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Call for a printed copy of the Resource Directory or more information. Growing Older in Massachusetts: A Guide for the Family , edition, is a publication listing a wide variety of Massachusetts resources, including a comprehensive list of home care providers. Regional editions of the book can be purchased by calling , or go to Growing Older in MA.

Assessments to Improve Care for Older Adults - UCLA Research Conference on Aging 2018

Certified Home Care Agencies and Hospice Agencies provide both medical and non-medical services and have met strict federal requirement for patient care and management and therefore can in some cases provide home health services covered by Medicare and Medicaid. These agencies take care of all benefits and tax requirements for their employees. Non-Certified Agencies also provide medical and non-medical home services but are not licensed.

The same labor standards apply to employees of these agencies as to the employees of certified agencies.

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Placement services provide medical and non-medical services and the providers are self-employed independent contractors, not employees. Independent Workers are employees hired directly by the elder or family caregiver, who is then legally responsible to pay state payroll taxes and worker's compensation. There is no oversight or licensing of these services, and no source of coverage to pay for them. For more information on the differences between these types of agencies, see the website of the Home Care Alliance of Massachusetts , Think Home Care. For elders who are medically eligible and homebound, some of the costs for home care services are covered by Medicare, Medicaid MassHealth , health maintenance organizations HMOs , and some health and long-term care insurance plans.

For people who meet eligibility requirements for programs managed by the ASAP, services are subsidized on a no-fee or sliding scale basis. Most families are not able to get the home care services they need covered by a third party, and home care can become a major expense. The issue of paying family caregivers to provide home-based care is a topic of on-going debate among elder care practitioners and public policy makers. There is currently no federal policy in place, but there are state-level demonstration projects designed to test the costs and benefits of such an approach. The overall goal is to keep elders in their homes and communities and out of long-term institutional care by extending the definition of caregiver to include qualified family and unrelated caregivers.

There are eligibility criteria both for the elder and the caregiver. The caregiver can be a family member excluding a spouse or legally responsible relative , or an unrelated adult 16 or older, who has completed a training course in home care and meets other criteria set by the state. A pilot project called the "Caring Homes" program was launched in Contact your local ASAP to learn whether you and the elder in your care qualify for this program.

Once you have determined what home care services are needed, how to pay for them and where to find them, then you are ready to compare the quality and cost of the services offered by different agencies. How will the agency assess need? Although you may have performed a needs assessment for the elder in your care prior to contacting the agency, you should ask the agency how it determines the appropriate level of services you need. Your elder's needs may increase or decrease over time and the agency should have a process to assess any change in the services needed.

What is the training and experience of the caregivers? Ask what training the agency provides to its caregivers, and if the home care aides are certified by the agency. Does the agency require that its caregivers participate in a continuing education program? Ask if the caregivers are trained to identify and report changes in service needs and health condition.

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Ask about the specific caregivers who will be assigned to your care. Do the caregivers have experience or receive special training in the type of care which is needed, such as Alzheimer's care? Or training with a particular type of assistive technology, such as a hoyer lift?

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  • How long have they been working in the home care field? How does the agency develop the client's care plan, and supervise the caregiver? Does a medical professional or experienced supervisor evaluate and supervise the caregiver in the client's home and get input from the client? How much control and personal independence does an agency provide to its clients?

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    • How does an agency involve clients and family members in the process of assigning and supervising caregivers? How does the agency assure continuity of care?


      There are clear benefits to limiting the number of caregivers involved with a client. Can the agency reasonable assure that the same caregiver s will provide the home care services each week? How long do caregivers stay with the agency? What is the turnover rate? If a substitute caregiver is going to be sent, when does the agency provide notice to the client? Ask how the agency assures that the substitute caregiver will be familiar with the care plan and individual needs of the client and the family.

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