By Mark Friedman
Massachusetts is taking an important and long-overdue step toward protecting older adults and their families by moving toward licensing home care agencies. The Commonwealth should be commended for recognizing that organizations sending caregivers into the homes of older and potentially vulnerable residents should be subject to meaningful standards and oversight.
For too long, Massachusetts has lacked comprehensive licensing of private-pay home care agencies. Proposed regulation can begin to change that by establishing requirements in areas such as background screening, training, consumer protections, insurance, and agency accountability.
I’ve spent years working in home care, and I’m pleased Massachusetts is finally taking this important step. Establishing a regulatory floor is meaningful progress, but experience has taught me that families need to understand an important distinction: Licensing establishes a floor. It does not establish a standard of excellence.
A license tells consumers that an agency has satisfied the minimum requirements established by the Commonwealth. It doesn’t necessarily tell them how far beyond those requirements an agency goes to protect its clients or ensure the competency of its caregivers.
The title ‘aide’ doesn’t tell you how someone was trained
One important example is the person actually providing the care. The proposed framework doesn’t establish a single professional qualification that everyone called an “aide” must possess. Massachusetts already has established training and competency standards for Certified Nursing Assistants and Home Health Aides, but families shouldn’t assume that every person described as an aide or caregiver has one of those qualifications.
At Senior Helpers Boston and South Shore, we made the decision to use these established standards rather than create our own definition of a qualified caregiver. We only hire CNAs and HHAs to provide care. Before entering our orientation program, every newly hired caregiver must also pass a 50-question version of the Home Health Aide written examination. We want caregivers to demonstrate foundational knowledge before orientation begins, rather than use orientation as a substitute for it.
When it comes to background checks, it’s important to know what’s actually checked
Background screening provides another example of the difference between minimum compliance and a higher standard. Families will increasingly hear that caregivers are “background checked,” but it is worth asking what that actually means.
Our screening includes Massachusetts CORI, a multi-state criminal background search covering 42 reporting states, additional searches based upon prior ZIP codes when necessary, motor vehicle records, FACIS health care sanction screening, drug screening, reference verification and E-Verify. Several screenings are repeated annually, and we check the federal Office of Inspector General exclusion database monthly.
The principle is straightforward. A background check performed when someone is hired only tells us what was known at that moment. Circumstances can change. We believe screening should therefore be viewed as an ongoing safety responsibility.
Training matters, but so does demonstrating competency
Training deserves similar scrutiny. Completing required training hours isn’t necessarily the same as demonstrating competency.
Every Senior Helpers Boston and South Shore caregiver completes our six-unit Senior Gems dementia training program based on the work of dementia educator Teepa Snow. Caregivers also receive education in fall-risk management, infection control and bloodborne pathogens, elder abuse, nutrition, medication support, end-of-life care and comfort medication support, and care documentation. Training includes written testing and a hands-on Activities of Daily Living assessment in a skills lab designed to replicate a home environment.
There is a meaningful difference between attending a class, demonstrating knowledge through testing and demonstrating the ability to perform a skill. Families should understand how an agency evaluates all three.
Good care starts with understanding the person
Finally, families should evaluate how an agency determines what care an older adult actually needs. At Senior Helpers Boston and South Shore, our intake process is nurse-led and uses our Life Profile assessment to examine three critical areas: safety, medical condition management, and autonomy and independence.
We consider mobility, fall risk, cognition, environmental risks, relevant medical conditions, medications, nutrition and changes caregivers should recognize and report. Just as importantly, we assess what the older adult can continue doing independently. Good home care shouldn’t simply do things for people. Whenever possible, it should help them maintain their abilities, choices and independence.
Massachusetts deserves credit for moving home care regulation forward. A meaningful licensing system can help protect consumers by establishing basic standards for agencies providing care to older adults.
But families shouldn’t stop their evaluation at, “Are you licensed?”
They should also ask: What qualifications do you require of every caregiver? What background checks do you perform and how often? How do you test caregiver competency? What dementia training is required? Who assesses my loved one? How do you determine the appropriate care plan? And what professional oversight continues after care begins?
Licensing can tell us whether an agency has met the Commonwealth’s minimum requirements to operate.
Quality is determined by the standards an agency chooses to meet beyond those minimum requirements and how consistently it follows them.
Massachusetts is taking an important first step by establishing the floor. For families choosing care for someone they love, understanding what lies above that floor remains just as important.
About the Author: Mark Friedman is the owner and Chief Education Officer of Senior Helpers Boston and South Shore. Passionate about seniors and healthcare, the goal of his agency is to change the trajectory of aging for his clients and their families first by delivering an exceptional homecare experience in a combination of highly trained and high-touch caregivers, and second by providing education and guidance with and connection to resources and services in the 43 communities his company serves. Contact Mark at MFriedman@SeniorHelpers.com or visit www.SeniorHelpersBoston.com.
