Dear Neighbor,
Last Thursday, the Senate passed a bill which combines two of my bills: Home Care Licensure and Long Term Services and Supports Insurance commission. Both bills will help ensure that people can age safely with as much independence as possible. In the photo, Vicki Halal (my chief of staff) and I celebrated with advocates who helped draft the Home Care Licensure bill: Chelsea Gordon, Alzheimer's Association; Jake Krilovich, Home Care Alliance; Vicki, Jamie Willmuth, 1199SEIU; me; and Julie Watt Faqir, MA Home Care Aide Council.
Home Care Licensure
Most of us will need some assistance with activities of daily living at some point. Imagine not being able to take a shower or use the toilet by yourself and you don’t have anyone in your house to help.
If you qualify financially, you can get home care through your local Aging Service Access Point (ASAP.). The person who comes to help you will be screened and trained and supervised by an agency approved by the ASAP. (The photo is of legislators, staff, and clients at the legislative breakfast of Mystic Valley Elder Services.)
If you have to pay privately, the person you hire will be from a growing number of agencies, many for-profit, that have no requirements to meet any standards or accountability. Imagine hiring someone to come into your home to care for you in very intimate situations. Wouldn’t you want that person to come from an agency that screened, trained and supervised them? (The workers themselves aren’t licensed, unless they work as Personal Care Assistants, paid by the state.)
In fact, we don’t even know how many home care agencies there are. Mass is one of only 4 states that don’t license home care agencies.
The home care licensure bill was based on the 2021 report of theHome Care Licensure Commissionand is supported by providers, unions, and consumer advocacy groups: AARP, the Alzheimer’s Association, Dignity Alliance, Home Care Aide Council, Home Care Alliance, the ASAPs, and SEIU 1199. It will require all home care agencies to be licensed, with license fees covering the state's administrative cost. They will have to meet suitability standards, and provide screening, training and supervision. TheGlobe editorialized in support of home care agency licensing in December, following anarticlein November about its importance. (In the photo with Somerville Cambridge Elder Services CEO Marta Corvelo and my co-chair of the Committee on Aging and Independence, Rep. Tom Stanley.
Of course, much of home care is provided by family members. The Mass. Healthy Aging Collaborative recently released a report revealing a"crisis point for America's 63 million family caregivers." AndSunday's Globe magazinefeatures a story about the challenges of caregiving across generations.
Home care licensure already passed the House; Senate Ways and Means combined it with LTSS Insurance commission, but my co-chair of the committee on Aging and Independence, Rep. Tom Stanley, and I can probably work out a way forward quickly.
Commission on Long Term Services and Supports (LTSS) Insurance
The bill also creates a commission on Long Term Services and Supports insurance, a step toward payroll tax-funded insurance.
Most of us will develop serious needs for long term carebefore we die and almost half will receive some paid care over our lifetimes. Most of us are unprepared for the cost of that care.
Older adults in MA are the second most financially insecure in the country. (The slide is from the2025 Elder Index for Boston.) There’s a big gap between older adults who are wealthy and those with fewer resources. 40% of older adults here don’t have the resources to pay for basic needs. They don’t have Long Term Care (LTC) insurance, they don’t have enough savings because of low pay over their working years, and more and more people are aging without defined benefit pension plans. Medicare doesn’t pay for Long Term Care. MassHealth only pays if you have low enough income and few enough assets.
At the same time, as older adults are a bigger share of the population, the cost of MassHealth coverage gets higher. Social insurance for LTC (paid for by will help individuals. It will also help the state if the insurance keeps people from qualifying for MassHealth by spending down their own funds.
Commonwealth Beaconpublished an article with this headline about the need for LTC planning. And the Globe's Shira Schoenberg wrote acolumn in favor of LTSS insurance with lots of information about the costs of care and private insurance and our aging population,
Sixteen years ago, one of Senator Ted Kennedy's last acts was to get the CLASS Act included in the Affordable Care Act. The CLASS Act would have created a social insurance program for LTC. But a few years later, the Obama admin said it was unaffordable and repealed it. Recently, Washington state adopted a plan for LTC insurance.
We took the first step last year in authorizing a feasibility study of LTSS financing options. Milliman consultants reported last year that actuarial study Taking this careful approach will avoid the failure of the CLASS Act. The next crucial step is to create a commission of stakeholders to recommend which approach to take in MA, which this bill does.
It's psst time to make a plan that will help people age with with more security, and help the state keep Medicaid costs more affordable. It won’t help immediately, but it is an important part of the affordability solution. Like all of us as individuals, we as a state should plan ahead for foreseeable costs.
Immigration Deportations Threaten All Health Care
The threatened end of Temporary Protected Status for Haitians, Syrians, and other groups will make the crisis in the long term care workforce even worse. (graph showing over 1/3 of home care workers are foreign-born and 27% are Latino is from a Boston Foundation report "Carework in Massachusetts.")
Assisted Living Followup.
Also last week: Following the tragic Gabriel House fire in Fall River last year, and the report of theAssisted Living Commission, on which I served, the Office of Aging and Independence issuednew safety regulations.
And last month,Attorney General Andrea Campbell issued regulationsfor consumer protections in assisted living residences.
Our Long Term Care bill created the assisted living commission, and alsogave assisted living residences the ability to continue offering basic, common-sense health services.
Assault on health care workers bill passes Senate
Last Thursday, the Senate also passed a bill addressing assaults on health care workers, a priority of the Mass. Nurses Association. Our bill makes such assaults misdemeanors rather than felonies, after hearing the concerns of disability advocates.
Songs of the month:
When I'm 64by the Beatles
Talking Wheelchair Blues,by Fred Small
Get Up and Go, by Pete Seeger
Stay in touch!
Pat Jehlen