BOSTON — Home care workers and older adults receiving non-medical services would gain expanded protections under legislation to bolster oversight of the sector that’s experiencing soaring demand in concert with the state’s rapidly aging population.
The House Ways and Means Committee advanced legislation Tuesday (H.4706) that directs the Executive Office of Health and Human Services and other state agencies to develop a licensing process for home health care agencies that offer services like assistance with eating, going to the bathroom, bathing, dressing, other activities of daily living, housekeeping and laundry.
Officials could suspend or revoke the licenses of home care agencies that violate state requirements, and they could also levy a fine of up to $500 daily for noncompliance. Home care workers must also undergo background checks, according to the bill.
Rep. Tom Stanley, co-chair of the Joint Committee on Aging and Independence, told State House News Service the bill aims to ensure that “everyone is getting quality services,” including those who are paying for private care out of pocket.
“Oftentimes, families go through two, three, four agencies before they can get the right one where they feel comfortable with them coming into the home of their parent and taking care of them,” said Stanley, who sponsored an earlier version of the home care legislation. “This would give people peace of mind that they know if they’ve been licensed and trained, so they’ll have a level of comfort.”
The Executive Office of Health and Human Services must conduct a suitability review of all licensure applicants, including for individuals with at least 5% ownership interest in the agency, and ensure they have the financial capacity to provide services under the redrafted bill.
A Home Care Oversight Advisory Council would help the Executive Office of Health and Human Services develop and implement licensure regulations and ensure those parameters align with standards that are already in place for the state’s 24 aging service access points, which contract with the state to deliver services.
“For the home care vendors that we work with, we already do a full vetting process per [Executive Office of Aging and Independence] standards,” said Betsey Crimmins, executive director of Mass Aging Access, which represents aging service access points and area agencies on aging.
“But there’s plenty of other companies out there running home health agencies that aren’t licensed,” Crimmins said. “This creates kind of a level playing field so every home health agency in the state will now have a requirement similar to what ASAPs put their vendors through.”
Stanley said it is unclear how many home care agencies are operating in Massachusetts due to the current lack of oversight.
An October 2021 report from the Home Care Licensing Commission — established under a 2020 law — had noted “gaps in the current oversight of home care agencies” and said “no state agency currently licenses home care agencies.” Meanwhile, 30 other states had some type of licensure requirement for home care agencies as of 2020, according to the report.
Jake Krilovich, executive director of the Home Care Alliance of Massachusetts, said the organization has pushed for licensure for 15 years.
“Our association gets two or three calls per week of people trying to start an agency,” Krilovich said. “I think the vast majority of them, almost all of them, are well-intended and trying to do the right thing, and they’re entrepreneurs, but I think just that volume alone of phone calls that we’re receiving to start businesses sort of illustrates the potential for how many entities could be out there.”
The legislation would also establish the Home Care Worker and Consumer Abuse Stakeholder Advisory Committee, tasked with making recommendations to the Executive Office of Health and Human Services about handling abusive treatment of workers, personal care attendants and older adults.
The panel would conduct studies and produce reports that address reporting abuse to home care workers’ employers and state agencies, tracking and maintaining records of abusive treatment, informing workers about potentially unsafe working environments, employee training and employer internal policies. The legislation defines “abusive treatment” as physical, verbal and mental abuse directed at or carried out by consumers, family members, caregivers and other individuals who are present in the home where services are provided.
A home health aide in East Boston said she was stabbed more than 30 times in January by a client she’d worked with for two years, according to Boston 25 News. About half of health care workers have also been verbally attacked in recent years, said Harrison Collins, legislative affairs director at the Home Care Alliance of Massachusetts.
“Agencies that can best train their staff on how to handle that, with walking into a stranger’s home, is the best for both the patient and for the worker themselves,” Collins said of the bill. “Overall it will just increase professionalism and a level of safety for all involved.”
Policies must be developed to ensure home care workers “have safe working conditions, adequate safety training and a process for submitting complaints,” according to the bill. Home care agencies must provide coverage for worker’s compensation and liability insurance, maintain a payroll process that follows state and federal labor and wage laws, and ensure their staff have “adequate” equipment and supplies.
Home care workers would need to receive annual and ongoing training tied to confidentiality and privacy rights of consumers; infection control; handling emergencies; reporting changes in the consumer’s needs or environment; identifying and reporting suspected abuse, neglect or “misappropriation of property”; understanding Alzheimer’s and dementia; and employee rights.
Stanley said the elder home care bill builds upon the 2024 long-term care reform law for nursing homes and assisted living residences. Massachusetts is also facing an explosion in its 85-plus population, and Crimmins pointed out all members of the Baby Boomer generation are now over the age of 60.
“This is the third leg of the continuum of care for older adults,” Stanley said. “This would be a really significant bill to finish out the three major improvements in the continuum of care for seniors.”