In states that require licenses for barbers, manicurists, and massage therapists, home care agencies that provide non-medical support go surprisingly unsupervised, despite the serious vulnerabilities of the people who depend on them.
Massachusetts is one of four states that does not have a licensing process for private non-medical home care agencies, said Harrison Collins, legislative director for the Massachusetts Home Care Alliance. This industry association represents approximately 200 organizations that provide assistance with daily living, such as bathing, toileting, housework, and basic companionship.
“In many ways, it is easier to open a home care agency in the commonwealth than it is to open a pizza restaurant,” he wrote in a letter supporting the bill.
That may change soon.
Earlier this month, the Massachusetts House of Representatives passed a bill that would create licensing requirements and establish standards and oversight for non-medical home care agencies. The law focuses on home care providers, rather than individuals working in the field, such as the state's Personal Care Attendant Program. It proposes background checks for workers, mandatory training in skills such as infectious disease prevention and dementia care, transparency about services provided by government agencies and their costs, and protections for workers.
“The industry wants regulation,” said state Rep. Thomas Stanley, a Waltham Democrat and sponsor of the bill that passed the House earlier this month. “We want to get more quality people to take care of our loved ones.”
If passed by the Senate, the bill would be the latest in a series of health-care laws to address Massachusetts' aging population and nursing staff shortages, including two bills that would increase oversight of long-term care facilities and hospitals.
According to 2024 data from the Bureau of Labor Statistics, well over 100,000 people in Massachusetts work as home health or personal care aides, many of whom provide exceptional care that is both mentally and physically taxing for a modest salary. Their national average annual income was just under $17 an hour, the bureau reported.
It's not clear how many people rely on these services because of a lack of oversight in Massachusetts. The state operates 24 regional senior services offices and provides home care to 70,000 people, not including the thousands of people who receive care through private agencies. The lack of oversight of these private agencies leaves the door open to unscrupulous or inexperienced contractors, leaving families on the hunt for competent help at home.
“Anyone can now walk into town, get their shingles removed, and hire people to provide home care,” said Paul Ranzikos, coordinator of the disability advocacy group Dignity Alliance Massachusetts.
When Kirsten Hano was diagnosed five years ago, she had a successful career as an advertising account executive and was raising three sons. According to her husband, she founded Vermont's first girls' high school hockey team and contributed to an urban girls' coaching program.
“She always gave back,” Doug Hano said.
He works from home most of the time, but has a home care aide help him from 11 a.m. to 3 p.m.
Doug Hano said the quality of care for temporary workers varies widely. One employee was listening to an online class through earphones while helping his wife with lunch. Another employee left her staring at the television while an employee stared at her cell phone.
Doug Hano said of his wife, “When you have someone who's not that great, not very attractive, and doesn't know how to maintain energy and stay positive, she can get into some really tough situations.”
Under the proposed bill, agencies would need a three-year license through the state Department of Health and Human Services to operate. HHS will be able to inspect and investigate government agencies and have the power to suspend, revoke, and refuse to renew licenses. Penalties include a fine of $500 per day until the violation is resolved.
Anyone with ownership of more than 5% of a government entity must identify themselves and provide background information, including criminal and civil findings.
An April letter from SEIU 1199, a labor union representing about 60,000 home care workers across the state, noted that private equity is moving into the home care industry.
If passed, the bill's requirements for home care agencies would go into effect within one year.
Home Care Alliance's Collins said many agencies already meet the proposed standards. But with virtually no barriers to entry, a glut of companies puts those spending money on training and quality control at a disadvantage.
“They're being cut down by agencies that ignore the rules,” Collins said. “The end result is subpar care.”
According to Rep. Stanley's office, there are 1,500 home care agencies operating in the state.
Rebecca Gutman, vice president of home care for SEIU 1199, said the bill would also benefit workers. In addition to safeguards to ensure fair pay practices and workers' compensation and liability insurance, it proposes creating a reporting and tracking system for abuse complaints from both customers and workers.
“If you have an employer who is constantly harassing workers who have their homes invaded, there needs to be a process in place to protect those workers,” Gutman said.
Although the licensing requirements only apply to agencies, the protections from abuse would benefit anyone working in home care.
This year, Doug Hano found home care workers ranked 11 on a scale of 1 to 10.
“She knew inside and out how to work with Alzheimer's patients,” he says.
Then, about two months ago, her car broke down. She has not been able to cure it and is currently only able to take care of him at night when he goes on business trips.
He said it's good to have more agencies, but his wife's condition is deteriorating and he fears she may soon need several more hours of daily home care assistance. If the current caregivers are unable to fill that time, they may have to look again for someone they trust to care about Kirsten's well-being.
“I think it's mind-boggling that Massachusetts, which is pretty progressive, wouldn't do something…to make sure there's more training, more vetting, and more accountability.”
Jason Laughlin can be reached at jason.Laughlin@globe.com. Follow @jasmLaughlin.
