Committee hears broad support and concerns for statewide nonmedical home care licensure bill

Lawmakers and stakeholders from across the home care ecosystem testified in favor of H.789 / S.470, an act to improve Massachusetts home care that would establish a statewide licensure system for nonmedical home care agencies and entities that advertise home care services.

Julie Watts, executive director of the Home Care Aid Council, told the Joint Committee on Aging and Independence the council’s members include roughly 100 nonprofit and for-profit home care agencies that collectively employ more than 50,000 home care aides. She urged passage of a licensure system that would create baseline standards for agencies, citing background checks, minimum service-plan standards, training and competency requirements, workers’ compensation and liability insurance, complaint and payroll processes, and survey-and-investigation authority for regulators.

Supporters’ case: Multiple provider groups and advocates framed the bill as a consumer- and worker-protection measure. Jake Krolovich, executive director of the Home Care Alliance of Massachusetts, said the industry has sought licensure for 15 years and that the bill follows recommendations of the Home Care Licensure Commission created in section 97 of chapter 227 of the Acts of 2020. Krolovich said licensure would “level the playing field” with baseline standards that protect consumers and the workforce and reduce the risk of unvetted operators who fail to follow wage-and-hour rules or background checks.

Providers’ perspectives: Visiting Angels owner Larry Michael described serving more than 20 communities and said agencies should meet minimum insurance, worker compensation, written care plans and complaint procedures. Anthony Soto of Soto Home Care and smaller private providers testified that standards are needed to expose “bad actors” who dissolve and reappear under new names and to require basic protections such as training and proper pay.

Union and system-level concerns: Tim Foley of SEIU 1199 urged passage and added a caution about rapid private-equity ownership of home care and hospice providers; he cited a Health Policy Commission report documenting numerous private-equity transactions in home care and argued that stronger state oversight is needed to protect quality as investment grows.

Questions and caveats: Witnesses and legislators sought clarification about scope and enforcement. Committee members asked whether informal, unpaid neighborly help or occasional paid help would fall under licensure. Providers and advocates said the bill is intended to cover agencies and entities that advertise or present themselves as home care providers and to cover compensated and advertised services; informal volunteer help or occasional favors by a neighbor would not generally be the target of this licensure scheme. Testimony indicated the bill prescribes fines and sanctions for advertising or providing services without a license, and that the Executive Office of Health and Human Services (EOHHS) would develop implementing regulations in consultation with other agencies.

Concerns about cost and enforcement were raised. Committee members and witnesses noted the state has not yet provided a clear implementation cost estimate; sponsors and advocates said enforcement and regulatory capacity would need definition in the rulemaking process. John Sneath, CEO of Tribute Home Care, cautioned that licensure design must avoid creating burdens that reduce competition or push smaller agencies out of the market; he also observed that licensure alone does not guarantee enforcement if oversight resources are not sustained.

Dementia training: The Alzheimer’s Association and family caregivers urged mandatory dementia-specific training in any licensure framework. Susan Ankoviak of the Alzheimer’s Association said trained home care workers can reduce avoidable hospital visits, support family caregivers, and better manage safety risks. Family members described repeated problems finding caregivers with dementia-specific knowledge and recounted incidents where insufficient training led to injury or distress.

No formal committee vote on H.789 / S.470 was recorded at the hearing. Advocates from provider associations, aging networks, unions, consumer groups and families asked the committee to report the bills favorably and to ensure rulemaking balances consumer protections with affordability and workforce recruitment.