As demand for workers rises, home healthcare agencies seek pay increases
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An aging Baby Boomer population and increased life expectancy are blowing up demand for home care services.
Home care service providers are supporting legislation to create more transparency in the rate-setting process for their workers, citing an increased need for services for the state's aging population.
Every two years, the state looks at factors such as mandatory minimum wage, inflation and the cost of travel, and comes up with a reimbursement rate for home care and health services. Providers of these services bill nonprofit agencies called Aging Services Access Points, which are then reimbursed by the state at the agreed-upon rate.
The legislation, filed by Sen. Pat Jehlen of Somerville and Rep. Carmine Gentile of Sudbury, creates new rate-setting regulations. They argue the regulations would help "providers ensure fair and adequate wages and benefits for their dedicated home-based workforce."
"The continuum of health care from when you call an ambulance to when you try to go home... everything is clogged up because we don't pay direct care workers enough," Jehlen said Tuesday afternoon at an event to promote the legislation. "If we don't start paying people closer to what they're worth, and what it costs to live, then we are losing lives, I believe, because people are not getting the care at home."
Gentile and Jehlen's bill (HD 213 / SD 854) would create a rate-setting methodology that would reflect all operating costs and governmental mandates that affect the cost of providing home care and home health services, such as changes to the state's minimum wage, the Paid Family and Medical Leave Act, health insurance, employee benefits and training, and increased technology costs.
The proposed legislation would not set the rates or dictate the amount for future rates, but would end the need for the Legislature to fund supplemental rate add-ons each year through the state budget process, according to the Enough Pay to Stay coalition, which is made up of home care agencies.
It also requires that reports on home health rates set by MassHealth and home care purchase of service rates set by the Executive Office of Health and Human Services be filed with the Legislature.
"This reporting will increase transparency and foster a better understanding of the true cost of providing home care and home health services and how the rates directly impact access to services for consumers," the coalition wrote in a summary of the bill.
Prior to 2020, the home health aide rate had not been adjusted since 2007, "with no explanation or insight into the rate determination analysis," the coalition said.
The state's reimbursement rate for home health aides' base pay as of July 1, 2022 was $26.92 per hour, $33.16 per hour with add-ons from ARPA and the state budget. Home health aides undergo 75 hours of training and are legally allowed to help patients with personal care and simple procedures as an extension of nursing or therapy services, assist in ambulation or exercises and remind patients to take medication.
Though the state reimburses at a rate of $33.16 per hour for these workers, only about 61.6 percent, or $20.43, goes toward their compensation. The rest is spent on benefits, nursing supervision, travel costs, PPE, taxes and other fees.
Home health aide is only one of several jobs in the home care aide field, which spans from homemakers -- who shop, menu plan, and do laundry and light housekeeping -- to certified nursing assistants.
"We're talking about people who are not making a lot of money," said Julie Watt Faquir, executive director of Home Care Aide Council, which is a member of the Enough Pay to Stay Coalition.
Nearly 50 percent of all workers in the field are foreign-born immigrants, 96 percent are women, 50 percent have a high school diploma or less and 48 percent qualify for MassHealth and other state benefits.
Coalition members and lawmakers argued that this bill is important in the face of an aging state population who will need these services more and more. They said workers need to be compensated high enough to be attracted to and stay in the field.
Massachusetts residents over 65 years old are projected to make up 22 percent of the state population by 2030, outpacing the projected U.S. rate, according to a report released by the Mass Taxpayers Foundation in December.
Rep. Susannah Whipps of Athol said there needs to be more resources for seniors to age in place.
"The silver tsunami has begun. We've got people leaving the workforce every day. More and more people need your services," she said.
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