Mass. should tame its Wild West of unregulated home care

Thank you for highlighting the urgent need to regulate nonmedical home care in Massachusetts (“Home care workers should be licensed and regulated,” Editorial, Dec. 9). As you note, many private home care workers currently operate without required training or oversight despite assisting older adults and people with disabilities with deeply personal daily tasks. This lack of standards places both clients and workers at risk.

Licensing, however, should be more than a formality. It must mark the beginning of a broader commitment to professionalizing and supporting this essential workforce. Through my work with GPS Group Peer Support’s MASStrong, a state-funded program that provides training, peer-support groups, and trauma-informed resources for health care workers in Massachusetts, including home health aides, nursing home workers, and personal care attendants, I have heard firsthand accounts of low wages, emotional strain, unstable schedules, and limited training. These stories make clear that regulation must be paired with real investment: fair pay, benefits, safe working conditions, mental health and peer support, and ongoing education.

Demand for home care workers is rising rapidly, yet they remain among the lowest-paid in health care. If Massachusetts wants a stable, competent workforce capable of supporting an aging population, we must ensure that licensure comes with the respect, resources, and career pathways these caregivers deserve. Licensing is only the first step.

Liz Friedman

Cofounder and CEO

GPS Group Peer Support

Northampton

The editorial “Home care workers should be licensed and regulated” underscores the urgent need for stronger standards in home care. Licensing, training, and oversight are all essential protections, but the piece overlooks a population for whom these safeguards are especially critical: behavioral health patients living with severe mental illness and complex medical conditions.

As the CEO of a home health care agency serving some of the Commonwealth’s most vulnerable behavioral health patients, I see daily how essential proper training and certification are to properly serving this population. Our typical patient is over 50, with between 10 and 15 comorbidities, and relies on highly skilled clinicians who can navigate significant medical, behavioral, and social complexities.

Undertrained caregivers are more likely to have patients who end up back in the emergency department, a serious concern given that complex behavioral health patients represent a relatively small fraction of the patient population yet drive a significant portion of health care spending. The last thing our hospitals need is this additional strain.

Without the proper care of well-trained and certified clinicians, these individuals are at a heightened risk of preventable hospitalizations, poor outcomes, and fragmented care. Lawmakers should move swiftly to enact these protections.

Joseph McDonough

Founder and CEO

Innovive Health

Medford

Massachusetts prides itself on being a national leader in health care yet continues to tolerate one of the most dangerous gaps in its long-term care system: the lack of licensing and oversight for privately paid home care agencies. At a time when more older adults and people with disabilities want to remain safely at home, the state still allows anyone to open a home care agency with no required training, no background checks, no standards, and no accountability.

The House has rightly passed legislation to finally create a licensing and regulatory system. But as the Globe’s editorial notes, passing a law is only half the job. The real failure comes when the state never writes the regulations needed to make the law real. That happened in 2017, when Massachusetts enacted home health agency reforms that still have never been implemented. The Department of Public Health did not issue the required regulations.

This is not because regulations are difficult. Massachusetts could easily adapt standards already used by Medicaid programs or by the 30 states that regulate home care. A special commission on home care licensing completed the background work years ago. Failing to act is not a matter of technical complexity — it is regulatory abandonment.

When state agencies do nothing, two groups suffer: vulnerable elders and people with disabilities, who risk receiving incompetent or unsafe care from unvetted workers; and caregivers, who are thrown into complex situations without training, support, or protection.

Good home care agencies support this bill because it would level the playing field and eliminate bad actors who hide in an unregulated market. If the Senate passes the legislation, the Healey administration must do what the Baker administration failed to do: write and enforce the regulations without delay.

James A. Lomastro

Conway

The writer is a member of Dignity Alliance Massachusetts and was an administrator in health care for 35 years. He was caretaker for his parents for 10 years.