2025-04-14 00:00:00 - Joint Committee on Elder Affairs
2025-04-14 00:00:00 - Joint Committee on Elder Affairs
SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Morning, director process.
REP STANLEY - Okay. We're good. Good morning, everyone. My name is Tom Stanley. I'm the chair of the House, Committee on Aging and Independence. To my right is the Senate Chair, Patricia Jalen. And I just want to introduce a few people that are here. I have the new vice chair of the committee, Samantha Montano, Representative David DeCosta, Representative, Gentile, Leader Hode, and Representative Scarsdale. Got it. Alright. Thank you very much. We don't have, a whole lot of bills on the docket today, but they are important. And as usual, we take, legislators out of turn. So we do have one legislator here right now that wants to speak. Representative Donahue.
REP DONAHUE - HB 765 - SB 487 - Thank you. Thank you, everybody. Chair Stanley, chair Jalen, honorable members of the committee, thank you for taking me out of turn. I'm here in support of H 765 S 487, an act relative to councils on aging. This bill would allow directors to make staffing decisions if the municipal council on aging is an advisory council. This change would allow COA directors to ensure that their departments can meet the needs of their municipalities. Without necessitating a formal vote from their council this would increase the effectiveness of the directors to ensure that their departments can meet the needs125 of their municipalities without necessitating a formal vote from their council. This would increase the effectiveness of the director and the ability to meet the needs of older adults. This would increase the effectiveness of director and the ability to meet the needs of older adults. It also updates some ageist terminology in the bill. I wanna thank Chair Barber for her partnership, as well as Senator Montigny, who filed the legislation in the Senate. Essentially, what this does is it just updates the bill as councils on aging have changed from when this legislation was, originally filed. Thank you for your consideration. It was a refile and was reported favorably last session. I ask that it again be reported favorably and can answer any questions. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Representative Gentile?
REP GENTILE - Well, thank you very much. Pleasure to see you, representative. So are you saying, you're trying to fix you're trying to this bill would allow, say, a town manager or187 a city, let's say in a town in a town, would this allow the town manager to just make the appointments director?
DONAHUE - No. It allows the director of the COA.
GENTILE - The director of the COA. It allows the director of the COA to hire staff rather than the town manager?
DONAHUE - No. Rather than, the legislation, if it's an advisory council, actually calls for the, Council on Aging to make the appointment. So it requires a vote from a committee.
GENTILE - To make what appointment?
DONAHUE - To hire anyone.
GENTILE - To hire someone? Because, you know, I've been on the council on aging in Sudbury for 10 years. And, I'm familiar with the Council on Aging in Wayland and other councils on aging. And, those councils on aging haven't been making the hiring decisions. The town manager's been making the hiring decisions. Maybe in violation of state law, I don't know. But I'm just thinking that maybe this bill is trying to fix something that's not broken yet. We have I'll take a look at it. Is that House 765?
DONAHUE - Yes. Thanks. The bill came about because a community was looking to update their charter, I believe. And it was determined that what267 they wanted to do was out of compliance269 with mass general law.
GENTILE - Okay. Take a good look at that. Thank you very much.
STANLEY - Thank you. So I think correct me if I'm wrong, representative, but one of the issues here is the bill is addressing more of the small towns, which, have a regional director for several towns. So it gets a little confusing. Am I right?
DONAHUE - It's actually No. If they're if they're structured if they're structured so that the council on aging is an advisory council.
STANLEY - So it's how they were set up. Okay.
DONAHUE - Yeah. It made sense when the bill when this legislation was originally enacted. But as councils on aging have become much as senior centers have become much more, professionalized and less volunteer-driven. It's essentially a technical fix, and I do think it addresses something that has happened in reality, not something that isn't real. I'm sorry. No. Nope.
STANLEY - Thank you very much for that clear clarification. SHOW NON-ESSENTIAL DIALOGUE
332 Alright.332 Can I just take a second? Sure. Senator Jalen.
SEN JEHLEN - I just wanted to336 recognize that Senator Lovely is338 in the house, but she's not here, but she's, here virtually while she's there in her district welcoming secretary Howe,352 and she appreciates the ability to be here355 virtually. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Alright. So the first name I have on the list is, person is remote, Julie, Julie Watt Fahair from the Home Care Aid Council. Julie, are you here?
Alright. We'll we'll go to the, we'll go to a panel that's here in person.
SPEAKER5 - Excuse me. I'm can you hear me?
SPEAKER1 - Yes. Now we can.
SPEAKER5 - Okay. Sorry. I I was wasn't sure anybody could hear me when I was unmuting, and my camera's not working. I apologize.
SPEAKER1 - Okay.
JULIE WATT FAQIR - HOME CARE AIDE COUNCIL - SB 470 - HB 789 - R - I am Julie Watt Faqir, and I'm the executive director of the Home Care Aide Council. We are a nonprofit trade association whose members include 100 nonprofit and for-profit410 home care agencies that directly employ, supervise, and manager over 50,000 home care aids who provide personalized and supportive direct care services to elders throughout the Commonwealth. We are grateful to the chairs of the Joint Committee on Aging and Independence, Senators Jehlen and Rep Stanley, and the Committee for the Leadership and Consideration you have shown during drafting of S 470 and H 789, an act to improve Massachusetts home care. The council supports these bills as drafted and the creation of a licensure system that would establish baseline standards for agencies to ensure a quality network of providers for home care consumers and keep services affordable for those who rely on them. Massachusetts does not currently license nonmedical home care services that are essential to the Commonwealth's long term services and support systems that allow individuals to remain safely in their homes.
As a member of the home care licensing commission, which was established in section 97 of chapter 227 of the acts of 2020, I participated in the state's effort to study and make recommendations to establish a statewide licensing process for Massachusetts home care agencies for the protection of consumers, home care agencies, and home care professionals. The commission was required to study and report to the legislature on the following, current licensure, reporting and oversight requirements across the long term care services industry and support systems, and other relevant state agencies, including the provider monitoring conducted by the aging service access points to avoid duplication of conflicting requirements, home care agency licensure requirements in other states, processes for implementing a520 statewide home care agency licensing522 process, and current licensure processes in the home care health care industry in Massachusetts. The Home Care Aid Council supports the legislation as drafted, which closely reflects the findings of the report of the Home Care Licensure Commission, particularly in the following ways.
They would it would require an agency or entity providing home care services to acquire a license and would authorize the secretary of EOHHS in consultation with550 AGE and DBH552 to develop regulations. It would also authorize the department to conduct surveys and investigations to enforce compliance and promulgate regulations related to background screening check requirements for all home care workers, minimum standards for consumer specific service plans, training and competency requirements for agency staff, minimum coverage requirements for workers' compensation and liability insurance, policies and procedures to ensure home care workers have safe working conditions, adequate training, and process for submitting complaints. Requirement and processes for reporting of consumer complaints and the maintenance of payroll and payroll process that follows all state and federal label, labor and wage laws. The council stands ready to work in collaboration with the legislature and the administration to develop regulations establishing a licensure system. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, Julie. Any questions? No? Alright. Thank you very much. I do wanna do wanna remind everyone, we do have, you know, the 3-minute rule. Although today, I think we have plenty of time, so we may, you know, allow to go over. But just to keep in mind to be as, on point and brief as possible. Alright.
We'll go to the first panel.
Jake, Krilovich, Anthony So to, and Larry Michael. Jake is from home Home Care Alliance. Anthony is from So to home care, and Larry from visiting angels.
JAKE KRILOVICH - HOME CARE ALLIANCE OF MASSACHUSETTS - SB 470 - HB 789 - Well, good morning. My name is Jake Krilovich. I'm the executive director664 for the Home Care Alliance of Massachusetts. I wanna thank the committee, for the opportunity to offer testimony on the bill at hand, which would create a licensure system, for non-medical home care services. And I particularly wanna thank and express our appreciation to the chairs, Pat Jehlen and Tom Stanley, and also Rep Gentile for all of your dedication and, you know, support for the care at home industry. Our industry has been advocating, and our association has been advocating for licensure for over 15 years. It's not often you have an industry coming to this body asking for itself to be regulated, and it's even more rare to see the industry alongside the union in support of a single bill. Yet, we believe in this initiative so deeply that we created our own accreditation standards in lieu of state licensure many years ago. This accreditation holds our members to a higher standard so that consumers can be certain they're receiving care in the best way possible.
This accreditation was largely served as the basis for this bill before the committee today. As you know, home care services are a vital and growing part of the health care delivery system. They're essential, cost effective, nonmedical companion and homemaking services that allow people to age safely in their homes and delay their need for higher acute, higher cost, and facility based care. Our association gets at least two inquiries a week from people looking to open a private pay home care agency. And as me and my staff often inform these prospective business owners, in many respects, it's often easier to open a home care agency than it is a pizza shop in Massachusetts, and I've said that to many of you on this panel. Currently, you simply file with the Secretary of State's office as a business, and then you're supposed to adhere to one or two DPH regulations when sending workers into an older adult's home, and then you can operate. And we remain one of only a few states without licensure for home care services.
We believe that agencies should be held to a baseline set of standards that would protect consumers and the workforce, and we believe that the bill's framework does just that without overburdening providers and inadvertently increasing the cost of private pay home care, which would drive consumers to seek care in the under marketplace or without care at all. The bill would direct the Executive Office of Health and Human Services to establish a licensure system that protects consumers by ensuring adequate background checks, minimum standards, consumer service plans, training, and competency requirements, everything that Julie just mentioned. This bill would not only license home care agencies, but any entity that serves or advertises as themselves as providing home care services in the home. It is imperative that we act now to establish these standards so that we can best protect our consumers and our workforce, and also level the playing field among operators across the state. Today, we have no idea how many home828 care agencies are operating in Massachusetts.830 If you ask any of our provider members and two of them are here today, any of them can give you an example of an agency operating in the shadows or skirting these best practices.
Whether it's by failing to adhere to wage and labor laws, not carrying liability insurance, or not conducting background checks on workers. All of these things are things you would think are required of a provider who's caring for a person in their home. This exposes the residents of the Commonwealth, it exposes our industry, and it exposes this legislature to a tragedy that occurs in the home that may have been prevented from licensure. We've already seen such tragedies. In January, a home health aide was stabbed over 30 times in East Boston. Two Years ago, a home health nurse was murdered in Connecticut. And elder abuse is a nationwide issue that can be prevented from basic worker verification standards. I'm not suggesting that licensure will prevent these incidents from ever occurring again, but it's a critical step forward in doing everything we can to protect our patients and our workforce. So I look forward to, the testimony from two of our provider members here today, and I really plead with the committee to vote this bill favorably out of committee and expedite it through the legislative process. And I'm here to answer any questions if you have any.
STANLEY - Jay, could you just, briefly speak to the history of the bill and how we got, to where we are now?
KRILOVICH - Yeah. And Julie kind of outlined it a little bit. I mean, the Home Care Alliance had introduced a bill probably over 12 or 13 years ago, and we've been advocating for a while. Julie's group, the Home Care Aid Council, was also supportive for many years. November SCIU was supportive. And in 2018, the legislature instructed a licensure commission, which Julie mentioned. And at that point, the commission with, representatives from all of our associations and the union and state, agencies came together and met several times to come up with that licensure report. The licensure report really, the now the bill at hand really tailored to the to licensure report. And so that's where we are now.
STANLEY - I just wanna add, briefly that there was, you know, one or two issues, left, that needed to be worked out. And, Chair Jehlen and all the advocates,967 we had many, many meetings to work out differences. And, I do appreciate all the advocates getting on board. Yeah. One, in my opinion, very good, bill.
KRILOVICH - Agreed.
LARRY MICHAEL - CONCERNED CITIZEN - SB 470 - HB 789 - Good morning. And thank you for the opportunity to offer testimony987 in support of S 470 and H 789, an act991 to improve Massachusetts home care, which would create a licensure system for non-medical home care services. My name is Larry Michael. My999 wife and I own two Visiting Angels offices located in Chelmsford and Newton. I would be remiss today if I didn't wish my mom a happy birthday. Today's her birthday. She's gonna be 94 years old. Together, our offices provide non-medical home care services to over 20 communities including Boston, the Merrimack Valley from Dracut to Winchester, and Metro West and Southwest from Watertown to Stoughton. The population of the communities we serve is over 600,000 with 65 plus senior population of over a hundred thousand and growing. Our clients want to aid safely in their homes with support from a caregiver. That support can range from one day a week for a few hours to help them around their home, to as much as 24 hours per day, seven days per week, to help them with everything from starting their day, getting dressed, personal care in the bathroom, preparing meals, medication reminders, getting to appointments, going to bed, and helping them multiple times in the middle of the night if they have to use the toilet.
We strongly support appropriate licensing for our business and the non-medical sector of the home care industry. As service providers, the needs of our customers and families, as well as our employees are our top priority. We all want our sector to be safe and affordable as possible for our clients and our caregivers. To meet that goal, all providers must be covered and be required to meet the same baseline standards to keep home care safe for our customers, their families, and our caregivers. Such as minimum liability insurance for the worker for the workers and agency, workers compensation insurance in case of an injury, consumer rights and written care plans, complaint procedures, worker background checks, and training requirements. We take great pride in offering robust training to our caregivers and our staff. We train annually on elder abuse and neglect, HIPAA caregiver education, infection control, infectious diseases and blood borne pathogens, professional boundaries, and observing and reporting. And we have over a hundred training courses for our care professionals. We know that when our caregivers are trained properly, the quality of service increases for our clients.
If all agencies are not held to the same standards, then the quality of service across the sector will suffer. This bill will help we to weed out bad actors and bring stability to the industry. Remember that when we get a call from a spouse or a family member, it is almost always after an unanticipated event. A fall and a hospitalization, a loved one wandering and getting lost, followed by a dementia diagnosis, or a debilitating illness. At that time of stress and uncertainty, families should not have to worry that they called an agency that does not do background checks, does not have adequate insurance, and does not train their care professionals. Lastly, it is important that if this bill were to pass, the regulations are not overly burdensome that they would raise costs for the agency and be passed on to the private pay cut consumer consumer. It's important to remember that licensure of these services will license provider home care agencies regardless of payer. Any burdensome or unnecessary regulatory structure runs the risk of pricing out consumers from the private1205 pay home care market. This1207 would result in customers going to the underground unregulated market, which increases risk to the consumer and defeats the overall goal of the bill. I want to thank you all again for allowing me the opportunity to present today. I hope that you will consider passing this important piece of legislation.
SPEAKER1 - Thank you. Any questions? No. Thank you very much. Oh, actually, I wanted to just ask, what experience have you had, and and how much experience with, consumers coming,
someone who was putting themselves out there, as a, you know, someone who was putting themselves out there, as a legitimate agency, but maybe didn't provide nearly as much as the services that the consumer expected.
SPEAKER8 - It's a pretty common occurrence. I would say that every month we receive several calls from clients or their families having had a bad experience with another agency, an individual provider, or someone that they found privately. It's pretty regular.
SPEAKER1 - And, do you find that, you know, the consumers have great difficulty in determining, you know, who to hire and, just to kind of elaborate on that.
SPEAKER8 - Yeah. So, some of our clients have long term care insurance, and 1 of the requirements of most of the insurers is that the home care agency providing services is licensed. When we1305 tell them that Massachusetts is not a licensure1307 state, they're usually shocked. We then talk to them about accreditation, from the home care alliance and the insurance companies almost always accept that as an alternative, but it's not what they prefer. Most clients that we talk to that are inquiring about services, but have not made a decision yet. We encourage them to always ask whoever they're calling if they are at least accredited. They had no idea that Massachusetts does not require a license for a home care agency.
SPEAKER1 - Thank you very much.
SPEAKER6 - Thank you. Mister chair, this is Steve.
SPEAKER9 - Oh, okay. I'm holding my questions in case you answer them, and I don't have to ask.
SPEAKER10 - Okay. Good
SPEAKER7 - morning. Thank you
SPEAKER11 - for this opportunity to offer a testimony in support of this key piece of legislation. My name is Anthony Sotto, owner and operator of Sotto Home Care based out1361 of Holyoke, Massachusetts. We provide 9 medical home1365 care services to communities that deserve consistent and quality care. My clients have also1371 had stories of working with agencies that don't provide language or culturally appropriate care. Worse yet, of these companies that seem not to understand the care part of home care. I was born and raised in Holyoke. I have witnessed families, friends, neighbors see less than adequate care for agencies that have limited accountability. Our community has seen companies come and go, dissolving after committing fraud only to reappear under what seems to be new ownership. My family and I have spent most of our lives in public service. With this mindset, we decided that we wanted to serve our community with the home care because the need only seems to be growing, and we wanted to be 1 of the providers with the face and name of a positive reputation and, most importantly, quality service.
We are only we are only 1 agency, though. The reason why I'm here is a strong support of establishing a licensure for our businesses and a nonmedical sector of the home care industry. It's because we we are all impacted by home care. It could be a loved 1, us 1 day, or another member of our community. Home care is a much needed, cost effective, and humane part of health care system. It should be personal, and it should be professional.
In order to ensure that that the needs of our customers and families, as well as our employees, are met across the field, licensure and oversight is needed to create a safe and reliable system that works best for our patients, our workers, and our providers. Let's set high standards to protect customers and our
SPEAKER1 - sorry. That's okay.
SPEAKER11 - Customers and our employees. Let's let's1486 expose the bad actors that abuse the system for their1490 own gain. In any industry, it should be a standard to require proper training for employees, have liability insurance, guaranteed overtime pay, conduct proper reporting, and doing background checks on employees, all business practices that you would all already assume providers are required to perform.
Without a licensure system, we continue to risk that a patient gets hurt by an undertrained worker or by a worker that has prior reports of bad behavior that were not screened for or that a worker is taken advantage of by an employer.
Massachusetts prides itself on being a leader in health care system. Sadly, we are 1 of only 4 states that do not have a licensure system. It is time that Massachusetts joins the majority of the states in implementing a licensure system, and I want to thank all of you again for allowing me this opportunity to present today. I hope that you will consider passing this important piece of legislation. Thank you very much.
SPEAKER1 - Thank you. Represent chair Jalen.
SPEAKER4 - Oh, we're
SPEAKER12 - so glad.
SPEAKER1 - Oh, representative DeCosta. I just
SPEAKER9 - 1 1 question I had is is, in terms of governing referrals, say, from the council meeting. At what point does someone who might occasionally help someone to mow a lawn? If we have a elderly resident mow a lawn, shovel snow, maybe come in the house and move something along, take something in or out, at what point would your bills require licensing? And, I guess, my first question is, would the council of aging director be able to refer anyone without your credentials? And number 2, at what point would you, would you limit that through licensing and so forth?
SPEAKER6 - I think if I'm hearing your question, you're talking about sort of, like services that may come from somewhere like Care.com?
SPEAKER9 - Some someone who makes themselves available. I have a number of them in Norwell. I know them by name. That if, someone needs to lawn mowed, some household, something done locally, They can call them up and for a few dollars. And I assume if they're following the law, they go through the normal schedule c process of of reporting the outside income. But would a council on aging director be able to for someone like this under your regulations?
SPEAKER6 - That yeah. Go ahead.
SPEAKER8 - No. Unfortunately,
we would not allow our caregivers to shovel snow or cut the lawn. Our insurance would not cover them if they were injured, and we wanna make sure our our employees are protected. But once they go inside the home and they're providing care or services for the senior in their home, then that is something that we would be open to, providing services for.
SPEAKER9 - So outside the home, no. Inside the home, yes. But so let's let's say for instance that you had, some older lady who wanted some furniture removed from the house or wanted some household task done, yeah, occasional cleaning or what have you. Would your bill cover people like that?
SPEAKER1 - I think
SPEAKER6 - I think that that's where when when I mentioned care.com, you know, I think that that that's a great question. I think that it's something that the the regulatory process is gonna have to sort through. I think that our association has always been committed to ensuring that this law applies to everybody who's providing, the services as defined in the bill, which are homemaking, companion, and and otherwise and and otherwise. And the reason I mentioned Care.com, or or as I mentioned, it it requires anyone who's advertising themselves as providing home care services is because we always felt that if if and when we license home care agencies, businesses, if you don't also require licensure for, freelancers or people on Care.com lists matching services, you know, inevitably, costs will increase on our providers, to to adhere to the licensure statute. And if you increase the costs on the providers and therefore increase the costs on the consumers, you're gonna, again, as we all mentioned in our testimony, drive people into, you know, the underground marketplace or you could say under the table where where consumers are finding someone anywhere, like you said, on Facebook or or Care.com. And so we always felt that it had to include that. As far as enforcement, I think will be difficult, to your very question, which is Well, you went to
SPEAKER9 - question, what type of sanctions, who's going to enforce it? It sounds as though you you want you said regulators, so I assume that means state bureaucrats, to to put some type of regulatory format together. Is is that your intent?
SPEAKER6 - Yep. Yeah. The bill does prescribe, fines and sanctions if you're found to be, advertising or providing
SPEAKER9 - So just just notionally, you could have a lady who's well known, and I'm I'm speaking with somebody in mind in my area, some known who occasionally spend time with older people on
SPEAKER11 - a regular basis overnight to
SPEAKER9 - make sure they're okay, people on a regular basis overnight to make sure they're okay and leaves in the morning. You would now prescribe somebody like that to go through training and carry insurance and, report to the state. Their professional, if you wanna call it that, activities. What if you have somebody who's just acting out of a a simple act of Christian charity or Jewish charity or religious charity, okay, who occasionally helps out older people. Do you want them to be covered under this?
SPEAKER6 - I understand what you're getting at, and I and I and I sort of I sympathize with the question. I would also I but I would say, you know, yes. And I and I'm not suggesting that, a a person who is acting out of the kindness of their heart would have to go through this strenuous regulatory licensure process. I think1856 that that'll be something the regulators will have to1858 sort through. But at the end of the day, if that person acting out of the kindness of their heart falls on the front steps of that person, they have no liability insurance, you know, what happens? Right? And I think that that's sort of the the question too. You know, your example is 1 with with individuals, but if we have agencies or businesses out out there operating who don't have liability insurance and the caregiver falls on the front steps of a person's home, what happens in that situation?
SPEAKER9 - It's it's kind of a you know, hard cases make bad laws, and I'm thinking and mister chair, I don't mean to draw this out, but I can give you dozens of examples. I am among probably 30 or 40 American Legion members in my town regularly pick up food on occasion and drop it off to veterans and widows of veterans. And it's a collective great system we have in the South Shore, also the South Shore. But what you're telling me is if they, for instance, you know, brought something into the house, delivered it, and put it away from them, you would say you now have to be regulated through this system?
SPEAKER6 - I guess the question is if they were doing it for hire.
SPEAKER9 - Okay. You've answered my question. Thank you.
SPEAKER1 - Can I just, follow-up on that? Is it more towards how it's be how the person is advertising their service?
SPEAKER13 - Yes.
SPEAKER12 - Right.
SPEAKER6 - And are they receiving compensation for it?
SPEAKER1 - So if someone,
just offered to, you know, whatever, come in, do a couple of a
SPEAKER6 - good deed to me.
SPEAKER1 - Things like that. And and they're getting some compensation. It's Right. It's not officially for home care services, so it wouldn't be a problem. As I sit
SPEAKER6 - here today, that's probably how I would say. But, again, I think the, you know, UOHHS is gonna have to interpret the law.
SPEAKER1 - Right. So I I just didn't wanna
SPEAKER6 - Yeah.
SPEAKER1 - Get a narrative out there that no one's gonna be able to help anyone with that. I appreciate that.
SPEAKER9 - Would would you be willing to to to the chair's point, would you be willing to have a a modification of the law to make that clear that the intent is not to regularize regulate people, I'll use that probably a better term, out of the kindness of their heart or however, that they are not subject to this.
SPEAKER6 - Yeah. I think we would be willing to look at language like that and defer to our sponsors. Yeah.
SPEAKER9 - Thank you. K.
SPEAKER1 - Yeah. Representative John Tyler.
SPEAKER3 - Thank you, mister chairman. So clearly in the Commonwealth, you know, volunteers, acting in a in a in a, for example, a nonprofit. For example,
Habitat for Humanity builds homes all over the Commonwealth. And if you and by volunteers, everyone is a volunteer. No one's compensated. And in order to work with Habitat for Humanity as 1 of their volunteers,
people, anyone who just chooses to do that has to sign a waiver that, that holds holds that nonprofit harmless
SPEAKER1 - in
SPEAKER3 - case they get hurt on the get hurt building a house, which, you know, you you can easily get hurt in a construction.
SPEAKER11 - Mhmm.
SPEAKER3 - So in in this instance, if someone was to, provide a home care service for free, as a volunteer, then they ought to be able to, to do that. I mean, signing a waiver, they maybe they have to sign a waiver or they that they that they won't be holding, and it's somewhat liable. But volunteerism is alive and well in the Commonwealth, I'm sure this the statue wouldn't interfere with that.
SPEAKER1 - Thank you. Good. Yeah. Good points. I think we're getting ahead of ourselves a little bit. But, I I also wanna recognize, representative Erica Idaho from Somerville about to do that. Thank you. And representative David Beal, as well. And I just, you know, we've been checking this, a few big bills around for 3 terms while I've been here, but a lot longer, I think, before I got here. And I thought that this 1 would be home care licensure would be easier to get through than, long term care and, the assisted living, residence, bill that we both of which we combined and passed last last2132 session. And but, you know, 1 of the first of all, it's2138 everyone's best estimate that home care, agencies in the state, 50%, certified and contracted through, ASAP, so this aging service access points. And the other 50% are not certified and, you know, don't have a con contractual agreement with any organization that has a contract with the state. Right?
SPEAKER6 - I think that there are between 225 and 250 certified home health agencies. Also not licensed, but they are certified through CMS.
There are someone else, you know, from the ASAP network could speak better to this, but I think probably around a 25 to a 50 providers participating in the ASAP home care program. In terms of purely private pay home care agencies, we again, we have no idea. I I my personal opinion is that it ranges somewhere between 515.
SPEAKER1 - Alright. So, the last point I wanna make is, I believe what's been holding the bill back is the cost. And, you know, we've we've tried very hard to, get answers as to what is the cost of the state, implementing such a program. And we've we've, we haven't got the answers. And I think,
you know, part of it is because the state has so many things that they're dealing with, and it's another whole big thing, you know, which the time is the administrator's time is limited and so forth. And, however, now, you know, we have bigger problems with, losing our financial partner, from the federal government. But I think it just adds to the,
to the point that we we need, services like this certified so that every consumer knows what they're getting, because everyone that I've talked to, whether it's administration or advocates or whomever, all agree that keeping people home cost the state2277 a lot less money than having to go to assisted living or long term care facility. Alright. Thank you very much. Oh, sorry. Senator Jalen.
SPEAKER4 - So So I I appreciate, Repdecost bringing up the question of individual people who may not advertise, but have an informal but paid relationship with a a person or their family. I am wondering about this is really helpful testimony today in so many ways. We've heard it before, and we're just, and we have reported it favorably in the past. And I2317 expect we will do that with some alacrity in the future. But I am interested in what the effect may be on peep I'm asking about the question of workforce and if it will make it. If people can't easily provide individual, you know, I'm thinking about my father whom we moved from an agency to an individual because we really liked that person.
If it will cause
SPEAKER12 - some
SPEAKER4 - of those people to move into employment situations with an agency and maybe provide, I'm asking you the the effect on the workforce, which is and I'd like
SPEAKER12 - to know a little bit more
SPEAKER4 - about how the workforce is Yeah. Is happening with you all with immigration restrictions.
SPEAKER8 - So I'm not sure if this directly answers your question, but it reminded me of an example of a client that we had several years ago. Her husband, was a veteran and received veteran benefits through that program, but it wasn't enough. And she wanted to hire,
she had another aid, privately. She got she set up an LLP. She got insurance. She got workers compensation insurance. And she played her paid the employer taxes and did the employee withholding. She knew what she needed to do to make sure that both her husband, her home, and the caregiver was safe. And it wasn't she didn't describe it as onerous or difficult, but she understood that there were certain things2423 that she needed to do to make sure that that relationship could, continue like the 1 you described.
SPEAKER7 - Mhmm.
SPEAKER8 - But she did it in a way that protected everybody.
SPEAKER12 - Yeah. Okay.
SPEAKER7 - Yeah. But I'll
SPEAKER11 - just update the almost the same exact words. But the only I I would say to councilor Torres, so if somebody volunteers, I don't think we're looking at any of that stuff. We're not looking at vol people volunteer to take care of of, elderly folks or if respectfully, if someone in my family wanted to take care of our grandmother or in that sense. I I think there just needs to be checks and balances. That that's, I think, that we're we're we're just looking for checks and balances. We're not they're not going after, you know, the boy scouts or America or the vets or that do volunteer work. We we just need we're asking for checks and and that we're able to verify who's in people's homes. But if someone privately knows someone and they're hiring them, that has nothing to do with agencies. That has that has anything to do with agents. That's your preference. But if you're you're looking for home care, you open a book and you're looking for a home care agency for your parents, your spouse, or you wanna make sure that they're they have all all the credentials that are required to to be in someone's home. This these are the most vulnerable people that we have. The most vulnerable people. And if if someone if all they need is 1 other person to say that they know them, and they allow them in their homes. They open their doors. They do. We've seen stuff that, you know, they open their checkbooks. It's it's it's really out of control in in a sense. We're not saying that people can't volunteer and the meals on wheels are due or all. What we're saying is agencies, business owners, people who provide the service that are held that are held to higher standards and that quarries so important for quarries to be done. So important for bet for for someone to have work with comm insurance. It's so important for us. There's, there's a database where we check where we put names in of individuals that we're required to do every month to make sure those people aren't bad actors. If if these companies aren't a buy letter, they're just putting whoever in your homes. You know, you're hiring them, trusting that they're doing this, and and it's not happening. That's where2562 where this day at the end of the day is a cost. But, again, we really need to look at this. We we really, really, really need2570 to to to hammer down, and this is stop kicking. Whatever the the analogy they used kicking it down the road a lot, we really need to to move forward on this. And I understand there's a cost, but understand there there's a higher cost if we don't do it. Thank you.
SPEAKER6 - I mean, if I could add on the, on the workforce question. I we hear from I mean, I've heard from Larry on this. Plenty of our members who talk about, right, the the workforce issues across all sectors is really dire. Right? We're all competing against a limited work pool. And in this workforce in particular, you're we're competing against retail and restaurant opportunities. And so as an agency of like the 2 we have here or any of our members who who do the right thing, as they try and do the right thing by training the workforce, requiring certain things of the workforce, that is that is a hurdle and it's a barrier for a worker to2625 come to employment. And when a worker, a prospective candidate, has an opportunity to work for someone like these 2 providers who might require training, the background check, and whatnot, it might be appealing for the worker to go to the agency down the street who's gonna require them to do nothing. And there's no, you know, training or onboarding2646 requirements. Right? And so you're sort of2648 it's weighing down the quality of care that's being provided out there. And so when I talk about leveling the playing field among operators, that's kind of what we're talking about.2656 And on immigration, I mean, that's a separate topic for sure. But there's a lot of, angst and anxiety among the membership, particularly around TPS.
SPEAKER1 - Okay. Thank you very much. Thank you, thank the panel for your time. Thank you. Next up, we'll, is Betsy Connell, available, remotely?
SPEAKER14 - Good morning. Yes. Thank you so much.
SPEAKER1 - Go ahead.
SPEAKER14 - Thank you. Thank you, chairs Stanley and Jalen and the members of the joint committee on, aging and independence. I appreciate the opportunity to testify today in support of s 7 65 and h 4 87, an act relative to2703 councils on aging. I also wanna thank2705 representatives Donahue and Barber and senator Montigny for their leadership on this legislation, which will certainly provide a much needed update on the council on aging statute. I'm Betsy Connell, the executive director of the Massachusetts Association of Councils on Aging, the nonprofit membership organization of the 3 50 municipal councils on aging and senior centers in the Commonwealth of Massachusetts, serving all your districts who support the 1,700,000 older adults in Massachusetts leading healthy and purposeful lives. The purpose of this bill is to amend section 8 b of chapter 40 of the general laws, and it's twofold. First, to amend outdated and ageist terminology, and second, to update language which does not reflect the current construct of the majority of Council on Aging Boards. Since the statute was established and passed in 19 56, 6, councils have grown to fall into2759 2 categories, supervisory and advisory. The current statute states the council may appoint, which only reflects the construct where the council on aging, which is appointed board members, has supervisory or hiring capacity. And that's approximately 6 councils on aging in the state. Whereas over the last 60 years, the majority of councils on aging, their boards, shifted to become advisory as municipalities built senior centers and created senior center council on aging director positions and other support staff for their council on aging departments. As you see in the bill, the proposed language change reflects both constructs of advisory and supervisory, providing the capacity for the municipality senior center director or the town HR department or the town administrator, whatever the bylaws are of that community, to hire staff. Whereas without the language, the additional language being put in, only the council is allowed to hire. So issues with the outdated statute were brought to our attention about 2 and a half years ago when the town of Sherborne, after having submitted and received approval through a town meeting of a warrant article to change their council on aging bylaws, was notified by the attorney general's office that the warrant article was disapproved. The attorney general stated they disapproved this article that authorized2846 the director rather than the counsel on aging to hire other staff positions2850 because it was in conflict with chapter 40 section2854 8 b. So I wanna urge the committee to support s 4 87 and h 7 65 to give this bill a favorable report so all COAs can continue their work to provide these much needed services and with the definition in the statute. And so senior center directors can continue to run their centers without the risk of being in conflict with the state statute. Thank you.
SPEAKER1 - Thank you, Betsy. Rep, Scarsdale.
SPEAKER15 - Thank you, mister chair. Thank you for the testimony. And just curious, when you were working, with the councils on aging throughout the state, did you hear any concerns about the bill, like unintended consequences? Or
SPEAKER14 - No. I did not. I and, again, you know, this is this is a refile of of this bill, and there was no opposition in the previous, session. And I I I think it's important to understand that the the existing construct is is very outdated. Again, it only represents that 1, structure of a COA board when, in fact, most boards across the state are advisory and not supervisory. And, I I think it's very important that people understand that adding the language here2936 just reflects the fact that both constructs exist because right now, the way the statute read, it's only saying2942 1 construct exists. And that conflicts with,
what what is happening in in 98% of the communities. So I just I wanted to really be clear about that. We've had no, negative feedback, and we've had the support of MMA on this as well. So
SPEAKER15 - Alright. Thank you.
SPEAKER14 - Certainly.
SPEAKER1 - Alright. Thank you very much for the very clear, testimony. We appreciate it. Up next, we have, Betsy Crimmins.
SPEAKER16 - Good morning. Thank you, chair Jalen and chair Stanley and members of the joint committee on aging and independence for this opportunity to testify in support of house bill 7 8 9 and Senate bill 4 7 0 and act to improve Massachusetts home care. My name is Betsy Crimmins and I'm the executive director of mass aging access, which is the nonprofit membership association for the 27 ASAPs aging service access points, and AAAs, area agencies on aging across Massachusetts. Our nonprofit network has been deeply embedded in local communities for over 50 years, providing the crucially important in home services and supports that older adults and people with disabilities in Massachusetts need to continue to live safely in their homes and communities as they age. Our statewide network fully supports these bills to license non medical home care services given how essential these services are to the work and mission of the ASAP's. We support the creation of a licensure system that would establish baseline standards for agencies to ensure a quality network of providers for consumers and keep services affordable for those who rely on them. As mentioned earlier by both Julie and Jake, these bills were developed from recommendations made by the Home Care Licensure Commission, which was established by the Legislature in 2020 with the mandate to make recommendations to establish a statewide licensing process for Massachusetts home care agencies for the protection of consumers, home care agencies, and home care professionals. Mass Aging Access would like to thank this Committee for the opportunity to testify in support of these bills. And we are especially grateful to Chair Jalen and chair Stanley for all of their work on this important issue, which will address the gaps in our current system, align Massachusetts with the vast majority of other states, and strengthen our long term services and support network for which allows older adults and people with disabilities to remain at home3107 where they want to be out of more costly settings with better health outcomes and higher quality of life. I would also like to take a moment just to state that Mass Aging Access also supports House 7 78 and Senate 4 75 enact relative to the LGBTQ Aging Commission. Thank you.
SPEAKER1 - Thank you, Betsy. Any questions? Thank you very much.
SPEAKER16 - Thank you.
SPEAKER1 - Lisa Gorgon. Remote.
SPEAKER7 - Yep.
SPEAKER1 - Okay.
SPEAKER7 - Hi. Good morning. Thank you, Chairman Stanley, Chairwoman. Jalen, it's an honor to be here today. I am here to issue support of House 7 89 S 4 70, an act relative to Massachusetts home care. My name is Lisa Gorgoni. I'm the executive director for Valley Elder Services. We are an aging service access point area agency on aging in Massachusetts. I have worked in the home health, home care industry for over 25 years, and really I used to work at Julie position at the Home Care Aid Council and I also had Betsy Crimmins position at MAS Home Care. So I've been in this network for a very, very long time. And I just want to start by saying that the first meeting that I attended related to this issue of home care licensure was actually in 02/2002. Harriet Chandler was a senator, I think, at the time,3193 and she held a meeting with all of us to talk about licensure because she had heard in her city of Worcester, where I grew up, of some issues of people going out to work with consumers and really, you know, not providing care, families losing money. And it was really you know, the company was advertising itself as a home care company and not providing good service. So she was concerned, and that was, you know, 23 years ago. So here we are. I wanna commend the legislature for filing, some budget3226 language a couple years back, I think, '20 '2 thousand and '20, to study this work. We were we have studied it. I was on the commission to study the work. We did a really good job, I think, coming together as all the people who had interest to come together with for this for the recommendations that then became3244 this bill. So, you know, the purpose of this bill is to really protect the consumers and the workers and really families. Again, I've been3252 in this space for a long time, and I wanted I do acknowledge that certainly there are individuals that wanna help their neighbors and do it, you know, on their own, and it's they're very safe, and they're doing a good job. But there are others that are not. Elder fraud is growing in our nation. I just pulled an FBI report that it's it's very large. And we see this. Mystic Valley also does protective services. We see reports of elder fraud all the time. I think chairman Stanley raised a question of, you know, some of the changes nationally, I think, will force more people to buy private home care services, which will lead them to the marketplace. And when someone hangs a shingle and says they're a home care company, you wanna be able to feel confident they are actually a company. They are following the laws. They are employing their workers. They are have insurance. They are protecting your money. You know, if I buy something for my mother, I wanna know that I'm paying for something that is valid. It's very different than a neighbor helping a neighbor, but it's really about making sure they're not there isn't fraud happening, and we do see that. 1 of the other speakers talked about the check they do. This is a Medicaid fraud check, and I'll acknowledge that, you know, the government is very focused on Medicaid fraud. Our law would require to be able to check that. So they're not just anybody who maybe committed fraud in the past of the Medicaid system. So we're really trying to protect our consumers, our taxpayers, people paying out of pocket for services. That's the purpose of this bill, to protect those people and to protect our workers. So they're not injured, that they're not taken advantage of as well. They're not not paid, and it would not impact people. You know, again, please read the law. I think it's really about home care companies, home care services specifically. It's not about, you know, law and work, dropping meals,3355 and it's really about companies that put themselves out as home care agencies. Call themselves home care agencies online, hang a shingle. If you're gonna purchase from them, you wanna know they're actually following some of3367 the things to protect you and your family. Thank you,
SPEAKER1 - Lisa. To your point, I I know before I was on this committee and before I was chair,
still a state representative, little over 10 years ago, my father first3385 needed services. And I knew, you know, a lot of these things. You know, where where to go because of just the, the constituents that we help or your, advocacy and other advocates are coming to us explaining things. But in that moment, when you, you know, you know it's Mhmm. Most people don't prepare. And it's Yep. It's game time. You know? What what do I do? And I remember panicking
SPEAKER11 - Yep.
SPEAKER1 - And and and, thinking like, oh my god. I should know exactly, you know, where to go right now. And, and quite frankly, I probably went to you or someone else for, advice to remind me of, services that are provided. So, it's a big part of the bill is, giving people, you know, consumer rights, giving people the, you know, the the knowledge that they're, putting their loved ones in good hands. Any other questions? K. Thank you very much.
SPEAKER7 - Thank you.
SPEAKER1 - Okay. I think we'll go
before we get to the panel in person, I, I want because that would take a little bit of time. Valerie Anne Bonds, would you like to? You had a speaker on House3466 789.
SPEAKER12 - Thank you. Oh, thank you. I didn't have to bounce out this time.
So,
okay. I'm 74 years old. My name is Valerie Ann Bonds. I live in Cambridge, Massachusetts. I am the chapter president of a senior organization, and I have been a home care provider. I have been a recipient of home care. My sister has macular degeneration. She's 75 years old, and she has a home care person who provides her weekly assistance at this point. I have a brother-in-law who was in home care and an agency where he was mistreated. And I have been a victim of elder abuse and elder fraud. So I think I cover all the gambits here today. And I wanna thank, senator Jalen as well as all the representatives for giving us giving me the opportunity to share with you my perspective, my views, beliefs, and opinions regarding this3556 bill. Oh, the joy of aging and independence. The central focus of this presentation I'm sharing with you is home care financial stability and the council on aging. We all know the importance of seniors' overall health care and well-being for financial stability, reliable, health care, and the well-being necessary, for resources, more importantly, required resources to assist those of us who are aging. The aging process begins at conception. The journey starts as soon as we leave the birth canal and enter a community of marginalization, privilege, or self determination. Everyone wants to get older, but nobody wants to grow old. However, you and I will continuously age until we veer onto the path where life's journey has stopped and the ever and the never ending path begins. Everyone wants to get older, but nobody wants to grow old. There was a time when getting older meant, the golden years, which would include relatively, adequate fixed income, the joys of retirement with grandchildren, friends, and family. And the best part, no more clock to punch. Choosing instead to select our own hours to be employed, selecting to volunteer, to work, to travel, or to do all of the above at our own discretion. Elderly community members were considered wise old owls who received respect and dignity and were provided essential needs as we entered the golden years. 68 years ago, I remember watching Superman soaring into the sky, standing with the American flag behind him, and hearing the words truth, justice, and the American way. Today, those words have a different meaning. Truth is relative, justice is vague, and the American way is hyphenated. Summarizing my understanding of 3 bills proposed by the house and senate are as follows. House Bill 7 8 9 and and Senate Bill 4 70, improving Massachusetts home care, will ensure that dignity and respect are entwined in the responsibility of those agencies tasked with maintaining high standards of home care for older adults and providing proper oversight to support and sustain those to support and sustain, those high standards. You have to pardon me. I have double vision, and I'm trying to beat with 1 eye, but I and I don't wanna put the patch on. Defining these roles and responsibilities is a primary part of these bills. Home agency and what that really entails. Home care services and those individuals who provide those services. A home care worker and who and what and where those people provide those services. Personal care attendant and the difference between a personal care attendant and a home care worker. The secretary of health and human services and the licenses that are necessary that need to ensure that the care elder people receive is quality standard and follow certain policies and procedures and regulations. Standards and procedures to address abuse and neglect and specific oversight guidelines essential for safety and security are included in this bill. The secretary and advisory council monitors the see, I didn't skip anything. Okay. The secretary and advisory council monitors licenses for agencies, trains employees, and ensures adherence to the rules and regulations to
7 7 and senate bills 4 7 1, House bill 7 7 7 and senate bill 4 7 1 aim to develop educational resources for economic well-being, allowing seniors to understand better financial management, fraud prevention, and an and3819 investment strategies. The council on aging through house bill 7 6 5 and senate bill 4 8 7 now states that the director, along with input from the advisory council on aging, may appoint staff and other employees for required municipal needs, delivering services to the needs of older adults by trained and experienced staff. Each of these bills I have described requires your support, from our legislative body, both in votes and funding. Your support is crucial for these bills to be enacted and make a positive impact. The potential benefits of these bills are significant. Older adults, children, and people experiencing poverty should not be the first communities to feel the pinch of cost effective measures. Instead, they should receive the support of elected legislative leaders to thrive and strive for excellence in the Commonwealth of Massachusetts. Oh, the joy of aging and independence. Thank you.
SPEAKER1 - Thank you very much. Any questions? Nope. Thank you very much for your time.
SPEAKER12 - You're welcome.
SPEAKER1 - And actually, Tim Foley, you're actually, next on the list. So if you wanna come up in person.
And before before we, Tim testifies, I also wanna, state that rep, Ciccolo, who is on the committee and cannot be here to participate, because of, the, response legislative responsibilities is, watching, remotely on online.
SPEAKER10 - Great. Thank you, madam chair. Thank you, chair Jalen and, chair Stanley and members of the committee for the opportunity to testify here today, in support of an act to improve Massachusetts home care. House bill 7 89, senate bill 7 40 are refiled, by this committee, and appreciate the leadership of the chairs, on this important issue as well as other members of the committee, critically important bill that we're discussing here today and heard from many folks prior to me. For the record, my name is Tim Foley. I'm the executive vice president of 11 99 SCIU. We're a health care workers union representing over 80,000 home care, nursing home, and hospital workers throughout the Commonwealth Of Massachusetts. And, actually, after nearly 2 decades of working, for 11 99 SCIU, today is actually my last day. And I couldn't find a more fitting, opportunity for me and my, 1 of my final acts as executive vice president to be before this committee today to testify on such an important bill and3983 an issue, that 11 99 has been working on, since 02/2017 when we filed our first, bill around home care licensure. We are proud to serve with, feels like a quorum of the members of the home care, commission that are here with us today, that form the basis of the recommendations that are in the bill, of critical importance. And I think we've heard from many of the advocates, and allies, and consumer groups, and, home care agency representatives here today about the importance of this bill, what is the the goals of the bill, which really is a consumer protection or worker protection bill. The way I like to think about it is in the state of Massachusetts, we have a lot of standards that we put in place to ensure, consumers know what they're purchasing, and this is just another example of that. If you were looking for health insurance, we have the stamp of approval that you meet some credible standards before you can offer that you're in health insurance, and you should purchase that health insurance. We have a lot of standards in our nursing home spaces as well as our hospital spaces, and it feels critically important now after, hearing today that many other states have similar licenses process in place, that we do that here as well. It shouldn't matter what the payer is, if it's from private pay or from Medicaid or Medicare. The consumer should know that if you're advertising as a home care agency, that they the employer themselves has or the home care agent themselves has met some credible, review process, standard review that we do in in long term care spaces, as well as the workers that they fill, some background, have some experience that you know as a consumer, that you're getting, quality home care services in the state of Massachusetts. And I think you've heard that, from a lot of the folks here today. The 1 piece I think, that I wanted to add that I have not heard and I think is new, since we've started the this conversation for us back, in 02/2017 is really the increased role of private equity. It seems I'd be remiss to not talk about how this bill is critically important for the legislature to enact enhanced state oversight over the home care industry that would also help to curb rapidly expanding equity investments in our home care market. Clearly, we all, many of us, particularly, as a union representing thousands of workers in the Steward health care system, understand, that that captured a lot of big headlines and attention. However, the majority of private equity transactions in Massachusetts actually involve providers of home care, home health, and hospice services. Over the past decade, as detailed in the Health Policy Commission's December 20 23 report, nearly 3 dozen of the Massachusetts of these Massachusetts home care service providers have been purchased by private equity for profit investors. With limited state regulation in these areas, these financial transactions threaten to reduce quality care and squeeze out remaining community based and locally owned competitors. Passage of this legislation is urgently needed to better4160 scrutinize this rapid growth of private equity in home care, and the state must act now to get ahead of this issue. As we all know, home care services are growing. Our elderly population is growing. These services are gonna be on high demand. Private equity also knows that, and they see an opportunity to get into this market prior, to these important new regulations to have some licensure process for home care agencies. So thank you for your time, and and attention to this important issue. Again, I wanna thank the chairs for your leadership in this space, as well as the long term care bill that was passed last time. And as you mentioned earlier, chairman Stanley, this seems the moment that we can bring up home care as the next industry that requires our time and attention to protect consumers, workers, families, and patients. So thank you for your time and attention, and happy to take any questions.
SPEAKER1 - Thank Thank you, mister Foley. Okay. Senator Jalen.
SPEAKER4 - I just wanna say how disappointed I am to hear that this is your last day. Yeah. Because I believe in working a long time, and I don't believe you're old enough to retire. So you're gonna do something else. We don't know what.
SPEAKER10 - I am. But I appreciate that, and we've worked together for a long time. And I appreciate the relationship and the great work we've done over the years. Been at $11.99 for 20. '19 and a half, but I'm claiming the half to 20, and I look forward to the partnership going
SPEAKER4 - forward. And what I wanna ask is is anybody gonna be proposing similar legislation for hospice? Because that is, as you pointed out, another area where private equity is moving in. And it's really discouraging to think about people facing the end of life making poor decisions and getting bad care.
SPEAKER10 - I'll commit4261 $11.99 to work with you on that issue.
SPEAKER7 - Thank you.
SPEAKER4 - I'd like I'd like to I'd like to file that bill. Okay. Late file.
SPEAKER1 - Thank you. Mister chairman?
SPEAKER17 - Yes. Leader O'Day. I I too would be remiss if I didn't, say thank you to, to Tim Foley and all the tremendous work that he in November has done over the number of years since I've been here, which is approaching 20. But his commitment to, these kinds of issues has been ever present, and I can just say, that I know that a large number of folks in this building are going to miss you and, your really persistence, but great, ability to have an attitude that is conducive to coming to yes. Right? And, that's gonna be missed. We're hopeful that whoever it might be trying to fill your shoes, they have big ones to fill, will, come to to towards us with a similar kind of I just want to wish you, nothing but the best in your future endeavors. Thank you for all you've done.
SPEAKER10 - Thank you.
SPEAKER1 - Thank you. I I I also wanted to say thank you. This is the only time we do this. Right?
SPEAKER10 - Yeah. Right.
SPEAKER1 - I mean, time perfect. Me. Whatever you do, don't run for public coffee.
But, you know, I any any,
bills that which is almost every bill that's involved and little complicated and different points of view. They require, you know, advocates, administration, legislature, all to work together to work out all the kids, because they never wanna pass a bill with unintended consequences. And I know we've always come back to you with questions, like you you you you're saying this, you know, give me, you know, examples or just come back at you. And and, you know, it's been great because you know how a bill gets passed. And, we all have to work together to to do that. And so thank you. We also, before I forget, rep Scottsdale.
SPEAKER15 - Yes. Thank you, and thank you, mister Foley, for your testimony. I would be remiss if I didn't say I serve the First Middlesex District, so 6 towns in the Neshoba Valley region directly affected by the Neshoba Valley Medical Center closure. And just the the creation of a health care desert in that area, you know, 430 jobs lost, seniors now delaying care. You can't get to care because of the backup at the the outer ring hospitals. But I did wanna ask you to repeat a statistic that you said because I was so shocked, I think I I must have heard it wrong about the ownership of, home health care agencies by private equity firms. Did you say 3 quarters?
SPEAKER10 - I I said 3 dozen of 3 dozen. Okay. The health policy commission, which I'm a commissioner, actually, resigned my position, did a study of the transactions that, like, we report, of all the transactions in health care that have a market impact. And it's clear from the last report that was produced in 02/2024, the the majority of private equity transactions are in
SPEAKER7 - the home health care space.
SPEAKER15 - Alright. Thank you.
SPEAKER1 - Yep. Alright. Thank you very much. Thank you. Alright. Next online, we we have, Lisa Krinsky from the LGBTQIA plus aging project. Good morning.
SPEAKER18 - Yes. Good good morning. I'm Lisa4495 Krinsky, director of the LGBTQIA plus aging project at Fendly Health, testifying in support4501 of
Senate 4 73, an act relative to the Commission on LGBTQ Aging. In 2014, Massachusetts was first in the nation to establish a legislative commission on LGBT aging, now referred to as LGBTQ Aging. This Commission has been co chaired by leadership from your Committee on Aging and Independence, and we thank, all of you who have been in those positions over the year. I have had the privilege of being a member of the Commission since its inception and have provided part Chem staffing support for the past 3 years. The Commission has a broad range of representation from LGBTQ community organizations, aging services, public policy and elder law experts, as well as LGBTQ older adults themselves. In its first 10 years, the Commission supported first in the4551 nation legislation for LGBTQ cultural competency training for4555 the Massachusetts State Network of Care through the Executive Office of Aging and Independence,4559 advocated
SPEAKER11 - for
SPEAKER18 - this year's passage of the Massachusetts LGBTQI Long Term Care Bill of Rights, saw the development of the PRIDE, Massachusetts' first LGBTQ friendly senior housing, and the expansion of social engagement networks for LGBTQ older adults. The Commission has just completed its 2025 strategic plan, which will be distributed soon, that outlines a robust set of action items in the areas of healthcare, housing policy, and social engagement for LGBTQ older adults. In the coming year, we're requesting sufficient funding to hire a full time director to achieve the goals identified in our 2025 strategic plan. Particularly in these current times when federal restrictions are targeting the LGBTQ community as well as programs and benefits for older adults. It is imperative that Massachusetts continue its support for marginalized and vulnerable communities. The Commission on LGBTQ Aging enables us to do just that. I thank you for your time and attention.
SPEAKER1 - Thank you, Lisa. Any questions? Oh, senator Jalen.
SPEAKER4 - I just wanna say how grateful I am for all of your leadership over the years on the commission, including times when there was no funding for the commission. And you're I think it's made a big difference, and I think you're right that this is a time when we need all the help we can get in resolving the problems. Just like I 1 thing I can remember is you're and members of the commission insisting on the importance of gathering data, which I think is under attack right now. So I appreciate you all and glad you could be here. And I hope we can move on this with expedition. I believe we can. And it certainly is a simple should be noncon controversial, at least, in this state.
SPEAKER18 - Great. Thank you very much, senator.
SPEAKER1 - Thank you very much for your time. John Smith from Tribute Homecare remotely.
SPEAKER13 - Hi there. My name is John Sneath. Thank you so much for allowing me to testify. I'm the founder and CEO of Tribute Home Care. We provide private duty home care services in Eastern Massachusetts, but also in 2 states that have licensure, Maryland and in Illinois. And we are I I don't say this with pride, but just to give you context, we're 1 of the largest, if not the largest, provider of private pay home care in Massachusetts. And I'm testifying either in support or in opposition to legislation. I just wanna influence the conversation. So as, we all consider this licensure process, I'd like to offer a few thoughts. 1 is, if what we hope is that people who need care in the home are able to find agencies that provide high quality, professional, reliable, trustworthy services, then from my perspective, the marketplace for home care services is working. And we should just bear that in mind. It's not to suggest that we shouldn't have legislation to do this, but we should bear that in mind. There's plenty of choice for consumers. There are many agencies with a variety of price ranges, and there are providers that have stood the test of time. Massachusetts has we've heard has has has many agencies providing private duty care, and new ones enter the marketplace all the time. This4770 competition ensures continuous innovation, and that those who can't deliver4776 on what consumers want don't last very long and certainly don't thrive. So if licensure becomes a reality, we should make sure it's designed so it doesn't limit competition. So for example, we wouldn't want smaller agencies, which, often provide more personalized services, define the licensing burdens, so much so that they merge with larger agencies or simply close. A second thing to keep in mind, I'm trying to keep my eye on the time here, if licensure goes forward, existing providers should have a seat at the table, and I may be wrong about this, but in my looking at the bills, it looks like literal providers have a, like get 1 seat on some of these advisory committees that are being are being set up. And I think the industry needs a much more, robust presence and participation in the development, particularly of the regulations, which are really going to be the thing that most affects, providers.
I want to say in other states where we operate which have licensure, of course you all know this, they're still bad actors, I know nobody thinks this is a panacea, it's going to solve all of that but, consumers who call us in other states don't ask about licensure, what they ask about are our standards for hiring, how we train. So unless there's enforcement, which I gather in these states, either the states can't afford or haven't made a priority, you know, you get a license and then nobody ever shows up again to see how things are going. Okay. I see my time is up. Probably a couple other things I would mention, but I just wanted to, wanted to mention those things. And I'm I'm, grateful to be here, and I thank you for all the work you're doing this. And we'd very much like to be a part of the conversation to make this, happen if it is going to happen.
SPEAKER1 - Thank you very much, John. If you see no questions, thank you for your time.
SPEAKER13 - Thank you.
SPEAKER1 - Alright. So, the last, folks that I have, registered is the panel, on, Alzheimer's. We have Susan Kowiak.
SPEAKER15 - And Kokia.
SPEAKER1 - Kokia. Yep. Doug Hanno and Lori Pontes.
SPEAKER19 - Chairman Stanley, chairwoman, Jalen, Lynn, and members on the joint committee of aging and independence.4934 My name is Susan Ankoviak. I'm the vice president of programs and services at the Alzheimer's Association Massachusetts, New Hampshire4942 chapter. I'm here to speak in support of house bill 7 89 and senate bill 4 70, an act to improve Massachusetts home care on behalf of the more than 135000 individuals living with Alzheimer's and their 213000 family caregivers in Massachusetts who rely heavily on home care. Due to disease progression,4965 many individuals living4967 with dementia require professional support and services. Home care services can allow individuals the opportunity to stay home longer if they so choose and when appropriate and delay entering a more costly living situation like a long term care facility. This reduces typically higher long term care costs to the family and the state. The licensure of non medical home care entities and agencies required by this bill will ensure better care for our families. In addition to our general support of the bill, we strongly support the dementia specific reach, training requirement for home care workers included in the bill language. We believe training is crucial to provide workers with the tools they need to effectively care5016 for this population. Currently, the 213,000 family caregivers in Massachusetts are providing 2460000005024 hours5026 of unpaid care a year valued at $5,680,000,000. However, family caregivers alone cannot provide all the care that is needed for individuals living with Alzheimer's and other dementia, and therefore rely heavily on home care agencies for activities of daily living. With education and training in understanding the disease, empathic response, and other relevant communication and safety skills, home care workers can provide appropriate care, emotional support, and prevent or reduce distress associated with dementia. In addition, home care workers are well placed to observe and report changes of status to families or clinical colleagues, thereby helping to reduce the risk of emergency department visits, avoidable hospitalizations, and other adverse outcomes that are disproportionately high among people living with dementia. Massachusetts currently requires dementia specific training for home care aids, providing care under a home and community based services waiver, and passing this bill would expand those requirements across all home care agencies in the state. We are grateful to chairman Stanley and chairwoman Jalen and the committee for your efforts, to always consider those living with Alzheimer's and other dementia and making important policy decisions. We believe swift passage of an act to improve Massachusetts home care will raise the standards for those requiring home care in the Commonwealth and protect some of our most vulnerable residents when receiving care in their homes. Thank you so much for this opportunity.
SPEAKER1 - Thank you.
SPEAKER20 - Thank you to the committee for hearing my testimony today. My name is Doug Haino. My wife and I, Kirsten, live in Wellesley. I'm here to speak on behalf of, the same bill, 7 89 and senate bill, 4 70. My wife, Kirsten, was diagnosed with Alzheimer's 5 years ago at the mere age of 53. She requires, 24 hour attention these days. She's at what we would call5162 late middle stage and requires help with all activities of daily living, like toy toileting, bathing, dressing. She can't really even recognize the toilet or know what to do with it even if she's staring at it. I started using, home home care services about a year ago, and I got a list from the Alzheimer's Association and was, willing to pay, you know, top dollar to make sure that I got the kind of service and reliability that I wanted. But it was pretty quick. So I needed those services. Right? I'm working at home, but still need help during the day, so I can continue to hold down my job. I have somebody coming in 5 days a week for, 11 to 3. Right away, it was clear that there's not, consistent ongoing training. And5216 I think as we talk about what's happening with the labor force, the high turnover makes it that much more critical that there be, a certain level of training and ways to monitor that training. Because we went through 7 or 8 caregivers in a 9 month period Mhmm. Before we settled in on the woman that we have today, who I would call an 11, a saint, and a real pro, but I couldn't say the rest about the ones that came before her. Most of the caregivers don't have an appreciation for, the certain basic things, to to do with, Alzheimer's disease and and, and how to communicate and deal with folks that have the disease. Her inability her inability at this point to recognize,
or the intake, verbal communications is pretty sort of basic across the spectrum of folks. And these folks clearly didn't understand, how nonverbal cues would really help the situation. Want her to be able to continue to do activities of daily living, like tying her shoes and and and those sorts of things. And you can ask her a million different times to to to put on her shoes, but, all that'll do is frustrate her. But if you put the verbal with the nonverbal, just touching her foot, all of a sudden she gets it. Other basic things, we're talking about safety. And if you all hold your hands up to your eyes like this,
pretty pretty early on in the progression of the disease, peripheral vision goes away. It's controlled by a different part of the eye, different part of the brain. And for somebody coming into your home to treat an Alzheimer's patient not to know that is really tough. 1 1 caregiver took my wife out day 1. They got off a path and wasn't really, supporting my wife the way that she should. Tripped over curbs, masked her face on the pavement, split her lip wide open. We spent a long night at the at the emergency room. But it's basic, basic sort of stuff that somebody should understand when caring for an Alzheimer's patient. She is progressing relatively slowly. I'm gonna need home health care, support for a long time5359 to come, and if this person leaves for whatever reason, I can't imagine going back and starting over again and having to deal with going through a host of folks that may not have even the basic, understanding on how to treat a person, dealing with Alzheimer's. Thank you very much. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER3 - I'll turn it over to Lori.
SPEAKER1 - Thank you.
SPEAKER21 - My name is Laurie Pontus. I live in Westford. I'm here to speak in support of House Bill 7 89 and senate bill 4 70, an act to improve Massachusetts home care. I was a caregiver to my dear husband, Julius, who passed away 7 months ago after living with dementia for nearly 8 years. Julius was diagnosed with a form of dementia in 02/2018 at the age of 63. Our decision to see a neurologist was based on memory decline and numerous job losses. In the early stages, Julius had difficulties following instructions. He became quieter, lacked empathy, and lost all inhibitions. In 02/2019, after he had been diagnosed, he suffered a stroke, then another 1 on Father's Day 2020. At that point, he went under hospice care at home based on recommendations5439 from several doctors. I was his only caregiver outside of the hospice aids who came to the house 5 days a week for about 30 minutes. I enlisted an agency that supplied help every 2 weeks for a 4 hour shift. This continued for the 4 years that he was under hospice care. I used this time to get groceries, manage my own doctor's appointments, and run various necessary errands. By this point, Julius was nonverbal and had a very difficult time walking. He was incontinent and had several OCD habits, like grinding his teeth, slapping his head repeatedly, and moaning. While it would appear to some people that he was completely unaware of his surroundings, he was still able to enjoy music and certain lively television5492 programs. While we didn't always have home care workers who were informed about dementia,5498 and that actually happened5500 a lot, when we did, it was so helpful. 1 man in particular, who I'll never forget, came prepared with a tablet and watched movies with Julius. Most of them were cartoons with odd animated voices or action movies with
or action movies with stimulating sounds. He also made suggestions to me regarding best ways to use gate belts for transfers. He even researched a piece of adaptive equipment for me, a commode wheelchair, which was easy to maneuver in a safer way to transfer Julius to the bathroom when Julius became immobile. I purchased this wheelchair and was forever grateful for that advice. Not only did it prevent Julius from falling, I felt more secure knowing that I would be less prone to suffer an injury to my own body, and my my own health was extremely important during this time. I hope that you will support this bill to guarantee that all home care workers have a greater understanding of the disease and can be better prepared to support their clients and their families. Thank you for the opportunity to provide testimony today. I appreciate your listening to Julius' story to hopefully help other families who are seeking home care for their loved ones with dementia. We're all happy to answer any questions you may have.
SPEAKER1 - Any questions? No. I think. Senator Jalen.
SPEAKER4 - I just wanna say, just listening to you, what you've learned in your experience and how important the Alzheimer's Association is, not just in legislation, but educating people about simple simple but unknown things about how to, as a family member, not only as a worker, to, relate to people know,
SPEAKER1 - we we we learn a lot as legislators. You know, we we we learn a lot as legislators, about Alzheimer's and other diseases. And I'm actually through, my role here as chair on the Alzheimer's advisory council. And,
but, you know, I I realize there's so much more that I I need to learn, but I I wanna tell you, you know, you're testifying today. I've learned I learned a lot today, and, you know, you you brought,
a lot more meaning to passing this bill as well. And I did notice the, you're wearing purple, you know, the color of Alzheimer's awareness, and, appreciate that as well. Alright. Thank you. Thank you very much.
Okay. That's the that's the end of the, folks that have registered. Anyone else here that would like to speak? No? Alright. Then, declare, hear a motion that the meeting
SPEAKER9 - is So moved.
SPEAKER1 - So moved. Seconded. So So moved. All those in favor signify by saying aye. Those opposed, the ayes have it. Thank you.
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