Advocates call for legislative changes following Healey's cuts to elder care budget
Image | Courtesy of State House News Service
Sen. Patricia Jehlen speaks at a home care lobby day at the State House on Tuesday.
When the governor trimmed the state's elder home care budget this month in a mid-year emergency cut, she said she was right-sizing the appropriation to what the state expects to spend on the program. But, Sen. Patricia Jehlen said, that's exactly the problem.
"It's not because there wasn't enough demand" for home care services, Jehlen said at a State House advocacy event Tuesday. "There were thousands of people either waitlisted, or not receiving the services that had been certified as they needed. So, since they weren't able to hire people, they cut the budget."
Gov. Maura Healey nixed $2.6 million from the home care line item, reducing it to $211 million, in her Jan. 8 budget-balancing move.
"I am reducing this item to the amount projected to be necessary based on current utilization trends," Healey wrote in her comment on the cut.
While the demand for services is there, the lack of utilization is a workforce issue, said Jehlen, who co-chairs the Legislature's committees on both elder affairs and labor.
She joined other lawmakers and the "Enough Pay To Stay Coalition" for a lobby day in support of a bill they said would get at the underlying problem. The coalition includes Mass Home Care, the Home Care Alliance of Massachusetts and the Home Care Aide Council.
Jehlen and Rep. Carmine Gentile's bill (S 755 / H 1195) would dictate the rate-setting process used by MassHealth and the Executive Office of Health and Human Services for home health and home care services. That would get at "the single largest cost factor impacted by the rate setting process," according to a coalition summary: "fair and adequate wages and benefits" that lead to "the ability of providers to retain and recruit sufficient staff."
"There's staff shortages everywhere. They can't hire enough people," Jehlen told the News Service. "People don't stay. They aren't paid enough. My mayor talks about it as two sides of a coin. [Somerville] Mayor [Katjana] Ballantyne says it's rents and pay. And if the rents go up, and your pay doesn't go up, you can't stay where you are."
Julie Watt Faqir, executive director of the Holliston-based Home Care Aide Council, said the industry doesn't know what factors go into the rate-setting process today.
"We don't know, because they've never been required to answer our questions," she said. "Particularly on the home health side, which is the MassHealth side, they'll just say, 'Oh yeah, we reviewed it.'"
Filed a year ago, the bill remains in the Health Care Financing Committee chaired by Rep. John Lawn and Sen. Cynthia Friedman.
It would require "the administration to be more forthcoming and transparent in how they set the various rates," Watt Faqir told the News Service. "This bill addresses our rates, those for homemaking and home health aides, but we're hoping it will extend to the entire process so the state will say, 'Oh, when we're reviewing your rates every two years, this is what we're looking at. The [Bureau of Labor Statistics] statistics, what the cost of living is, what inflation is -- so that we can make sure that the workers that you hire have enough money for training, enough money to be able to work in this industry and make a living."
Jehlen likened home care aides' present situation to a recent predicament at the MBTA.
"When the T, for years, couldn't figure out how to get more people to drive their buses, they could not figure it out. And then they raised the pay. And people wanted to be driving buses," the Somerville Democrat said.
She added that the governor's reasoning for the mid-year budget cut was "a negative feedback" or "vicious cycle" showing that "if you don't have utilization, you cut the budget, and then you don't have the workers to perform the service."
"People like to live at home," Rep. Carmine Gentile of Sudbury said at the Grand Staircase event. "They like to continue living in their homes. ... And what's the alternative? The alternative is a rest home, a nursing home, not as good a life as continuing to live at home," he added.
Rep. Thomas Stanley, House co-chair of Elder Affairs, said attracting and retaining the home care workforce "is critical to meet the growing demand for services."
Continuum Of Care
The coalition also registered its support Tuesday for a bill (H 649) cosponsored by Stanley, Jehlen, and House Majority Leader Michael Moran, to create a licensing process for non-medical home care services.
"Half of the industry is licensed through the [Aging Services Access Points] with contracts with the state. But the other half isn't licensed. So you don't know what you're getting when you hire personal care attendants and home care makers," Stanley told the News Service.
New state regulations created as a result of the bill would include background screening for all home care workers, specified training and competency requirements, workers' compensation and liability insurance coverage requirements, safe working condition policies, and use of a compliant payroll process, according to the coalition's summary.
A sudden need to hire home care assistance can put family members in "panic mode," the Waltham Democrat said, sometimes with just a few days to line up a provider as a relative comes out of recovery.
"And so this will ensure that everyone knows what they're getting, that they're getting proper care for their loved ones, and what they're paying for," Stanley said.
That measure is part of a trio of continuum-of-care bills Stanley listed as priorities for this term, along with a bill overhauling the long-term care industry and another dealing with assisted living facilities.
The long-term care bill (H 4193) cleared the House in November, and has sat since then in the Senate Ways and Means Committee.
Elder Affairs recommended its assisted living bill (S 2527) four days before Christmas. It is now in front of the Health Care Financing Committee.
Health Care Financing has issued reports on 37 pieces of legislation this term, according to the Legislature's website, and still has 180 bills sitting in its custody with an initial March 27 decision-making deadline.
"It's like the three stages of the continuum of care," Stanley said of the trio of bills. "We've made great progress, and I'm hopeful that all three can be passed this session."
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