Legislators are weighing a bill that would impose new training requirements for workers at homemaker companion agencies, which have risen sharply in number over the last decade as more people age at home but remain largely unregulated.

The agencies provide non-medical, home-based services such as housekeeping, meal preparation, running errands, transportation and companionship.

Under the proposal, new employees at homemaker companion companies would have to complete at least 10 hours of training on a variety of topics, including cardiopulmonary resuscitation, first aid, maintaining a clean and safe environment (practices related to dressing, bathing and toileting), identification and reporting of abuse and neglect, communication, identifying and reporting changes in a client’s condition, and non-medical services for people with Alzheimer’s or dementia.

Agencies would also have to provide at least 10 hours of continuing education to employees annually on those issues. They would have to ensure workers complete every program on the list at least once every two years.

The state’s consumer protection commissioner, working with three other departments, would have to come up with the list of programs. Upon completion of training, homemaker companion employees and their supervisors would have to submit a form attesting that they’ve finished the program.

“It’s a simple thing we can do to get better home care. It’s the right thing to do,” said Rep. Jane Garibay, a Windsor Democrat who is co-chair of the Aging Committee, which raised the bill. “If I were a home care worker, I would appreciate it.”

The Connecticut Mirror reported in 2023 that the state’s growing home care industry was operating with little oversight. In 2012, there were 380 registered homemaker companion agencies. By 2022, the number had swelled to more than 900.

Officials estimate the number is now around 1,100.

Despite that, the industry still operates with little regulation. Unlike nursing home employees and home health aides, who must be licensed by the state Department of Public Health, there is no licensing process for homemaker companion workers. Instead, those agencies must register annually with the consumer protection department.

Managers at the companies are required to conduct criminal background checks on prospective employees but aren’t required to share that information with the state, which does not track who works at the agencies.

CT Mirror reviewed more than 75 complaints against homemaker companion agencies filed with the consumer protection department between 2018 and 2020 and discovered at least half a dozen cases in which homemaker companion agency employees were arrested for allegedly stealing from their clients, more than a dozen findings by DCP investigators of agencies that routinely misadvertised the services they provided and seven complaints of clients being left alone for hours at a time.

Many of the DCP investigations led to small fines of less than $5,000 or an employee being fired. Agency officials acknowledged the department had never denied a homemaker companion business’ registration and had never revoked a business’ registration following an investigation.

Concerns and support

At a public hearing on the bill Thursday, advocates expressed strong support for the training mandates while some agency leaders shared concerns.

Tracy Wodatch, president and CEO of the Connecticut Association for Health Care at Home, said she is in favor of additional training. Employees currently undergo instruction on mandatory reporting and sexual harassment, and those who work with people in Medicaid waiver programs must complete special training through the state. But other types of training are optional.

Wodatch urged the state to consider higher Medicaid reimbursements for homemaker companion agencies.

“We are concerned that the administrative and tracking requirements in this bill would create significant unfunded mandates for agencies already operating in a severely underfunded and stressed environment,” she told legislators Thursday. “If our shared goal is truly to improve quality and build a stable workforce, the best solution is to invest in agency-based Medicaid homemaker companion services.”

Wodatch said first aid and CPR are outside the scope of the services homemaker companion staff offer.

“It is important to remember that these agencies are required by law to provide solely non-medical care. Mandating medical-focused training creates confusion about scope of practice and could increase liability,” she said.

“On the other hand, we fully support training requirements that are aligned with non-medical care, such as personal care, communication, infection control, and appropriate dementia and Alzheimer’s support.”

Marie Allen, CEO of the Southwestern Connecticut Agency on Aging and Independent Living, said she also was concerned about funding for home care companies.

“I would ask the committee to consider the financial burden of doing business within the home care program, where Medicaid reimbursement has not kept pace with increases to minimum wage, health insurance and other unfunded mandates,” she said. “We find it more difficult every day to connect older residents to quality-based home care agencies.”

Lisa Brower, who owns a home care company, worried about the cost of the training.

“I have been the sole owner and operator of a small non-medical home care company since 2009. … Our services do not require formal training other than what we provide in our orientations. The cost of training caregivers for basic tasks will simply drive the cost up for our seniors,” she noted in written testimony to legislators. “What I charge is directly related to how much I can pay our caregivers. There is no extra to waste, and I do believe unnecessary training will be a waste.”

More than a dozen advocates expressed support for the proposal, including officials with the AARP in Connecticut and members of the Connecticut chapter of the Alzheimer’s Association.

“I was in my early 20s when my grandmother came to live with me and my mother because of her Alzheimer’s diagnosis. I was totally unprepared to de-escalate my grandmother’s behaviors to keep her calm,” said Karen Carty, a volunteer with the Alzheimer’s Association.

“This homemaker companion training is a necessary bridge to essential caregiving knowledge for companions, because we know this job is extremely challenging. The companion is a stranger to the person with dementia, so when they start the job, they need to already know the skills to gain the person’s trust through patience and compassionate communication.”

The Aging Committee’s deadline to advance legislation is March 10.