Union Power & Policy Change: Oregon SLPs Ended Pay-Per-Visit (Home Health & Hospice)

Dr. Jeanette Benigas, SLP, sits down with Oregon SLP Kara Hayden, MS/SLP, to unpack how clinicians organized, lobbied, and helped pass a state law requiring hourly pay, ending pay-per-visit in home health and hospice. They cover timelines, productivity pressure, joining an existing nurses’ union, building a small core team, securing a sponsor, writing testimony, and answering the big question: “Won’t agencies just pay less?” If you’re ready to push for change in your state, pay models, Medicaid rules, or workplace policies, this episode gives you the blueprint and the courage to start.

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Creators and Guests

Host

Jeanette Benigas, PhD/SLP

Host of Fix SLP

What is Fix SLP: Advocacy & Accountability in Speech-Language Pathology?

Fix SLP is an SLP Podcast by Dr. Jeanette Benigas about advocacy, autonomy, and reform in Speech-Language Pathology. This show exposes credentialing gatekeeping, dismantles CCC requirements, and helps SLPs advocate for change. Each episode equips SLPs with tools to reclaim their profession. Subscribe now and join the movement transforming speech-language pathology. Follow @fix.slp on Instagram and TikTok. Visit fixslp.com.

Jeanette Benigas 0:05
Welcome to Fix SLP. The podcast shaking up the field of speech language pathology. We're calling out the barriers that hold clinicians back fixing broken systems that limit our care and giving the power of our profession back to the people who live it every day. This is where fearless clinicians come together. It's time to change the field, with our voices, leadership and advocacy leading the way. So let's fix SLP!

Jeanette Benigas 0:34
Hey everybody, welcome back. It's Jeanette. I have a special guest with us today. Don't have Preston. We are always accommodating. When we have guests, we accommodate their schedule first, and then, if Preston can jump in, he can so he's fortunately or unfortunately, I don't know, depends on if you like him. He's at work. So before we jump in today, I have two things I want to talk about. First is just a reminder that if you are in the DC area during the ASHA convention, or if you're attending the ASHA convention, Friday night during the convention, we are having our Fix SLP, after dark meetup. We've got tickets on sale at the top of fixslp.com, we have paid for security. We are going to have snacks, a DJ, a really cute, intimate setting to get to chat with all of our Fixers and let you guys chat with each other so you can network and make new Fixer friends and just have a good time with us. Tickets are limited. We wanted this to be a smaller, intimate event, so please don't delay and also two weeks prior to the event, the price jumps up. So if you want to save a little money, don't wait. Go now. Fixslp.com you can get tickets there. And the second thing I have is to thank our sponsor. Our sponsor of today's episode is verse therapy. We have spent quite a bit of time getting to know the folks over at verse. We want to make sure that any company that we are talking about on our platform is reliable, and we do the best we can. And we agreed that verse is killing it. They are sort of like a business in a box solution for SLPs, who aren't happy with their corporate jobs. They're not happy working for school districts. They want to start, run and grow their own private practices. Listen, I own one. I own a private practice. It's tough. I build nursing homes. I don't have a brick and mortar. I don't travel to do home health or Part B because I didn't want to get credentialed. It just felt like a headache to me. So I stick to nursing homes only. I build the nursing homes. But if you're someone like me, verse therapy's mission is just to make private practice a little more realistic for SLPs by providing you with the credentialing an AI integrated EHR, they give you marketing support. They do monthly trainings, which sound really cool. So not only are you paying for the service, but they're building you up as a business owner, which is so important, because none of us are trained to do this. So they're going to help you build your brand, run your practice. They've got an experienced team behind you. Go check them out at verse therapy.com when you support our sponsors, you're supporting our team directly, and we thank you for doing that, because we can't keep doing this without the support. So let's jump in. I've got Kara from Oregon today. Welcome to the podcast. She's going to share her story of her part in the Oregon Senate Bill, 1168, that recently passed and was signed into law that requires home health and hospice agencies to pay their health care workers per hour, not per visit, which is huge. I know I have some questions that other people have asked, so we'll we'll ask those of you. But why don't you start by telling us who you are, where you work, what you do, and then we can go from there.

Kara Hayden 4:17
Awesome. Thanks. Jeanette, I'm Carrie Hayden. I'm a speech language pathologist in Oregon, primarily working in the Portland metro area. And I'm an augmentative and alternative communication specialist. I work on a very small team in our home health agency.

Jeanette Benigas 4:33
Is that adults, kids, everybody?

Kara Hayden 4:36
It's all adults currently.

Jeanette Benigas 4:38
Okay, okay. And have you always done that, or have you worked in other areas of the field?

Kara Hayden 4:44
So I used to live out in Hermiston, which is Eastern Oregon, and I worked at a critical access Care Hospital and Healthcare system out there, where I did a little bit of everything straight out of grad school. So I did my clinical fellowship, and then went on to be a full time. Speech Language Pathologist there and clinical manager for a short stint fun times. I did our video fluoroscopic swallow studies there. I did our inpatient, which is like 25 ish beds, and we carried full outpatient caseloads from all the way from littles up to geriatrics and then a little bit of home health out in rural areas. So a little bit everything before I came over to Portland Metro. Ever since I came over to Portland metro area, I have been full time home health, primarily adults, doing all augmentative and alternative communication.

Jeanette Benigas 5:40
So I heard you say home health in rural areas. So you probably know better than anyone how difficult it can be to work a full time job. Quote, full time get paid full time hours and do that because there's a lot of driving, sometimes in between patients and we do not get paid for that. Typically, some people get mileage, if they're lucky. I know I never have and I've worked for in the last almost 20 years, I've worked for five different home health companies. I've never been compensated for travel, and I've never received mileage. So why don't you tell us how you started this work. What I know you and I have been talking off and on for quite some time, but what, what went on? Tell us the story.

Kara Hayden 6:36
Well, when I came over to Portland Metro, into home health and hospice. I'd had quite a bit of experience, and I don't want to misrepresent my my experience in Eastern Oregon. I worked full time at the hospital, and the Home Health that I did out there was part of my hourly job, so I didn't have to worry about not getting paid if the patient wasn't available when I showed up to their home or didn't want to be seen or was declining the cares I was going to be paid for that time in my day. Nice, you're lucky. But me, it did give me insight as to like, mileage and time driving between patients in a rural area, and gave me some insight into like, I can imagine how that would be difficult if you were working full time rural and home health, just for an agency. And so when it came over to just working in home health, I'd had this experience, and I'd been a little bit of a manager too, so I've got that experience as well and that perspective, and I did not like it, and I'm very actively choosing to be a clinician, hopefully forever, and during the pandemic, maybe around 2021, my employer decided to come down really hard on productivity expectations. For some reason, we decide that we've just put these healthcare workers through this very traumatic pandemic, right? Makes sense? Still in it, and we're going to come down really hard on productivity expectations. And that was a huge impetus for therapists to join a union. We had been toying with the idea. It had come up, off and on at that employer over the years, from what I had heard before I even joined, but when that came down hard, it was like, Okay, we need something to protect ourselves. We need another tool to advocate. And I personally, I always found unions to be kind of a hindrance, actually, like in my previous line of work, prevented me and my boss from getting things done in a timely manner. On photo shoots, I found it kind of obnoxious. But in healthcare, in my current job, I was like, I could see this being a really useful tool, and a union is what you put into it. So if you want the union to work for you, you need to be active and involved, especially in a small discipline like speech language pathology, compared to like our nursing colleagues or our PT colleagues, there's always going to be greater numbers of them. So if you want to make your issues heard and make the union work for you and your discipline, you've you've got to be involved. You've got to do that.

Jeanette Benigas 9:07
Yeah, since the beginning of Fix SLP, there have been people throughout the two years that we have existed, coming to the platform and asking why we're not forming a union or just inquiring about that. And it's not that we're we are for or against unions. It's just not the work we're doing. Unions tend to be hyper localized. I think you're a very good example of that. You have a very hyper local union that is strong and working for you, but it wouldn't also necessarily work for me over in Ohio, you're in Oregon. So you know that that's one thing, that our job, not our job, but our mission, is to make it so people have choice and can walk away from ASHA if they want to. And there's a lot of other things we want to do to strengthen the profession. We can only do one thing at a time, but a union just isn't it? That doesn't mean we don't. Don't support it, and so we continuously say we support all efforts. If someone wants to start that and get it going, not that we're going to collaborate, but we certainly have a platform to get information out.

Kara Hayden 10:11
I think folks need to realize that the National Labor Relations Board also determines who has common areas of interest and how unions are allowed to form so we could, as a profession, be like we want to have an SLP Union, but we work in so many diverse settings. There are federal rules and regulations around how different unions can form and who has common areas of interest and are even allowed to be in a union together, even in just like health care, it is very workplace by workplace. You know, you notice, nurses might have a state Union, but they literally are made of these tiny collective bargaining units, employer by employer. It is not one nursing unit like the way that maybe a blue collar union might be for all, like fake fitters, or something like that, or welders.

Jeanette Benigas 11:08
So in your union, is it all just SLPs, or is it otpt, St? Are there other disciplines?

Kara Hayden 11:16
So we are a historic unit within the Oregon Nurses Association in Oregon, where our nurses were an existing, recognized collective bargaining unit, we had to vote to join them. And then this past year, our AIDS and assistants, who are considered by the National Labor Relations Board to be non professionals. We don't use these terms. We respect all our colleagues, but, yeah, they're non professionals, and they voted to join us, and we had to vote to accept them into our unit.

Jeanette Benigas 11:52
Okay, so when you say we again, is it just st or is there also PT and OT involved?

Kara Hayden 11:59
Sorry, our unit is nurses, physical therapists, speech language pathologists, occupational therapists, social workers, bereavement counselors, and now we voted in our physical therapy assistants, our certified occupational therapy assistants, our LPNs, our CNAs and our one licensed massage therapist in hospice that's 11 disciplines.

Jeanette Benigas 12:26
And I've heard, I think I've heard Preston say before, you're almost better off to join an existing union, like a nurse's union, than try to form your own. So that's exactly what you guys did. And again, that's not what this particular podcast is about, but you're the first person that I've had on who really like has in depth knowledge about this, so I wasn't gonna let you go away until we got some of that. Okay, so you guys joined the Union 2021 ish, right.

Kara Hayden 12:54
So it took us a while we organized in 2022 and we won our authorization vote in early 2023 we negotiated through 2023 I think it was October 6, 2023 when we got ratified our first contract, meaning the speech language pathologists, physical therapy, occupational therapy, social workers. That was our those disciplines. First contract, we were joining the existing nurse contract, and I tell you, that is a sweet spot to be in, because the nurses, bless them, had done so much work and had an existing contract that we were being added into. There was a lot of work to still be done that was discipline specific to our different needs, but we were able to join that and that eliminated a lot of negotiation time. So that great spot to be in.

Jeanette Benigas 13:50
So you know what question I'm about to ask, if it was discipline specific? Did you talk about requiring the CCC or not of the SLPs,

Kara Hayden 14:04
That is actually not in our contract and never, and it's a workplace policy that, except for advocacy issue, one of our managers who's an SLP, who's incredible, we talked a lot About having choice. And, you know, the Fix SLP conversation had come up and really inspired us to ask, just ask if they would consider changing our workplace policy. And they did, across all seven states that they opt the employer operates in, and they removed the C's from home health and hospice requirements for doing the job.

Jeanette Benigas 14:44
So I'm pretty sure that's how we started talking in the first place, right? You messaged me to let me know that that happened, and then there were we were going to announce it as a win, and then you're like, wait, hold off. Can I officially announce it as a win?

Kara Hayden 14:56
Now you can, but it's more complicated. It because our employer sold. I don't know what's happening in the other states now. I just know that in Oregon, that business deal has not yet been approved. So I'm like on pause with whether or not the seeds will be required in our future workplace.

Jeanette Benigas 15:17
I think it's still a win that we can announce you are a living, breathing example of having the conversation with someone, taking it to the decision makers, asking for it to be changed, educating, getting it changed, right? Yeah, and it was changed for that job. It was changed now the business sold, and you might have to do it again, but you still did the work. All right, so you've negotiated that first contract. Nurses did most of the work. They were already there doing it. Then what happened?

Kara Hayden 15:49
So in the fall, so we're enjoying our contract, our aides and assistants are organizing now. They're wanting to join us. So they vote to join us, and we have to vote to accept them. They come on board. We start negotiations again in 2024 in anticipation of our contract expiring during that time, in the fall of 2024 again, this joint venture was announced. This business deal to sell 50% of our operations and hand over the day to day operations of our agency to another operator. And that was really concerning to us, because that meant that like everything that we know about how our business operates, we're currently part of a nonprofit, so that's always been a huge difference in how we're able to identify community need and create like specialized teams to deal with that. So our home health agency has a mental health nursing unit team that like goes around and just focuses on mental health needs. We have a wound care nurse team. We used to have a palliative nurse team and a remote monitoring nurse team, and both of those teams were eliminated. And then for speech language pathology, we have our augmentative alternative communication home health team. We partner very closely with our local als clinics. Um, that's like the one of the backbones of our caseload, and creating that continuity of care from clinic out clinic and outpatient services to inpatient home over the progression of their disease, and then pass off to hospice with, like, a really warm handoff, sometimes still being involved there to maintain communication until the end. So we have these specialized teams that, like, don't exist in a lot of other home health agencies. And a huge will do that is we are a nonprofit, or, I think that's why we're able to do that, and so we really focus on quality of care and community needs. And that really felt threatened by this potential business yell that is going to turn us into a for profit agency. A lot of other motives. And our motive, and my motive always is patient care and quality of care. And so while we have a contract, and while labor rights and workers rights go hand in hand with the quality of care that we're able to provide and our working conditions, there's only so much you can do through a union contract that impact patient care, right? And so we were looking around like, what else can we do? And what else can we are in this unique position. We have our union here. Our union has some political power. You know, that's something that you get from being in a union. And so we're like, Well, what can we do here? And our occupational therapist, one of them, said, like, Hey, we're not paid per visit currently, and it looks like in Oregon, the statute says that since 2011 nurses in home health and hospice are protected from pay per visit rules because of perverse incentives that it provides and things like that that can impact care. How come therapists can still be paid per visit, and we know many of those therapists, our colleagues at other home health agencies who are miserable don't love that pay structure. And we were like, well, what can we maybe we could just expand the protections of the existing law, again, piggybacking off of like what already exists, and how can we expand that and make better and tighter and, yeah, we always talk about our contracts being like a ratchet, like, you don't get everything you want every time, but you ratcheted it up, you tighten it up, you work at it a little bit, identify the weak points, and you try to make it better the next time and the next time and the next time, it's never going to be perfect, but you always try and you make it just a little bit better incrementally. So we were like, well, maybe this law is like, the same thing. So we, we pitched it to our government relations team at our union. They initially were like, I don't know.

Jeanette Benigas 19:52
It's always the response we get the thing at Fix SLP! We get the same thing. We talk to all these like "meh, meh, meh." It's just again, it's the education you. Have to. Nobody understands the therapy world. Nobody understands.

Kara Hayden 20:05
Yeah, and a lot of it is, a lot of it is, you know, we do, admittedly, we're part of a nursing union. Primarily, we are the first non nurse unit there. So we have to be loud. We have to, we have to be willing to speak up and tell people and communicate which SLPs are great at, yeah, what do we need to do our jobs? What do we need for our patient care? What's going to make this better? What's going to let us do our jobs in the way that the research in our field is telling us that we should be doing our jobs? And so we worked at it, and we just said, like, Hey, this is what we really need. This is what we think would work good. And they were like, well, you know, actually, that might not be like that difficult of a lift, considering they had been the one, yeah, put forward the original law for nurses in 2011 so they were like, Let's look at it. And then we explained some of the current issues our nurses are having, even with their protections against pay per visit, and ways that employers have maybe been manipulating them and to get around it. And so we added in our lawyer. You know, this is we're having a union. You do have these resources. There's a lawyer there, and he we brought these issues to them, we presented them, and then they think about them from their perspectives and their disciplines. And he said, Well, maybe this kind of language could help address that concern, and maybe this language could help address that concern. So it became, not only just an expansion of pay per visit cannot be for therapists and any home health or hospice worker, also your pay cannot be tied to the number of visits you make in a day or the number of people you see in a day. And so just really being more explicit about what that means. It does not mean that you can't have productivity standards. Your employer absolutely can have productivity expectations, that is part of running a business, but they cannot tie your compensation to that. So they cannot say you must make five visits today, or like you're not getting paid, or your pay is going to be impacted by, you know, 10% less or something like that. And as a clinician, you ethically like, should be doing your job like you shouldn't just be seeing one patient a day. You You know, need to see a reasonable number of people in a day. But also, if you have issues that come up, or the drive time between your patients for that day is unavoidably, ridiculously long, but you're going to make sure that all the patients are being seen, that maybe those visits are particularly important for triage reasons, or something like that. You're not being penalized as a clinician and worried about your paycheck because you've chosen to provide this care, or you've been assigned to provide that care. You know, some agencies don't give you a choice. They just say you must see these people this

Jeanette Benigas 23:03
Mmm-hmm. In terms of protections. That's where some of the questions have come up that I've seen online. Maybe having this union backed organization might help with some of this. Maybe it won't, and hopefully you can clarify all of this. But the number one question I've been seeing, or comment that I've been seeing since we posted about this bill was, well, they'll just pay less to make up the difference. And so is that something that you're anticipating, or is there some language in there to try to prevent that?

Kara Hayden 23:36
Unfortunately, with legislation, you can't be like you must pay so it's true. Yeah, I won't sugarcoat it. We can't control like agencies might decide that they're gonna pay less. I do have a colleague who she was negotiating a contract to do some PRN work, and they were like, we can pay you like, something ridiculous, like 200 something dollars a visit or something. And she was like, really, well, you know, in January, like, you're not gonna be able to do that anymore because that's gonna be illegal. And they were like, okay, we can pay you $40 an hour. Then that was, like, their hourly wage that they gave her, like, on the spot, and she negotiated them up to $60 an hour. Like, again, don't just because, yes, they might try to lowball you, doesn't mean that you don't still have the power of your individual labor, even not union, to say, hey, you just said that you could pay me 200 and something dollars for this visit.

Jeanette Benigas 24:38
So it is possible depends on how bad you're needed. And I had a brilliant professor who taught us in grad school they need you more than you need them. And I took that to heart, and that is how I have operated ever since, and I have never had a problem.

Kara Hayden 24:57
Those are great words to live by, and I just encourage like. Right anyone, whether you're unionized or not, like when you're negotiating a job or like interviewing for the job, like you're interviewing them as much as they're interviewing you want that to be a place that's going to work for you and that you're going to be happy at and be able to practice the clinical practice that you want to practice. Need to be able to practice for your license, and so I just think it's important to ask those questions, even if you don't, even if you don't get that job or or you turn that job down, just asking those questions, the more of us who are asking like, what's your reimbursement rate? That's not really what I want. You know, the more of us doing that, the more employers are going to take note and later be like, gosh, we're missing a lot of can't we're missing out on a lot of candidates. Or the candidates that we're able to get aren't maybe the quality that we wanted. But you're like, it's because we're low balling them, you know? And so, and they're saying, and, you know they might not ask why, but if you ask those questions at your interview like you may not ever get an exit interview, but you always get an interview to start the job.

Jeanette Benigas 26:10
If I don't get an exit interview, which doesn't normally happen in therapy, I make sure they know why I'm leaving when you have had a job posted for however many months, and I'm the only one who applied, and now I'm out good luck finding someone else. You should have listened to me while I was asking for those changes, while I was here,

Kara Hayden 26:28
Absolutely and like, yeah, you want to leave it better than you found it. You want to leave that job position better for the next SLP, who comes along than it was for you?

Jeanette Benigas 26:39
Yeah. So in my resignation, I will make sure it is clear.

Kara Hayden 26:43
I think one of the biggest things I learned from being at the negotiating table, you know, like I said, you make your union what it is. So I am at the negotiating table for the SLPs, for our tiny AAC team too, because we are a small team within our SLP discipline. And just to give people some numbers for context, like, there's like, probably approximately 200 something nurses in our unit. There's like, maybe 75 PTS, 45 OTs, there's 12 SLPs, and there's three AAC SLPs. But we are at the table. Our little group is very involved, and they give me feedback on what their priorities are and what's important to them. And we share the workload amongst us, and we communicate about what we need. And you would be surprised when I've been at the negotiating table, your directors are more open to change than you think. They just don't know your job, and you need to help them, and you need to educate them in a kind respectful way, what the issues are and what would make it better for you and for your discipline. And they are more often than not, more willing to consider it. Do they have job constraints? Absolutely and one of the best things you can do is ask them, What are the difficulties that they encounter leading your organization or making those changes that you know that they see once you've educated them about and like how to make that happen.

Jeanette Benigas 28:10
I'm glad that your admin and the leaders have responded like that to you. That actually has not been my experience.

Kara Hayden 28:19
It's not always the case, and not on every issue.

Jeanette Benigas 28:23
So you guys came up with the idea. Lawyer gave you some language. You had to get a sponsor for the bill, I'm assuming. Did they take care of that for you, or did you guys have to do that?

Kara Hayden 28:34
That is the beauty of having government relations team at our union.

Jeanette Benigas 28:37
Nice.

Kara 28:38
Our union is well known at our capital. And so they did get us a chief sponsor, and then they set up some lobbies. And again, like I said, they're mostly a nursing union, so they have an annual lobby day where they bring all of their main legislative priorities. I would say that we were, like, maybe not a main legislative priority, but we made it a main legislative priority. Good for you. We were loud enough with our government relations team about it, and passionate enough, and we showed them that we had members, and members, meaning other colleagues of mine at our agency, that wanted to go down and lobby this bill. And so they actually set up a mini lobby day just for our bill, where we went down capital with one member of our gr team, government relations team, nice. And it was almost like being on a field trip where we didn't have to worry about the logistics. All the meetings were set up for us. We just had to worry about telling our story. And that comes so easily to us as healthcare workers. Like, just talk about your job, you know, yeah, and like, the fact that you don't get to pee in 10 hours, or that you have colleagues who are, like, peeing in bottles in the middle of, like a field or something, or you are eating while driving all the time because you never get to take a lunch break. Just telling them about your job, telling about your day to day, telling. Them why this bill is important, how you're not able to get paid for follow up phone calls to doctor's offices to coordinate care and referrals for your patients, like all things that are critical, especially when you have patients who, like, have communication disorders, it's not so easy to tell them to, like, follow up with their provider, right? If they have AAC, you know, it's not so easy for them to log into my chart with like, two step verification and all that, to read a message or send a message to their provider. So doing those things is critical to getting them the care they need and making sure that they're followed up on and that there's good communication with the patient all their other providers. So we just went down there and explained all that to them, and we had some people, some legislators, who just nope, did not want to talk to us. You could tell they were not interested. That's okay. We've tried to tailor our message to to like which representatives we were talking to, so if they were in a rural area, we stressed, you know, the equity and access issues a pay per visit, and the impact on rural areas and rural communities. And, yeah, it was really good. We just so we did the mini Lobby Day, and then we did it at a bigger Lobby Day where we had more nursing colleagues, which was a great opportunity to educate our nursing colleagues about why this mattered so much for their interdisciplinary colleagues, like pts and therapists and stuff, and they were really receptive and supportive of us, too. So they lobbied on behalf of it with all their meetings. And then we prepared testimony. So several SLPs, PTs, nurses, OTs, we all wrote testimony. Unfortunately, we were a little disappointed we did not get to present it.

Jeanette Benigas 31:44
Yeah, did anybody get to?

Kara Hayden 31:46
The committee ran late that day.

Jeanette Benigas 31:49
Okay

Kara Hayden 31:49
And so we ended up but our government relations team had prepared us for that possibility, and so we all just quickly submitted what we were going to say in writing instead. So it's still that on the record. It's just I have testified for other bills. It's kind of nice to be able to say it, yeah, but yeah. So it was a multidisciplinary effort, like when we went for a mini lobby day, it was me another SLP, a PT, a PTA, an OT, and a nurse. So really, like, think the more voices the better, but also, any voice is better than no voice. And so even if you're on your own in your state, like just speaking up.

Jeanette Benigas 32:30
I don't know if this is the same in every state, but I'm we're going through this process now. In Michigan, our bill is not yet signed into law. Our girls, Michaela and Alexa, got their own sponsor. There was no lobby day they, I think they did go meet with him, just to meet with him, but I think he was already sponsoring the bill, or maybe it was right before he decided to, I forget that far back, but we then had, we put out a package for a call to action for clinicians all over Michigan to write their representative. And so we didn't have to have a lobby day. We did it like that. And people in Michigan got really involved, because of Fix SLP, our sustaining partners, funded the postage for that. So I ordered stamps. I shipped them to Mikayla. Mikayla got them to people, and she then also ordered some stickers and mailed those out to people so they could all send letters. And that's how we did it. And it was just as effective. And so we did get to testify. It was the sponsor of the bill, and then Alexa and I. I really wanted Michaela to do it, but she wasn't able to. But I'm licensed in Michigan, so it was just as appropriate. So Alexa and I both got to testify in the Health Policy Committee, which was really cool. And then when we were scheduled first, so we knew we were going to get to go. It's, it's, it's quite the experience. So I'm assuming you had to do that as well. Did you start in the House or the Senate?

Kara Hayden 33:57
SB 1160 so you always know where it's based on the name of a bill. So I started in the Senate, then it had to get out of the Health Committee first, then go to full senate, then to the house, then it was identified as having a budget, which means, then it has to go to the Ways and Means Committee. That's where a lot of bills go to die, especially in this legislative session, because of all of the federal cuts to health care and things like that, you did it, though, I don't know how we managed it, but it got out ways and means with an approved price tag of 150 a little over $159,000 which was designated to bully, which is the Bureau of Labor and Industries, which will be the enforcement and rulemaking arm of this bill when it goes into effect, and then it has to go to another vote after that. And then. Was considered pass.

Jeanette Benigas 35:02
It's a long process. The governor can still veto it, yeah, and potentially not even sign it, right? Yeah, it's a lot. It's such a long process, but so worth it, and you guys totally did it. What would you say to people who are thinking about doing this in their own states?

Kara Hayden 35:19
I would say, don't be intimidated by the process. No, have realistic expectations, like Jeanette and I just said, there is a lot of steps. There's a lot of places for things to fall through. But just start. Just start. It doesn't matter if you're part of a union. It doesn't matter if you're not like Jeanette just gave an example of doing it without a union. We did it with a union. Also, don't forget about forget about your state associations. Through this process, I learned that OSHA, our Oregon speech Hearing Association, has a lobbyist too. So even if you're with a union like the more the merrier, the more voices so like bringing in their lobbyists and bringing them on board, and like asking them, Hey, are you willing to support this, or put out an e blast or something about this thing that we want to do, like, they could get behind you too and be an organization that wants to support that legislation at the state level. So, like, don't be shy. I would say the biggest thing is, like, speak up. Don't like, un silo yourself like other colleagues. Like, there are Facebook groups that are about home health, PT, OT and speech. There's a huge one. And, like, there's lots of complaints about PPV on there. Maybe there's some allies on there that you can become friends with in your state, and you don't have to become besties. Like, just become legislative besties and collaborate on it and and get together and start, you know, talk to your talk to your representatives, and then identify other people in your state who might live in other areas, because they can easily get meetings with their representatives. But hard is when you live in one area of the state and you need to get a certain person, a certain representative or senator from another part of the state that you don't live in. Yeah, when you live in your area, like your senator and your representatives are supposed to talk to you like there's a meeting to you. That's their job. Yes, it's not their job to meet with constituents from other parts of your state. So that's where you want to talk to other people who live in other parts of your state, and honestly, don't be afraid of that dialog. Like even if that person disagrees with you about certain things, that dialog makes the outcome stronger. Yes, having a back and forth and having a little disagreement and having the conversation. So don't be afraid of that.

Jeanette Benigas 37:39
We ended up with 11 cosponsors, and I'm getting chills. I think it's because our Michiganders, our Michigan Fixers, were so good about sending letters to their representatives, but that by the time it came in front of them, or they were asked if they wanted to co sponsor, a bunch of them got on board, and that's why we're not really concerned about it passing the house, because we did that work. Are we going to have to replicate that in the Senate? I don't know what that's going to look like yet, but again, you know, if we have to do another call to action, we will. We're not Senate. Again, nobody's going there for Lobby Day. We'll do it through the mail or phone calls or whatever. But the other thing that I hear a lot when I comment, not just about this, but in general, when people are like, Why isn't or is fixed? SLP, going to take this on. Or we can't wait to see what you do in our state. Or, you know, I wish that this would happen in my state. My response is, we need people to do it. And then their response is, well, I'm too busy. Yeah. I mean, we can't make we are all busy, but we cannot make significant changes without putting in the work. So number one, exactly what you said, those representatives are not going to meet with constituents from other places, especially outside of the state. Fix SLP, cannot go into your state and do this. You have to do it in your state. We can collaborate with you. We know Kara now we're going through a process in Michigan. We've got a model for this now, right? We've got a model. Kara can write it down. We can call Kara. We've got this relationship to collaborate, but we can't do it. We can do it with you, but not for you.

Kara Hayden 39:39
Yeah, the same goes for our union too. The union is us, right? The Union doesn't do things for us. Tell our union what we need, and they give us the tools and the support to make it happen, but they are not jumping in and proposing things for. US or doing things for us our contract the issues that we have for speech language pathologists in there. We bring those issues to them. They help translate that into contract language. And I tell my colleagues all the time, like, if they don't like what the union is doing, okay, tell me your co worker who's sitting on the chair. You know, what do you need? What don't you like? Let's see how we can address that in contract language. But I can't do that unless you talk and tell me what you need. I am not a mind reader, and you have to think about who has legal obligations to who. And your representative does not have an obligation to someone from out of state or even from the next, next district over you have talked to people, and honestly, we are all so busy. One of the best pieces of advice, I don't remember where I got it from, but I read it or heard it somewhere, was like, you just do one small thing towards that big goal every day, like those meetings with representatives, they're busy. They really only take 15 minutes. I've done them while I'm driving, because talking about your job is just so natural, and you're going to be so passionate about it. It's really not that hard to do. Yeah, it's just really not that hard. It doesn't take a lot of time at all. You can make the time just a little bit every day your testimony can only be like two minutes or less.

Jeanette Benigas 41:24
And listen, we've got Preston. Okay, this is his job on our team. He will write your testimony for you. Oh my gosh, if you if you missed our episode where we played some of that testimony, Preston wrote those. Okay, he's so good. He's good. So, you know, again, we can collaborate with you. We can't do it for you through this whole Michigan process, especially once it started getting some traction, Preston was at every meeting. I was at a lot of them. If Preston couldn't be at one, I for sure, was at one. So, you know, we were collaborating with Alexa and Michaela before they were on our team, because they were the last to come on. They just, we just did all this work together that we didn't want them to go away. So we figured it out, and now they're just here, and we love them, and now, like you know, they're helping others too. Again, we didn't have the pre existing relationship. We built that relationship because we were attending meetings with them as people outside of their state. Maybe I'm remiss in saying this. When you look at what has to happen, it is a lot of steps and a lot of things going on, but it's really not that much work, like it doesn't especially if you have one or two other people doing it with you. There are times, of course, where, if you're doing a letter writing campaign, where, of course, Michaela was hearing from people daily via email or DMS, but a quick response was, okay, I'm sending out stuff later this week. Send me your address, and then she had to take the hour or whatever to send stuff out. It's not like you're tying up your entire day, weeks at a time, doing this if you have to go to the State House to testify, yes, that can take some time. And if you can't, there are other people that can do that in your place. So we're actually finding that smaller teams are more effective. We have these state teams, teams with more than three people are too many. The state teams that we have where there are like two or three core individuals getting the work done are becoming the most successful. And then there's people on the outside who can help when you need them with through a call to action.

Kara Hayden 43:41
It tends to keep the core team very tight and small, and then those people know people and can and partners for certain steps along the way. Yeah, our core team that did this was pretty small, and like I said, they were like the 1234566, of us really, who really followed it like tightly, but there were many others on our in our unit who I don't even know, who had meetings with their representatives from their areas that they live in. I don't even know who they are, nice, but, you know, they had a meeting here or there, but virtually because they couldn't make it to the State House. The State House testimony, you can go in person, let you testify just by phone, audio or video, so you can literally just be going about your day, have your testimony ready to go and pull over the side of the road. And once you're they'll give you a heads up, hey, so and so is on deck. And then you just pull over your testimony. You give it, boom, it's done. Yep, you gave testimony.

Jeanette Benigas 44:45
In Michigan, they gave me that option. I was like, excuse my language, but hell no, I am coming in person. Okay? No, no, I will drive the four plus hours to make this testimony. No one is holding me back. This is happening. And I specifically said to him, too, we're hoping to replicate things like this in other states. So I want to fully go through this process so I can walk beside other people and prepare them for what's going to happen. So if I don't go through it myself, I can't tell others what to expect. So you know, I got a hotel, I drove up the night before. Got a hotel, and I did it. Will I drive there again every time? Probably not, you know, again next time, I might do it over the computer. But to me, this is part of my job at Fix SLP, is to do these things so others can do them. Because, again, if I am saying I'm going to collaborate with you, or Preston's going to collaborate you, or Michaela or Alexa, we're all doing that. So Alexa went to the last one with me. Michaela was going to go for the vote. It got. It's been canceled multiple times this last one, and then all of a sudden we got, we got a message. It was voted out of the house. And on to the next step. We didn't even know what was happening, so we weren't there, but we wanted someone to be there so we could see the process. We're trying to always have someone there so we can see how it goes. So we should probably wrap up. Thank you for doing this. If anybody is interested in doing this kind of work in their state, doing this pay per visit type thing, or eliminating the Medicaid requirement, which is what we're doing in Michigan. Please do not hesitate to reach out to us. The best place to do that is states. S T, A T, E, S at fixslp.com that is a different email than the one that has 200 unanswered emails that I will respond to. We actually have someone very specifically monitoring that email for us. Her marching orders were never have more than five unread messages in the box, and she is doing great with that. Now you will get a response. Does that mean we take action right away? No, it does not, because then it comes to me and you get what you get. We need more help. It's just me and Alexa and Michaela. You know, we all have our little thing. They do great at their little things. And then I have 27,000 little things, plus all the other things. So we will get with you, I promise. And that person who's monitoring that email is very good about staying on top of me, and we'd love to collaborate with you. That's why we're here, and we have a huge platform. Kara, had a union. You don't have a union, or maybe you do, but if you don't, you have the Fixers. And we're not a union, but man, Are we strong. So Kara, thanks again for coming on. Your story is amazing. We didn't have anything to do with this, but what a cool win for SLPs and all health care workers. It's just it's exciting. Hopefully now people can negotiate rates, because I know that's a concern, but it should be doable. So thank you.

Kara Hayden 48:05
Thank you, and you say, you keep saying that you didn't have anything to do with this. However, just the fact that there are other SLPs out there being loud about making change in our field gives other people like myself and my co workers, courage to make change in our state and our field in our neck of the woods. So it's contagious. We inspired you. Yes, it's important to have other people out there being loud at the same time and making change. We are part of a larger movement of wanting something different for our field, and we can do it, and we want something different for our patients. So it's awesome.

Jeanette Benigas 49:13
All right. Kara,

Kara Hayden 49:17
Thank you

Jeanette Benigas 48:47
Before we go, I just want to remind you to go check out verse therapy.com. If you've ever thought about starting a private practice, but all of that administrative stuff is what has held you back. It's at least worth looking into. They have launched in 14 states. They're looking out into the future to adding a bunch more on. If they don't know you're interested, they might not be considering your state, so go check them out. Thanks for listening this week. Guys, don't forget. Go get the tickets to the meetup. Thanks for fixin it.

Jeanette Benigas 49:18
Thanks for listening to the Fix SLP podcast, the podcast shaping up the field of speech language pathology. Don't forget to check out our social media or fixslp.com for our latest promo codes for continuing education, therapy, materials, merch and more. Supporting our sponsors also supports our Fix SLP team. Don't just listen. Be a part of the change. Share this episode and our social media content, and let's keep fixing the field one fight at a time.

Transcribed by https://otter.ai