The Massachusetts House last month passed a bill to establish a licensing scheme for private-pay home care agencies, which would put protections in place for both workers and consumers. The bill was the result of a 2021 report by a special commission studying home care licensing and was the product of negotiations between organizations representing home care agencies, consumers, and workers, all of which now support the bill. The Senate has not yet announced plans to take up the bill, but the Senate should pass the bill and Governor Maura Healey should sign it.
The need for a new law was highlighted in a House floor speech by state Representative Thomas Stanley, a Waltham Democrat who cochairs the Joint Committee on Aging and Independence and sponsored the legislation with committee cochair state Senator Pat Jehlen, a Somerville Democrat.
Stanley spoke of a man who hired a caregiver to help his wife, who has Alzheimer’s disease, with toileting, bathing, and dressing. The couple went through a half dozen caregivers over nine months before finding one who was familiar enough with Alzheimer’s to know how to communicate with the woman and help get her into a routine. “With no standards in place for this type of training, consumers do not know what they are getting,” Stanley said.
Stanley told the editorial board that people are often looking for caregivers on short notice. “You have a couple of days to search on the internet or someplace else to find appropriate care, and often times you’re not getting someone that’s been vetted,” Stanley said. “This would give consumers peace of mind.”
The bill would create a state licensing system for home care agencies, through which state regulators would review applicants’ suitability and financial capacity. The state would post online a list of licensed home care agencies and establish metrics for evaluating agency quality.
Under the legislation, agencies would be required to conduct background checks for all home care workers and provide them with training on specific topics including fall prevention, understanding dementia, identifying abuse, and infection control. Agencies would be required to give consumers written contracts outlining the services provided and a rate.
The bill would also require agencies to maintain worker’s compensation and liability insurance and to have procedures in place for consumers and workers to submit complaints.
As of June 2020, 30 states had some form of licensure requirements for home care agencies. But Massachusetts’ current requirements apply to only some agencies. The state has 24 regional Aging Services Access Points, organizations that contract with home care agencies to provide services through Medicaid or state-funded home care programs. These organizations oversee the home care agencies and ensure they comply with state and Medicaid requirements.
However, if a home care agency doesn’t accept these contracts and takes only private-pay clients, the state has no oversight other than requiring them to register as a business. There is no way to know how many agencies fall into this category.
Associations representing home care agencies support the bill because it would level the playing field by requiring all agencies to operate with similar standards and oversight.
Harrison Collins, director of legislative affairs for the Massachusetts Home Care Alliance, said the current system “creates a lack of confidence in who’s coming into your home.” Collins said agencies he represents want to eliminate “bad actors.”
Equally important, if the bill becomes law, the Healey administration must write regulations to implement the new system. While that should happen as a matter of course, it doesn’t always.
Former governor Charlie Baker signed a law as part of the fiscal 2018 budget creating a licensing scheme for a different but related category of businesses — home health agencies, which provide at-home medical support. But the law, which went into effect Dec. 31, 2017, was never implemented because the Department of Public Health never wrote regulations. (Many home health aides are paid and regulated through Medicare or Medicaid, but those paid privately fall into a regulatory gap.) A spokesperson for the Department of Public Health said when Public Health Commissioner Robbie Goldstein realized the Baker administration never wrote those rules, he directed his team to begin developing them, and that work is ongoing.
If the Legislature and Healey approve the home care aide bill, the administration shouldn’t let such a long delay happen again.
Massachusetts has an aging population, and having high-quality home care is vital to keep elders out of nursing homes and in their communities and to allow people to be discharged more quickly from hospital stays. Lawmakers should close gaps in regulation to ensure that anyone entering a vulnerable person’s home is properly trained, vetted, and supported.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
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