Dave Totaro — chief government affairs officer of Bayada Home Health Care and president and executive director of Hearts for Home Care — plans to retire from these roles at the end of the year.
“I had a mentor, who told me the most important thing in your career is timing,” Totaro told Home Health Care News. “Timing is very important, and when I looked at what I had built at Bayada, and the strength of the team, it was the right time to move on, take a step back personally, as well as explore how I could help others within the industry build something similar.”
Bayada provides home health, home care, hospice and behavioral health care services in 23 states. The company also has international locations, operating in Germany, India, Ireland, New Zealand and South Korea. Bayada has about 32,000 employees nationwide. Hearts for Home Care is Bayada’s 501 (c)4 advocacy arm.
Totaro confirmed that he plans on remaining involved in home-based care advocacy.
Upon Totaro’s retirement, Sue Chapman Moss, senior vice president of payer strategy and government affairs, will step into the role of president and executive director of Hearts for Home Care. She will also continue in her current role.
Totaro joined Bayada, as its first chief marketing officer in 2009. Soon after, his knack for building relationships with clients led to the opportunity to take this skill and apply it to the company’s government relationships.
“We were doing so well building relationships with our clients, our patients, but our biggest client, which was the government, no one was building any relationships with them, not only at Bayada, but essentially within the industry as well,” Totaro said. “70% of what we do comes from the government, so they are our biggest client. I said, ‘you know what. I think I can do that. It’s very similar to building a brand, which is an expertise that I had developed over the previous 20 years of my career.’”
Totaro’s started out with a small team in New Jersey and Pennsylvania.
“We didn’t do any work in Washington for about a year, but then we started to expand our services,” he said. “As the return on our investment grew, we added more feet to the movement. Today, I’ve got 12 [people], we span from Florida out to Missouri. We have over 12,000 members in Hearts for Home Care, who are advocates. We’ve come a long way.”
In many respects, Bayada is a pioneer. It was one of the first home-based care organizations to create a role dedicated to government affairs and advocacy, according to Totaro.
Totaro explained that Bayada wanted to go beyond policy development, and that the company has three legs to its “advocacy stool.”
“We do direct lobbying, just like everyone else and policy development, but we also recognize that it’s just not good enough to develop a strong policy, it’s also important to be able to sell it,” he said. “Therefore I have two other legs in my office. One is grassroots engagement … and maybe four years ago, we realized that we need to get consumers involved in our advocacy efforts.”
The company’s Hearts for Home Care arm, is the epicenter of its grassroots efforts. Currently, Hearts for Home Care has over 350 trained ambassadors.
“We have one [ambassador] for every service office,” Totaro said. “[They’re] trained in our issues and ready to mobilize their office team when we need them. No one else is doing anything similar to that.”
When reflecting on the accomplishments that helped move the company forward, a few stand out the most to Totaro.
Bayada has contributed over $500 million in incremental revenues to the company, through reimbursement increases.
“Our number-one goal has always been to go after higher reimbursement, so that we can fund recruitment and retention of necessary nurses, and aides, and improve access to care,” Totaro said.
The company also tracks its return on investment closely. Throughout his tenure as chief government affairs officer, Bayada’s return on investment has been 14 to 1.
In other words, every dollar that Bayada has invested in its government affairs program or advocacy program, has resulted in $14 returned to the company.
Totaro is also proud of the way Bayada has been able to attract individuals to its mission at Hearts for Home Care.
“We have gotten our clients involved, our patients, our field staff,” he said. “Of the 12,200 members that we have at Hearts for Home Care, over 55% of them are not Bayada employees. They are from other home care companies, other businesses, consumers who have read about us. We are building a nationwide network of home care advocates. We have a goal for next year of 15,000.”
As we move closer to the end of 2025, Totaro is focused on a number of federal and state priorities.
“Unfortunately, this is one of the most difficult times for home and community-based service programs,” he said. “We’re getting hit by very significant Medicare cuts. We’re waiting for the first week of November, to see what CMS is going to do with the final rule. We’ve got Medicaid cuts coming down the pipe, starting in 2026. Those two things, on the federal level, are certainly top of mind.”
On the state level, Totaro singled out North Carolina and Pennsylvania as major areas of concern.
“Some of our states, like North Carolina and Pennsylvania still don’t have a 2025 budget approved, and it’s beginning to hurt significantly, even before the Big Beautiful Bill is implemented,” he said. “In North Carolina, for example, effective last week, there were across the board Medicaid cuts of between 3% and 10%. We’re already hearing that there are several agencies in North Carolina who are saying they’re going to have to shut their doors because of these significant cuts.”
Ultimately, Totaro hopes to galvanize the industry to get involved.
“It’s very important, for us as an industry, to raise our voices, and to stand up for a health care system that recognizes that access to home care is important to all Americans,” he said.
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