Nine days before the state of Michigan shut down the vast majority of its businesses, First Day Homecare opened its doors for the first time.
Based in Flint, Michigan, the pediatric home health provider had its sights set on accreditation status and eventual expansion, which would allow it to serve more clients statewide. But the pandemic threw a wrench in those plans.
The past 15 or so months have offered many harsh realities, but despite a terribly unlucky opening date, a shuttered business has not been one of them. First Day is still standing — and still hoping to grow in the near future.
That’s an important mission, as there simply aren’t enough agencies serving pediatric clients in the home, Emily Wiechmann, First Day’s owner and director, told Home Health Care News.
“I have consulted in private-duty nursing on a national level,” Wiechmann said. “And my opinion on this particular issue is that it is a national problem — not just a local one. There are just universally not enough home health providers in the private-duty nursing space to meet the demand of the medically complex infants and children.”
First Day currently has nearly 30 pediatric clients, as well as some senior clients that it took on at the beginning of the pandemic, before it was accredited as a pediatric provider.
It’s census could be much larger, but staffing challenges currently limit the number of patients it can take on.
First Day currently has 40 pediatric clients on a waitlist due to lack of staffing.
“There are not enough pediatric private-duty nursing providers,” Wiechmann said. “So staffing is definitely the biggest challenge in private-duty nursing. Finding qualified [registered nurses] and [licensed practical nurses] to provide the care is tough, primarily because of the pay rates that we are able to offer to the nurses.”
The Medicaid reimbursement rates in Michigan for the pediatric care services that First Day provides are about the same as what a nurse would get paid to work in a hospital. With that reimbursement, First Day has to pay off overhead costs and pay the nurse and other ancillary benefits.
“It really makes a big difference,” Wiechmann said. “So we see a lot of nurses coming to private-duty nursing, taking sometimes between a $5 and $10 pay cut.”
About 1% of the pediatric population in the U.S. falls under the “children with complex medical conditions” category, according to a 2016 study. While small, that population accounts for almost 30% of the pediatric health care cost.
First Day is a part of the Michigan HomeCare & Hospice Association (MHHA). It is currently working with the association on vying for higher reimbursement rates.
A 10% increase in reimbursement in October was a major relief for the agency, which immediately turned around and hiked its workers’ wages. It also helped with recruiting, but it is still not enough, Wiechmann said.
Nurses are sometimes unwilling to work in pediatric home health care because of the fear that they’ll be working with sick children. But that is not necessarily the reality.
The majority of pediatric clients are not necessarily sick, but instead need care in their early stages due to issues like a premature birth. Eventually, with the right care, they are able to be phased out of a care program.
“We have a lot of myth busting that we have to do with a lot of our applicants,” Wiechmann said. “To explain to them that these are not dying children, even if they’re on a ventilator. It does not mean that this little one is sick and dying. It’s quite the opposite.”
But that fear, along with low wages, still makes recruiting hard. This October, MHHA and First Day are asking for a 40% hike in reimbursement, hoping for at least a 20% increase.
“We’d pass that right along to our nurses,” Wiechmann said. “The only way to solve a problem is to pay the nurses what they deserve to be making.”
First Day had just a handful of clients when it reopened its doors in mid-2020. The need is so large, however, that it was able to rebound quickly.
The agency services clients across the entire state, including one that is seven hours away from its brick-and-mortar office in Flint. That’s why Wiechmann is hoping to open two new offices in Grand Rapids and Ann Arbor — two hotspots for pediatric care needs — by the fourth quarter of this year.
Although there are serious challenges, some home health providers have been able to make pediatric care a major part of their overall business.
One such example is Bayada Home Health Care, which told HHCN in 2019 that it gets roughly one-third of its revenue from pediatric home health services. Another is Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH), though the company has outlined plans to more aggressively grow in the senior care arena.
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