paying for it. We have a lot of Medicaid clients. We have a lot of veteran clients. We have a lot of family-funded clients, and then we have other programs or insurance policies.
I can speak to really all of them because we accept everything and we run the gamut of options. I think, yes, there are billing rates on the rise for the families that pay family-funded clients. Yes, they are. It’s important to us, and it’s always been, because we weren’t the model where we came into the industry and wanted to be the person that charges the most money. It was, let’s make this as affordable as we can.
It’s still really important to us. We’ve never gotten away from that as a culture and it’s a core value, but the prices continue to go up because I think the main reason is it’s harder to hire than ever. I bet everybody that’s watching this will relate. Not only is it harder to hire, but we need more of them than ever because the population is just booming. Where do you get them from?
Well, they come from the retail or food industry. First off, you just have to educate them that these jobs exist. It’s a relatively young industry and immature, I think. A lot of people don’t even know that it exists. You talk about things other than money because you should want to be in this because it has a tremendous purpose behind the work, and it has flexibility in your schedule that you can fit whatever your work-life balance requirements are.
At some point, money comes into play and you’re not going to lure them away to come take a chance in this home care industry unless you can pay them pretty well. If you want to have a viable, profitable operation, yes, the prices have just gone up as a result of that. I think it’s different everywhere we go, but as a whole, yes.
HHCN: Then on the Medicaid side, it must be tough as well because you want to be serving clients everywhere you can, and things vary so much state by state.
Stevens: Well, every rate’s different. We got to this point where Medicaid rates state by state were in a stagnation for a while. Right now, what’s happening, for those that may not know who are watching, is a lot of states have contracted with actuarial firms to come in and perform a rate study and say, ‘Hey, this is now lagging behind to a point where it’s become a problem. We need to raise the rate to X.’
If you were to ask me, why don’t you go to a certain state? There’s a lot of factors, but sometimes it is as simple as just the reimbursement. It’s not that I can’t make enough money there. It’s that I’m not sure it’s even a feasible, viable option to do it.
HHCN: Mike, on your end, I’m curious. What do you think the final rule is going to look like here at the end of October or in early November? Then what do you think about some of those clawbacks that are hanging over the industry’s head? How would you like those to be figured out?
Johnson: I think if history is any lesson, the proposed cuts, which right now are just slightly over 4%, will get cut in half. We’ve seen this pattern — decreased in some way, but not eliminated. The thing for folks to keep in mind is that the annual updates that we got were less than 4%. The relative cut is still 1.7%. There’s conversation about, well, CMS gave us an update. Well, when you give me two and ask me to give back four, it’s not a payment increase. That’s the real impact.
If it stays at 4% and you look at the last three years, it’s a 10.5% payment cut, just in three years. Through a pandemic with wage inflation and so forth. It’s not an existential crisis, but it is really concerning long-term, especially as you talk about the clawbacks. There is this expectation, based on how Medicare has interpreted some of the Medicare regulations and legislation, about this idea that they’ve got to claw all these dollars back.
I don’t think it’s overstating to say the industry will not survive, or most of the folks in the industry will not survive. We’re at this point, we’ve got to figure out how to do that. The Partnership for Quality Home Health Care does some really good work on this. Part of what they’ve laid out, if you read MedPAC, is that home health utilization is down. Not as many people are accessing home health care. Medical complexity for folks coming into home health has actually gone up, which is not terribly surprising, given this sort of, I would call the illness load, is my word, coming from pandemic because people put off care and so forth.
The visits per episode, in the MedPAC’s 2024 report, they definitely saw, and we see, fewer visits per episode, in part because we have to stretch our nurses further because we don’t have as many staff. Now, the number of visits to me is one important factor, but you can take fewer visits and spread them over a longer period of time and actually get equally good outcomes. That’s not necessarily a bad thing, but it is an indication that access to care is clearly going down. It’s going to be harder and harder for us to deliver the care at the levels at which we’d like if the cuts and the clawbacks continue to go.
The one thing I would mention, there’s big disagreement in the home health industry, in terms of how CMS has interpreted the rules for this piece. One potential bright spot is the Chevron Doctrine. If people aren’t familiar, the Supreme Court struck down what’s called the Chevron Doctrine. That was basically saying, ‘If federal legislation is ambiguous, or leaves an administrative gap, the courts must defer to regulatory agencies’ interpretation, if it’s reasonable.’
The decision stops with the regulatory agency, not with the courts. This struck that down, which means you could take it to the courts and get adjudication that way. We’re hopeful that will loosen up some of this disagreement. The final thing I’ll say is, with PDGM coming into effect, we had some real problems with how they were calculating that, and making determinations because of their methodology.
With skilled nursing, PDPM, people know, went into effect in the fall of 2019 and PDGM went in January 1st, 2020, right before the pandemic. They went back for the skilled nursing and looked at that and made some changes, but made the decision not to do any of that for home health.
How it’s being communicated and interpreted is really a big issue for us. It’ll be interesting to see what the Chevron decision will do in terms of our ability to adjudicate some of this in the courts.
HHCN: Over the last few years, how have things changed at Bayada because of the cuts?
Johnson: A couple of things. One is we’ve had to pay more and closer attention to payer mix. Our mission says we want to serve millions and millions worldwide. We’re actually in seven countries. They’re small operations, but we’re growing. What it doesn’t say is we want to take care of millions and millions of Medicare beneficiaries, which was the path of some of our competition for years.
We want to take care of everybody, but the reality is fee-for-service Medicare Advantage, the payments we get typically don’t cover our costs. Medicare is willing to pay more, which suggests to me they value the services more so, and so we’ve got to make sure we have the best mix.
Then the other piece is just continuing to get more efficient. How do you reduce the administrative burden and still get good outcomes? Some of that’s actually good housekeeping. As we grow and as we scale, how we grew 10 years ago won’t work with how we grow today.
I’d say, watching the payer mix, looking at ways to make sure that we’re delivering really good care and getting paid well for it, and then making sure we’re minding our P’s and Q’s in terms of are we being efficient? Are we being effective? Are we running lean and mean, so we can continue to reinvest the surplus dollars back into innovation and better care?
HHCN: Jeff, going back to you, we talked earlier this year about the “common sense” growth approach that Village Caregiving wanted to take. You’re already in 20 states. What does that common sense growth approach look like? How does payment play into it?
Stevens: The common sense growth approach that you and I talked about, to me, what that means is we want to grow, but it has to be done responsibly. You’ve got to learn a lot of lessons along the way. We were never VC-backed or PE-backed. For us, it was just a totally organic start at the bottom, grow the thing out. Then our home state, West Virginia, and I live right in the tri-state area that touches Kentucky and Ohio, that’s our home base.
It’s important to me that we can responsibly serve all of these areas before we just set up shop in Idaho. We’ve done that. We have nine offices in West Virginia and I think 10 or 11 in Ohio and 7 in Kentucky. I feel good about that. You learn all these lessons along the way that are really important. I’ve learned a lot personally and matured a lot through the process. That’s just common sense, do the right thing, have really good values, and have a great culture.
How does payment play into that? Well, you can’t grow unless there’s money there to support it. I’ve said this before, say that our newest office this year is in Wisconsin. There’s someone, and we’re in some really rural areas, that we are the only option.There is someone today, in West Virginia, we say up a holler, who’s getting care that would not have another option.
It all builds upon itself. The success today has launched Wisconsin. Next year, maybe the state is Montana, and you can tell the story, this new person in Wisconsin of how we got to this point, because that will be based on your success too. It all builds on itself and the payment has to be able to support that. For a company like ours, are there markets that I like or dislike? How do we decide where we go? First off, I’ll say it is more than just payment. I can tell you stories that are, to me, just crazy.
We went to one state, which I won’t say unless you really want me to, where we had to wait over a year to even be able to begin to provide service. That’s nuts to me. We’re coming to your state. We want to take care of people, give jobs, pay taxes and provide great care. We wait 13 months for you to even look at the application. We’ve learned some lessons like that. Let’s make sure we know the licensing and regulatory issues that the state has.
Then also, we go where services are needed. It’s not just some guys trying to sound nice on a panel. I mean that. If there’s already 11 agencies in this town, one on every corner, this isn’t needed here as much as this area where there’s literally nothing. That’s really important too.
Then there’s always the payment piece of it. Is it viable to go there? It’s not like, again, I like or dislike that state, or that area. It’s that, you can’t. You know what I mean? It’s not even an option to go do it. We look at all those things. It’s a holistic approach with lots of data and making decisions that way about where we want to open up shop next, but certainly a part of it.
HHCN: Particularly on the Medicaid front, you said already that it’s tough in some areas to cover the cost of care, to operate because of what the rates look like. What do you think will happen if the 80-20 provision becomes enacted? How do you think that will change agencies’ approaches?
Jeff: You and I have talked about this a little bit before. Will it come to fruition? I don’t know. It’s set to go into effect in 2030, although I will say this, states have the option to go faster than that if they’d like to. Just to think that it’s way, way off in the distance, that’s more immediate than you might think.
I would step back for a second. This is what I think we’ve talked about before. Forget Village Caregiving, forget home care period, let’s just talk about business. If you’re somebody that’s a team, or an individual entrepreneur and you want to invest your time, your capital, your energy and heart and soul, and blood, sweat and tears and anything it takes to make a business run right, 20% might be a good goal.
Well, whenever you start, that’s the top number that is even possibly achievable before you’ve even begun to pay a lot of overhead. Because again, these 20 states, for example, every one of them is different and you have to have a lot of people to figure out a lot of moving parts. It’s expensive to even run the agency. Then, of course, you got to have buildings and pay rent and utilities and you got to market and advertise. Everything costs a whole bunch of money. All of a sudden, what’s your profit left there? None, maybe 5%. I don’t know.
My suspicion is at that point, some business owners out there would look at it, say a 5% margin, and just say, ‘let’s just do real estate,’ or, ‘I could get that in the stock market.’ I am a purpose-driven guy. If I even have that thought, my suspicion is there certainly are going to be other providers that are like, ‘Well, my time is just better spent elsewhere because this is hard.’
I just say it takes a toll on my mental health. I have to deprioritize my family because I put so much time and effort into the business. It’s really, really tough. My fear is that it’s an unintended consequence that when you try to tie pay to the rate, you might lose providers.
The caregivers, they deserve to be paid well. I’ve done this work myself. It’s really tough. It’s really important. To me, I’d say they’re doing the Lord’s work out there. I have massive respect for them, but there are other ways to make sure that they get treated well. I’d be totally fine with a high minimum wage that doesn’t just hamstring the pay rate to the pay. There are just logistical issues with that that I think by 2030, my guess is that it will not come to fruition just because in that much time, they will figure out that there are better ways to achieve the same goal of taking care of the caregivers. That’s just a guess though.
HHCN: Mike, I’ve been covering Medicare Advantage and home health care and some of the subpar rates that are being paid out there by the MA plans for a long time now. It seems to me that over the last few months, and this could be because of the cuts on the fee-for-service side, there’s more momentum than ever in terms of providers saying, ‘We might just have to tell this plan that we can’t take your patients anymore because it’s not enough, the rate is not there” or providers finally convincing plans to say, ‘Hey, if you don’t want to pay us more per visit, we have to do some sort of value-based arrangement where we have upside potential here because we know we’re providing good quality care and we want to be rewarded for it.’
What are your thoughts on that? Am I off in terms of the momentum there? Also, if you wouldn’t mind just giving us a briefer on what Medicare Advantage payment does look like right now in home health care.
Johnson: You’re definitely on track. I’m not necessarily against Medicare Advantage conceptually because it does allow them to offer some services that aren’t part of typical Medicare, and you have to pay for it someplace.
What does bother me is when they treat a sector like home health as if we’re a commodity, which is always a race to the bottom. Who’s willing to do it for less? At some point, there’s no place lower than the bottom. The trajectory feels like, ‘Okay, we’re going to go to the bottom of the bottom of the bottom.’ That’s not a winning game.
We have started to look very strategically at where we have contracts and where we let contracts lapse. For our organization, we’ve got eight specialty practices, seven of eight delivering care in the home, the eighth is behavioral health autism services. We’ve got clinics for that. We do what we call assistive care, the same work that Jeff does. We do high-tech skilled pediatrics.
My point is, a contract with United, for example, may touch multiple practices. For home health to say, “I want to get out,’ that’s the plus of having multiple practices. If you look at United, for example, the decision that Enhabit made, Barbara Jacobsmeyer, to give them a termination notice, I thought that was really courageous. At some point, the race to the bottom is not going to get the answer.
Early on, David Baiada and I would go and we talked to any payer about how we share risk and get value-based contracts.
We finally started to get some, but the biggest reason that they weren’t willing to do it is their systems, they didn’t know how. Their systems weren’t set up to do it that way. Which was a real eye-opener. They say, yes, we love your idea, but we can’t do it. Our first value-based contract was really just a case rate.
Give us a flat dollar amount, don’t dictate how many visits, please don’t dictate how much time, and don’t ask for pre-authorization and we promise you these outcomes. That was a game changer for us because now all of a sudden we had to prove it, and it was a good exercise because otherwise you get paid for showing up.
That’s a business model. It’s very easy to predict what you’re going to do, just do more visits. Those days probably never should have happened to the degree they did. There was a lot of over-utilization, but those days are over. Working with, I’ll say, payers who are forward-thinking, we’ve had some really, really good conversations.
The payer is not the enemy. There are good people in there trying to figure it out. Whether or not they see the value in home health care is probably our opportunity to make that point and they’ve got competing costs, physicians, hospital costs, but for us it’s we’re looking for partners. We’re not just looking for a payment source.
I’m hopeful. I tend to be an optimistic person. The glass is always half full from my perspective. It has to be if you work in health care, or you just basically don’t get out of bed. We beefed up our contract management office with some real talent coming from other industries. We’re full throttle on how we build partnerships and payment models where everybody wins.
Getting paid more means we win, they don’t. How do we get paid more, give them what they need in terms of reduced costs and there’s several ways to do that and, so that part is actually fun and interesting, but part of it is there’s some that aren’t ready and do we continue to see the patients with those payers or not? It’s a hard decision because just like Jeff, I want to take care of everybody. We don’t want to have to make those decisions, but I also need to keep a viable business if I’m going to be here in 100 years, so hopefully that answers the question.
HHCN: Mike, in my conversations with providers, I have found that in a lot of cases, sometimes even the heads of the MA plans are saying, ‘We like this idea that the home health provider has,’ but the department that works with the home health provider is incentivized to keep the unit cost down. There’s a detachment there and that’s why sometimes nothing gets done in terms of a better payment system.
Johnson: Yes, incentives drive behavior. We’ve seen that as well, which is really frustrating. I don’t blame the department if that’s what your incentives are, it’s going to drive your behavior more versus less. Trying to figure out how you have aligned goals, visions, and incentives, and when you get that, which is not an easy thing to do, then you can do some really cool stuff.
HHCN: Jeff spoke to what may happen to the industry at large, home care that is, if you don’t have a healthy margin for providers. Mike, on the home health side, if you don’t have a healthy margin, what do providers run the risk of losing other than just a bottom line? What does that do to a business if there’s not a healthy margin?
Johnson: We refer to our bottom line as a surplus, that’s non-for-profit language. It’s what’s left over after you spend all the expenses. The thing that folks listening need to understand, our profit or surplus, whatever term you use, is our innovation fund. We have to fund it ourselves.
In electronic medical records, whether it’s EVV now coming into home care, it’s been Homecare Homebase for the last 15 years. When that was basically mandated, the HITECH Act, if you remember that from years ago, had millions of dollars to help the hospitals and physician practices fund EMRs. We got none of that. Which is fine, but then recognize our surplus, our profit is our innovation engine.
The more you cut into that, the less opportunity you have to innovate, which the risk now particularly is with the advances in technology, AI and so forth. I’m actually really excited about how that can actually reduce documentation for field clinicians, so that people spend more time with people, not with their tablet, not with whatever documentation administrator. Technology has the potential to do that, but it is going to take a couple, probably several risky bets. We’re going to lose on some of those, to figure out how to integrate that.
Those dollars only come from what’s left over after we’ve done our best to take care of people. Squeezing margins, in the end, I don’t think this will happen, I would agree with Jeff. I’m not sure the 80-20 rule in the end is going to go through particularly as it is now because of the impact it would have on the home care industry, the same with shrinking margins.
If CMS were to follow through with all the clawbacks that they propose, the 10% cut we’ve had in the last three years would look like chump change. There’s no way to make enough money to pay our providers and pay them more, which we’d prefer. I heard Jeff, you say that too, couldn’t agree more, and innovate and do all the other things we do.
Again, the sky isn’t falling, but we’ve got some serious conversations to have with each other.
The final thing that I’ll say is, I’m a firm believer that there is absolutely enough money in our health care system to pay for the care that people need. Just not the way it’s delivered now. There are a lot of people that are going into hospitals that don’t need to be there, going into SNFs that don’t need to be there, and home health and home care are a low-cost option.
Our system is built up, we’re so used to using that pathway. Go to the acute care hospital, we’ll just double-check, but if we could really think about how to keep people in the community first and go to the hospital second versus the other way around, we should be a pre-acute environment, not a post-acute environment.
That’s a big change to how we do things, but that’s the vision that we have, not that we are against hospitals and SNFs. There is a place for them, but more people than necessary are going to high-cost institutions that probably could get their care in the home. We’re seeing more of that, and more and more people, that’s their preference.
HHCN: Jeff, has Village Caregiving considered adjusting the business model to care for patients that fall more in the middle?
Stevens: It’s really tough. Before we even started the company, one of our co-founders, his grandfather lived in Florida and they had to pay for 24/7 around-the-clock care, and you’re talking six figures a year. That stuff costs a lot. Given our model, again, we’ve always wanted to be the most affordable option. It’s just sort of a motto and something we go by. I don’t really know if there’s anything much to change.
What we would do for those people that are in the middle, so you don’t qualify for Medicaid, but you’re not rich. We, first off, try to help them find any payer source that they might be eligible for. That’s step one. Number two would be, we don’t have a set rate. It’s not like corporate comes down on every office we have all over the country and says, ‘private pay is blank.’
They have autonomy and flexibility. If somebody’s really struggling, they can lower the rate. Let’s try to be compassionate people here and make this affordable for them. We don’t have a minimum number of hours we’ll show up for, so let’s have a discussion with this family about what is your weekly budget, or your monthly budget.
Okay, where can we work with maybe some family support that you have to shave a few hours off here and there, or let’s get clever about the schedule? Maybe the first day we come in on Monday, we make meals for the whole week so that it doesn’t take as long on other days. Maybe this day you only need an hour of care or even 30 minutes. We’ll go try to do that. We don’t have a minimum. I’m aware that some places have four hours, or we can’t come. We try to avoid that at all costs.
Sometimes it’s hard to get employees that want to go do that, but we do our very best. Yes, I think that all the things I’m saying, it just comes back to being as flexible as you possibly can to help a family out. That’s really all you can do, I think.
HHCN: What’s one change each of you would like to see happen to home-based care in the near-term future?
Johnson: I would say greater flexibility and willingness and openness to try new models of care because how people are paid dictates what they do. A quick example we talked about earlier is we had a model with an ACO, a separate payer in North Carolina where people who were SNF eligible were going directly home.
The innovation, as I chuckled earlier, was we added home health aide services, the work that Jeff’s team does, 24 hours a day for the first few days, 12 hours a day. It cost the ACO $400, something in that range. Yet we got better outcomes at a much lower cost. We’ve seen about 200 people in that case, and we’ve saved the ACO nearly $2 million.
There’s no payer model for that unless you get innovative and creative because in the end. A really good home health aide is worth his or her weight in gold because they know how to interact with people. A lot of what you’re managing in a transition is anxiety and expectation.
How do you have somebody in there that just helps people? We’ve got to take care of mental health, that transition. There’s some real power in clinical medicine connecting with the people-focused interaction that the home health aides provide.
HHCN: Jeff, what about you? What’s one change you’d like to make?
Stevens: Mike made great points there, as he always does. I had three things pop into mind. One would be better communication. I mean that all the way around with our payer sources, whether the state Medicaid office or the VA centers or maybe at the federal level or state licensing bodies, sometimes it’s just the communication breaks down to the point where I want to do everything by the book, the right way, the right thing. Sometimes if we don’t communicate well enough, I’m not sure what I’m supposed to be doing. I bet some people that are watching this may have a similar experience.
Two would be more uniformity, I guess, across states, across payers. It would be nice if we could just have one training standard at Village Caregiving, or one licensing process that looks the same everywhere. That would be such a game-changer. The third one is, I hope this doesn’t come across as whiny, but there’s so much good work that is done in home care and home health care that really changes families’ lives.
By the way, that’s not just the older person that we take care of, that’s the rest of the family in there too. This happened in my house when I was a little kid and my grandfather lived with us and we had to use home care and people would call off. It wasn’t consistent enough and my mom would have to come home and leave her job, and almost lost her job because of that.
This has effects on everybody. I’m still talking about it right now and I’m 43 years old. This stuff is real-world life stuff that matters to people and we change lives and we do a ton of good. When I see a lot of stories in major US newspaper publications, I feel like they paint the agency sometimes as we don’t treat the caregivers well enough.
Okay, well, there are probably some actors out there that don’t and that needs to be reported on. Where are a lot of the good stories? There’s a lot of good stuff to talk about.