Legislature Acts to Bring Oversight to Massachusetts’ Unregulated Home Care Industry

The Massachusetts Legislature today passed a bill that establishes a licensure process for home care agencies to ensure that consumers receive quality non-medical services and home care workers are protected.

 

An Act to improve Massachusetts home care creates a licensing and oversight process for home care agencies whose staff provide care such as dressing, meal preparation, bathing, companionship, and other tasks that help them safely age in place.

 

The legislation ensures the safety and security of residents who rely on home care workers, who often provide significant support to not only the individuals utilizing their services but to their families as well.

 

“This legislation takes important steps to improve services for seniors, and to ensure a safe work environment for home care workers,” said House Speaker Ronald J. Mariano (D-Quincy). “I want to thank Chairman Stanley for his work on this legislation, as well as all my colleagues in the House and our partners in the Senate for voting to send these important reforms to the Governor's desk for her signature.”

 

“Aging in place should offer peace of mind and comfort to individuals and their loved ones—not uncertainty about who enters their homes,” said Senate President Karen E. Spilka (D-Ashland). “With this legislation, we are establishing critical accountability in an industry that serves countless families but has operated without consistent vetting standards. This bill will give older adults and their loved ones the assurance they deserve while supporting a workforce that is entitled to recognition for the essential work it does. I applaud Senator Jehlen for her unwavering leadership on this legislation, Senator Brownsberger for his stewardship of the conference committee, each Senator for their support, and our colleagues in the House for getting this to the Governor’s desk.”

 

“Once again, the House and Senate answer the call to meet the needs of our older adults and prioritize aging in place,” said Representative Thomas M. Stanley (D-Waltham). “This legislation follows up last session’s landmark Long-Term Care reform law by strengthening another key pillar of the Commonwealth’s continuum of care for older adults and individuals with disabilities—home care. At a time when our aging population is growing and demand for home care is expected to increase, the licensing and oversight process established in this bill for home care agencies is needed more than ever to protect consumers, their families and home care workers. The work ahead involving the commissions on family caregiving and long-term care financing will be incredibly important to improve supports for our family caregivers and address the affordability of long-term services and supports for the middle class. I’m grateful to Speaker Mariano for his leadership on these crucial issues and to my fellow conferees for their efforts to produce such a comprehensive bill.”

 

“The House and the Senate share a commitment to protecting vulnerable people who need home care,” said Senate President Pro Tempore William Brownsberger, Senate Chair of the conference committee. “Senator Jehlen and Representative Stanley have done a great job working together to create a strong bill speaking to that commitment.”

 

“This legislation will make a meaningful impact on the lives of our Commonwealth’s older residents and ensure that they are receiving the safe and responsible care that they deserve,” said Representative Frank A. Moran (D-Lawrence), Second Assistant Majority Leader and member of the conference committee. “This legislation would not have been possible without, as well as the leadership of Chair Thomas Stanley and my fellow conference committee members, as well as Speaker Ronald Mariano for making this bill a priority this session.”

 

“Everyone—consumers and workers—will be safer and better served with home care licensure in place,” said Senator Patricia Jehlen (D-Somerville), lead sponsor of the legislation and a member of the conference committee. “This legislation is the culmination of years of collaboration with advocates representing older adults, care providers, unions, and regulators to ensure all agencies are vetted, workers are protected, and consumers receive high-quality care. The commissions on long-term services and supports and family caregiving are important next steps in providing more affordable options for our residents to access care and services. I am grateful to the Senate President, her team, my co-chair Representative Stanley and his team, along with my fellow conferees.”

 

“The bipartisan support for this bill in both the Senate and the House showcases the commitment within both chambers to keep aging residents in Massachusetts,” said Senator Ryan Fattman (R-Sutton), a member of the conference committee. “The protections created in this bill will give families the ease of mind that their older relatives will receive safer and higher-quality care at their homes through more training, oversight, and accountability in the licensure process and beyond. I am grateful for the partnership and swift actions of my fellow Conferees to bring forth this final version of the bill to help ensure a higher standard of home care in the Commonwealth.”  

 

The bill tasks the Executive Office of Health and Human Services (EOHHS) with implementing the licensure process and grants the secretariat the authority to approve licenses, survey and investigate home care agencies, and impose fines when appropriate.

 

Under the bill, home care agencies would be required to disclose anyone with at least a 5 percent ownership interest in the agency, carry workers compensation and liability insurance, and provide appropriate levels of training for their employees.

 

Having passed the Legislature, the bill now goes to the Governor for her signature. Details of the legislation are below.

 

Strengthens Care Providers and Gives Families Peace of Mind

The bill creates a licensure process for home care workers to ensure peace of mind for families, safety for people receiving care, and a high level of integrity for all home care workers. EOHHS would create the licensure structure, which would include background checks. A worker’s driving record would also be checked if they provide transportation to their client.

 

It sets annual training and competency requirements, which would include:

• Confidentiality and privacy rights of home care consumers;
• Infection control and communicable diseases;
• Handling of emergencies, including safety and falls prevention;
• Observing, reporting, and documenting changes in home care consumer needs and environment;
• Identifying and reporting suspected abuse, neglect, or theft; and
• Understanding Alzheimer’s disease and dementia, including person-centered care, activities of daily living, safety, and dementia-related behaviors and communication.

 

Develops Oversight to Promote Transparency and Accountability

• Grants the Executive Office of Health and Human Services (EOHHS) the ability to fine any person or entity that represents themselves as a home care agency without proper licensure or violates any other rules and regulations developed as a result of this act.
• Grants EOHHS the ability to work with the Executive Office of Aging and Independence (AGE) and the Department of Public Health (DPH) on surveying and investigating home care agencies to ensure compliance with this act.
• Requires EOHHS to conduct a suitability review for all licensure applicants, including for all individuals with at least a 5 per cent ownership interest in the agency, and a review to ensure all applicants have sufficient financial capacity to provide a minimum standard of care.
• Helps families and individuals in need of home care connect with a properly checked and licensed home care agency. Requires EOHHS to post a list of licensed agencies online. Makes clear that unverified entities cannot advertise themselves as a home care agency without state licensure.
• Establishes standards for consumer-specific service plans and contracts, including a description of services, total cost of care, and agency contact information.
• Establishes quality metrics and standards for monitoring home care agency performance.

 

Ensures Workforce Protections

• Establishes procedures to ensure home care workers have safe working conditions, adequate training, and a process for submitting complaints.
• Requires licensed home care agencies to have coverage for worker’s compensation and liability insurance, and to provide adequate equipment and supplies to home care workers.
• Creates the Home Care Worker and Consumer Abuse Stakeholder Advisory Committee to study and make recommendations on standards and procedures for addressing abusive treatment, including physical, verbal, mental abuse, and bullying, of home care workers, PCAs, home care consumers, and family members, including:  

o   Reporting abusive treatment and debriefing after incidents of abusive treatment;

o   Tracking and retaining records of abusive treatment;

o   Informing home care workers of potentially unsafe working environments; and

o   Training for all employees of home care agencies, including on escalation cycles and effective de-escalation techniques.

• Grants PCAs anti-discrimination protections to shield them from harassment or discrimination based on sex, race, and religion.

 

Seeks Advice and Informing Future Work

• Creates a panel—the Home Care Oversight Advisory Council—to advise EOHHS on licensing requirements. The council would review existing licensure, reporting, and oversight requirements across the long-term care services and supports systems; home care agency licensure requirements in other states; how to ensure the licensure process aligns with and avoids duplication of licensure for home health agencies and with the existing oversight of Aging Service Access Points under the Home Care Program; and how to develop a process for the Commonwealth to conduct a statewide home care market analysis.
• Creates a special commission—the Family Caregiver Commission—to study family caregiving policy in Massachusetts. The commission would report on the current landscape of all state-funded efforts in caregiving research, clinical care, institutional and home-based and community-based supports, along with the feasibility of allowing spouses to serve as paid caregivers in the MassHealth program.
• Creates a special commission—the Long-Term Services and Supports Commission—to explore the idea of a possible state program which people would pay into and from which older and retired adults would receive long-term services or supports.

 

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Statements of Support

Jake Krilovich, CEO of Home Care Alliance of Massachusetts:

“For more than fifteen years, we have worked to establish common-sense standards for home care providers across Massachusetts. Passage of this bill will mark a pivotal moment for the industry and for families who rely on home care services. Consumers will have greater peace of mind knowing their providers are held to consistent standards of quality and accountability. We thank the Conferees for their swift action on this bill. We are grateful to Senator Pat Jehlen and Representative Tom Stanley whose longstanding leadership and commitment to this issue was critical to today’s milestone.”

 

Julie Watt Faqir, Executive Director of Home Care Aide Council:

“We would not be here today celebrating the Conference Committee’s advancement of this important home care consumer protection legislation without the leadership and steadfast support of Senator Pat Jehlen and Representative Tom Stanley.  Together, they have served as the lead supporters of this legislation and have worked tirelessly to ensure our state’s most vulnerable residents receive the care and support they need to live safely at home in their communities. The Home Care Aide Council joins our colleagues in expressing our gratitude to the Conferees, and Senate and House leadership for advancing House Bill 5627 to establish home care licensure with vital oversight, accountability and standards for all home care agencies.”    

 

Betsey Crimmins, Executive Director of Mass Aging Access:

“Our statewide ASAP network is grateful to the Conference Committee for its leadership in advancing H.5627 to license non-medical home care services which will ensure a quality network of providers for consumers and keep services affordable for those who rely on them. This Bill will strengthen our long-term services and supports network that allows older adults and people with disabilities to remain at home where they want to be, out of more costly settings, with better health outcomes, and a higher quality of life.”

 

Cari Medina, Executive Vice President of 1199SEIU United Healthcare Workers East

“As Massachusetts’ population ages, the demand for homecare is rising. Older adults and people with disabilities who receive care at home, and their families, deserve protection and strong oversight. This legislation establishes clear standards to ensure that those entrusted with caring for our state’s most vulnerable residents live up to that serious responsibility. We appreciate Chair Stanley, Speaker Mariano, and the entire Massachusetts House for their support of this critical legislation. We look forward to final enactment and working with the Legislature, Administration, and all stakeholders to implement the bill's many important reforms."

 

Chelsea Gordon, Massachusetts Government Relations Director for the Alzheimer’s Association:

“We applaud the passage of this important home care legislation, which will help ensure individuals living with dementia receive high-quality and safe care in their homes. Requiring dementia-specific training for all home care workers is a critical step toward building a workforce that is better prepared to meet the complex needs of the growing number of Massachusetts families affected by Alzheimer’s disease and other dementias. We also look forward to serving on the special commission to study a statewide long-term services and supports benefit program and ensuring people living with dementia and their caregivers are represented to help shape solutions that better support families in the future.”

 

Jennifer Benson, State Director of AARP Massachusetts

“Massachusetts older residents and their families are the winners today. This action will strengthen protections for people who receive home care, support the state's 1.4 million family caregivers, and help improve long-term care services for nearly 1.8 million older adults. These are important steps toward making it easier for people to live independently and age with dignity in their homes and communities. We commend the Massachusetts House and Senate for putting the needs of older residents and their families first.”

 

Elissa Sherman, PhD, President of LeadingAge Massachusetts

“The inclusion of a commission to examine new approaches to how the Commonwealth finances long-term services and supports (LTSS) is an important step toward addressing one of the most urgent challenges facing older adults and their families. Too many struggle to afford the long-term care they need, and the human and financial consequences will only grow more severe as our population ages.  Developing a sustainable financing solution is an absolute necessity if we are to ensure that older adults can access essential care without placing an overwhelming financial burden on themselves or their families. We are grateful to Chairman Stanley and Chairwoman Jehlen for their leadership in recognizing the urgency of this challenge and ensuring that Massachusetts take this meaningful step toward addressing it. We look forward to working with policymakers and stakeholders to advance lasting solutions that meet the needs of older adults and families today and prepare the Commonwealth for generations to come.”

 

Marc Cohen, PhD, Professor and Co-Director LeadingAge LTSS Center @UMass Boston

“I am thrilled that the Legislature has taken this important step toward addressing the growing challenge of long-term care financing. By establishing this Commission, Massachusetts is bringing together the leaders and expertise needed to develop practical solutions that strengthen financial security for older adults, people with disabilities, and their family caregivers. I applaud the Legislature and the Committee Chairs for their vision and leadership in advancing this critical initiative."