WAPDA, the Washington Private Duty Association, is the Washington State chapter of the Home Care Association of America. As a founding board member and current president, as well as President and CEO of my own Seattle-based licensed home care agency, Family Resource Home Care, I’m continually watching and analyzing the changing landscape of home care in Washington as well as state and national policy changes impacting long-term care in general.

Last month, in Part I of WAPDA Addresses Challenges to Licensed Home Care Agencies, I wrote about two challenges currently facing WAPDA member agencies: fallout from Washington State Initiative 1163, and the probable demise of the federal Companionship Exemption. Here are two more challenges facing home care agencies, and therefore challenges to the clients we serve.

1) The Patient Protection and Affordable Care Act (PPACA), otherwise known as Obamacare. There are still many unknowns about how the details of PPACA will be implemented. What we do anticipate is that the greatest impact to home care agencies will occur in 2015 and will involve what’s known as the “employer mandate.” The employer mandate requires that all businesses with over 50 full-time employees either provide health insurance or pay a penalty. As a 50 person home care agency is a small agency, most Washington State home care agencies will find themselves subject to the mandate. While some businesses providing home care services do provide traditional health insurance coverage, most do not.  In recent years we have seen healthcare costs skyrocket and in 2015 home care agencies across the nation will need to either start offering health insurance, pay a penalty, or reduce the hours of full-time caregivers to part-time.   

The Bottom Line: Costs to elderly clients will go up and/or caregivers will suffer reduced wages as a result of reduced working hours.

2) The Impact of Registries. Registries are companies that, for a set fee, will send a person to a private home to care for a vulnerable adult. The person who is sent becomes the employee of the family and there is no requirement that the person be trained, insured, certified, or has undergone a reference or background check. There will likely be no supervision, benefits, or compliance with wage and hour or other labor laws. Unlike licensed home care agencies, registries are beyond the regulatory authority of the state Department of Health. Registries are however a cheaper way to go than a licensed home care agency ― just as it’s cheaper to have your neighbor give you legal advice rather than hire an attorney.  PPACA, along with Washington State Initiative 1163 and the end of the companionship exemption will increase costs to licensed home care agencies, putting pressure on agencies to raise fees. This could very well lead to more people hiring caregivers through registries as a lower cost alternative.

The Bottom Line: For families opting to use a registry, the vulnerable elderly or disabled person will see increased risks from unlicensed and unregulated providers.

The Patient Protection and Affordable Care Act and the growing influence of caregiver registries are not likely to improve the home care services provided to our elderly clients. The long-term health of home care agencies in Washington should be a concern to anyone working in long-term care. It should also be a concern to those of us who know someone who is aging or is planning on aging themselves!