Caring for a 14-year-old girl who doesn’t speak English and is frightened because she’s going to be a mom. Supporting a 95-year-old veteran who is nearing the end of his life in hospice care. Helping a family that is grieving after the loss of a parent. 

These are examples of the varied services provided by EveryStep Care & Support Services, a unified nonprofit organization based in Des Moines that encompasses hospice, home health care and other human services programs. 

With nearly 400 employees and 700 volunteers across the state, the nonprofit rebranded just over a year ago as EveryStep. The organization represents the combined operations of Visiting Nurse Services of Iowa and HCI Care Services, which merged seven years ago. 

The combined organization has undergone significant changes in the past several years,  among them an expansion of its home care services to more rural areas of Iowa. In total, its programs and services benefited more than 65,000 Iowa residents in 47 counties across the state in the past year. 

To help address low worker pay in the home health care industry, EveryStep last year raised its wages for all of its staff to at least $15 an hour, and expanded health insurance benefits so that lower-wage employees pay less of the benefits cost out-of-pocket. 

In 2014, the organization took Amanda the Panda, a grief support program, under its wing; it’s one of dozens of health and wellness programs that it supports. 

Over the past several years EveryStep has also taken on other key health initiatives, including the Healthy Homes project. That multi-agency initiative launched in 2015 focuses on addressing health factors in low-income Des Moines households to reduce asthma-related hospitalizations in children. 

EveryStep is also in the early stages of developing a palliative care program, an initiative to  counsel patients and families to make informed decisions about health care choices as they approach the end of life.  

I recently sat down with Tray Wade, CEO of EveryStep, and a couple of members of his leadership team — Darby Taylor, vice president of Community Health Services, and Tammy Stapp, vice president of Clinical Services — for details about the changes that EveryStep has undergone and a look at what’s next for the organization. 

What is the significance of the rebranding to EveryStep?

Wade: We all just felt very passionately that we have a great story to tell, but it was kind of siloed so that when we would go out and try to tell that story, it was very choppy. That was when we decided that we have a very special story to tell, but we can only tell it if we unify under one name. That’s when we decided to go down that road and came up with EveryStep. That really was our tagline — “With you at every step.” It really took us longer than it should have to realize that that fits us very well. 


How are services supported financially? 

Wade: So much of what we do is contingent on the work our foundation does. Our foundation raises about $2.2 million a year. Some programs it supports completely. For example, with Amanda the Panda, all the services are completely free of charge to anyone who walks through the door who needs them. We do not turn anyone away within our hospice program, which is also made possible by the work of our foundation. The community has been incredibly generous and incredibly supportive of what we do, and we just couldn’t do it without their support.


What was the reasoning behind raising wages for your employees?

Wade: We had a large group of employees that we realized were out trying to help folks and raise them up out of poverty, and at the very same time [those employees were] needing to access some of those same services. And so ultimately we decided it was just the right thing to do. I’m not fooling myself into thinking $15 an hour is enough for a family to live on, but at least it’s a start to try to make sure that people are earning a livable wage for the incredible work they do for us. 


It actually went beyond the raise — we have a tiered health insurance premium system, so if you make below $35,000 a year, you pay a much, much lower premium then if you make above $65,000. We knew that people who are earning that kind of minimum floor wage were one catastrophic event away from really being in trouble. And so we implemented a PTO [paid time off] policy where people could cash out PTO if they had an emergent need. So it was just a number of things that we’ve looked at over the last few years to try to say, how can we better support the people that are really making this organization go? 


Do you think this will show a return on investment in lower staff turnover? 

Wade: That’s a great question. Actually our partners at United Way reached out and we’re really looking at this as almost a research project. They’ve been kind enough to both partner with us with some funding to dig deep into the impact it’s had. I would say it’s definitely too early to really tell. I can tell you that our turnover in those positions is lower today than it was in the six months prior to when we did it. 


What’s driving the growth in home care services? 

Wade: What I always describe is, we’re not a divide-and-conquer organization; we’re not interested in trying to take over the world. If a community reaches out to us and says, “Hey, we’re lacking services,” then that’s what really gets us excited that we can fill a need there. And one of the things we’ve seen in rural Iowa is many parts of the state are lacking home care services. Either they don’t have them at all, or it’s very limited. So we’ve really seen an expansion in our home care service area where we’re offering home care to more individuals across the state.


What’s next for the Healthy Homes project? 

Taylor: It’s been a community collaboration and partnership. Now EveryStep is going to be taking the lead on that going forward. So we’ve got trained educators who go into homes where children are identified as having asthma and do education and teaching and try to mitigate risks associated with asthma to reduce the clinic and emergency room visits, and we’re finding success with that and looking forward to expanding that as we go forward.


What’s been cool about [the project] — they may need medical intervention, but that isn’t usually the most prevalent reason. They may need help with cleaning supplies, all the way up to needing home remediation [such as cleaning black mold and installing exhaust fans]. Or it could be a refugee population that isn’t used to having carpeted homes and knowing that they need to vacuum. … When you get into the homes, you can really start to see that impact.


Do you think the program will be expanded?

Taylor: We’d love to be able to expand that farther than our current service areas, if we could. We look at identifying as many children as we possibly can through multiple referral sources and working with different providers in the community to get those families.

Wade: We’ve had some conversations with some of the Medicaid managed care companies who have reached out and said we’re willing to partner with you on this topic and benefit our population, and so that would be something that we’re expecting to happen that would be pretty cool for our next year coming up.


How has Amanda the Panda changed since taking that on in 2014?

Stapp: Historically, Amanda the Panda had been known as an organization that served only children — and that’s sort of a myth. At least today, Amanda the Panda serves anybody who is suffering from grief and loss. And that can be grief and loss associated with the death of a loved one, but it also can be life-changing events that create grief and loss and are disruptive to life. And so one of our strategic initiatives, probably the biggest change that we’re positioning for right now, is helping our communities know that EveryStep is committed to being an expert in grief and loss care. Some of that can come through our Amanda the Panda program, which focuses on traumatic loss. But we also have a whole bench of bereavement care specialists in our hospice program who help families deal with the death of a loved one through hospice. Many folks don’t realize that you don’t have to have a loved one enrolled in hospice in order to access those services. 


Tell me about the palliative care pilot program. 

Stapp: So many of the folks that we provide services for we know have complex serious health conditions. It was fairly apparent to us that there would be some benefits for individuals to have access to palliative care, which is really a skilled experience-guided conversation with somebody to make some decisions about their own health care choices. Through the generosity of Telligen providing a $50,000 grant, we were able to launch our palliative care program last January. 


We are in the process right now of partnering with Madison County health care professionals in implementing a palliative care clinic right on the hospital campus as a way of testing a rural model. One of our underpinning interests in all of this was how can we make a difference in getting access to Iowans who live in the rural areas where right now they don’t have access to these services? We’re hopeful that we’ll be able to show sustainability for this palliative care clinic, with the idea that we would replicate it where it makes sense.


What other projects are you working on? 

Wade: One of the things I pride us on is that we’re very innovative, and we’re willing to work with others and collaborate. Just in the past year we’ve started a community garden. We wanted to support these young families — whether it’s moms-to-be or moms who just had a baby — to make sure that they were able to get fresh produce, which isn’t always affordable or easily accessible. So we started a community garden where they’re able to come here right on our campus. Both families and our staff contribute because they are often working in the gardens. But also with the garden, we can make sure that our staff are armed with fresh produce when they head out [to visit clients].


What else is important to know about EveryStep?

Wade: We’d be remiss if we didn’t mention the reliance we have on volunteers and community members who are willing to step forward and help with our programs. And we plan on continuing to grow and to look at where we can be of service, both with expanding the programs that we have today and some of those newer programs. How can we continue to make an impact and work with our other community partners to really make sure people who are in a vulnerable place are getting the services they need?