From the Wellness Wave morning radio show, January 17

For more than a decade, Massachusetts has operated with a regulatory blind spot: home care agencies that send workers into private homes have not been licensed by the state. On the Wellness Wave morning radio show on January 17, industry and advocacy leaders warned that the consequences are no longer theoretical — families are being placed at real risk in a rapidly expanding, largely unregulated market.

Jake Krilovich, chief executive of the Home Care Alliance of Massachusetts, said the state’s failure to license home care agencies has created a system where consumer protections lag far behind demand. House Bill H.4706, which passed the House in late 2023 and now awaits Senate action, would establish licensure requirements for the first time in more than 15 years.

“This is fundamentally a consumer protection issue,” Krilovich said, describing a marketplace where families often assume oversight exists when it does not. Under current law, agencies only register as businesses. There are no consistent standards for caregiver vetting, insurance, training, or complaint resolution.

Widespread Lack of Insurance

Krilovich said one of the most alarming realities is how many agencies operate without basic coverage. An estimated 60 to 70 percent of home care agencies in Massachusetts are uninsured, lacking liability or workers’ compensation policies.

“When something goes wrong, families may have no recourse,” he said. “An agency can dissolve and reappear under a new name, and there is no accountability.”

He urged families to ask agencies directly about insurance before signing contracts, noting that many do not realize this is even a question they should be asking.

Misclassified Workers, Broken Care

Krilovich also raised concerns about agencies that rely on 1099 independent contractors for caregiving roles — a practice that is illegal in Massachusetts. These workers are not insured, are not guaranteed hours, and can decline shifts without penalty, creating instability for clients.

“When care is disrupted, it is the client who pays the price,” he said. Overnight coverage can collapse, dementia routines are broken, and families are left scrambling.

By contrast, agencies that employ caregivers as W-2 staff provide insured, supervised care, but struggle to compete against operators who reduce costs by ignoring the law.

A Level Playing Field

Krilovich framed H.4706 as a long-overdue baseline, not an added burden.

“This bill protects families and levels the playing field for agencies that are already doing the right thing,” he said. “It gives consumers confidence that when someone comes into their home, there are real standards behind that service.”

The legislation would also prevent agencies from closing and reopening under new names to avoid complaints or liability.

Families Caught in the Middle

Home care costs between $35 and $50 an hour, while nursing home care in Massachusetts often exceeds $10,000 a month. Krilovich noted that only about 14 percent of Americans can afford private pay care without assistance.

Many families rely on long-term care insurance, home equity, or Medicaid spend-down programs. He pointed to the growing strain on the “sandwich generation,” caring for aging parents while still supporting children.

“We cannot keep pretending unpaid family caregivers can carry this alone,” he said. “It’s not sustainable.”

A Call to the Public

Krilovich said the Home Care Alliance has developed an accreditation program aligned with the proposed law, along with consumer checklists and guidance for families.

He encouraged listeners to visit thinkhomecare.org to learn how to vet agencies, confirm insurance, and follow the progress of H.4706.

“This is about dignity, safety, and accountability,” he said. “Our families deserve a system that protects them — not one that leaves them guessing.”