Countries must do more to support this essential but neglected workforce
Thank you for highlighting the urgent need to regulate non-medical home care in Massachusetts (“Home Care Workers Should Be Licensed and Regulated,” editorial, December 9). As you point out, many private home care workers currently assist elderly people and people with disabilities with very personal daily tasks, yet do so without the necessary training or supervision. This lack of standards puts both customers and employees at risk.
However, a license is more than just a formality. This must mark the beginning of a broader effort to professionalize and support this essential workforce. GPS Group Peer Support's MASStron is a state-funded program that provides training, peer support groups, and trauma resources to Massachusetts home health aides, nursing home workers, personal care attendants, and other health care workers. Through my work with this program, I have heard firsthand stories of low pay, emotional strain, unstable schedules, and limited training. These examples make clear that regulation needs to be combined with real investments in fair wages, benefits, safe working conditions, mental health and co-worker support, and continuing education.
Despite the rapidly increasing demand for home care workers, healthcare workers remain among the lowest paid. If Massachusetts wants a stable and capable workforce to support its aging population, it must ensure that these caregivers are licensed with the respect, resources, and career paths they deserve. Obtaining a license is only the first step.
liz friedman
Co-founder and CEO
GPS group peer support
northampton
Safeguards are especially important for behavioral patients
The editorial, “Home care workers should be licensed and regulated,'' highlights the urgent need for stronger standards in home care. Licensing, training, and supervision are all important safeguards, but this article overlooks the population for whom these safeguards are especially important: behavioral health patients living with severe mental illness or complex medical conditions.
As the CEO of a home health agency that serves some of the most vulnerable behavioral health patients in the commonwealth, I realize every day how important proper training and certification is to properly serve this population. Our typical patient is over 50 years old, has 10 to 15 comorbidities, and relies on highly skilled clinicians who can navigate significant medical, behavioral, and social complexities.
Poorly trained caregivers are more likely to have patients end up returning to the emergency department, a serious concern given that patients with complex behavioral health conditions represent a relatively small portion of the patient population but account for a significant portion of health care spending. The last thing we want is for our hospitals to take on any further burden.
Without proper care from well-trained and certified clinicians, these people are at increased risk of preventable hospitalizations, poor outcomes, and fragmented care. Lawmakers should act quickly to enact these protections.
joseph mcdonough
Founder and CEO
innovative health
medford
Reforms are implemented, and if they are not implemented, they are meaningless.
Massachusetts prides itself on being a national leader in health care, but it continues to tolerate one of the most dangerous gaps in its long-term care system: a lack of licensing and oversight of private paid home care agencies. Even though more seniors and people with disabilities want to live safely in their homes, states still allow anyone to open a home care agency without the necessary training, background checks, standards, or accountability.
The House of Representatives finally duly passed a bill to create a licensing and regulatory system. But as the Globe editorial points out, passing laws is only half the job. The real failure occurs when states never write the regulations necessary to make the law a reality. That's despite Massachusetts enacting home health agency reforms in 2017 that have yet to be implemented. The Department of Public Health did not issue the necessary regulations.
This is not because it is difficult to regulate. Massachusetts could easily adapt standards already used in 30 states that regulate Medicaid programs and home health care. The Special Committee on Licensing Home Health Care completed its behind-the-scenes work years ago. Failure to act is not a matter of technical complexity, but regulatory abandonment.
If state institutions do nothing, two groups will suffer. One is the vulnerable elderly and people with disabilities who are at risk of receiving incompetent or unsafe care from unvetted workers. and caregivers who are thrown into complex situations without training, support, or protection.
Top home care agencies support this bill because it will level the playing field and eliminate bad actors lurking in an unregulated market. If the Senate passes the bill, the Healey administration would have to do what the Baker administration failed to do: create and enforce regulations without delay.
James A. Lomastro
conway
The author is a member of the Massachusetts Dignity Alliance and worked as a healthcare administrator for 35 years. He had been caring for his parents for 10 years.
