COVID-19 Making a Case for Nationwide Home Care Licensure Requirements

While nursing homes have come under fire for widespread COVID-19 infection outbreaks, home-based care providers have been largely regarded in a more positive light. 

Unlike skilled nursing facilities (SNFs) and senior living centers, home-based care providers have lower virus transmission risks due to the individual nature of the service delivery. As such, hospitals and families have been turning to home care and home health providers — rather than congregate living facilities — for help amid the coronavirus. 

But still, there’s room for improvement, particularly in the home care space, where lack of regulation can serve as a threat to patients and caregivers alike.


While medical home health providers are required to uphold certain practices and standards to stay open, a large number of nonmedical home care providers are not.

Federal guidelines govern home health providers, which are paid by Medicare. Meanwhile, nonmedical home care rules are left up to states because most services are either paid for out of pocket or by Medicaid. 

Currently, only 30 states have some form of licensure requirements for home care agencies, according to the Home Care Association of America (HCAOA). But COVID could prompt more states to follow suit going forward — or at least that’s what some stakeholders are hoping for. 


Founder and president of Tucson-based Catalina In-Home Services Judith Clinco recently argued that point in the Arizona Daily Star. She lives in the state, which currently lacks home care licensure requirements for most agencies.

One exception is those agencies contracted with the Arizona Long Term Care System, which is part of the state’s Medicaid program and does require home care agencies to provide caregivers with some infection control training.

However, that’s not the case for private-pay agencies in Arizona.

“To start a home-care agency, just register with the Arizona Corporation Commission and obtain a local business license,” she wrote in an op-ed. “There’s no professional license. At no point will you have to demonstrate your fitness to do the job, and there’s no master list of agencies.”

That’s problematic for a number of reasons, especially amid COVID-19, according to Clinco, who is also the founder of the Tucson-based CareGiver Training Institute.

For one, it makes sharing vital infection control information difficult. Additionally, it leaves consumers with no way to be sure caregivers are receiving important training. And on top of that, it means most agencies aren’t required to provide infection-control training, period.

“Caregivers do their work out of sight, in the client’s own home,” Clinco wrote. “In my book, they’re front-line heroes. But the opportunities for spreading infections are abundant. Many clients need just a few hours of service per week, so caregivers often work with a number of clients. About one in 10 work for multiple agencies. One infected caregiver can spread illness widely.”

While the Arizona In-Home Care Association (AZNHA) has advocated for training and licensing requirements for years, state legislators have yet to turn their recommendations into law. Still, AZNHA requires its members, at least, to adhere to certain standards and ethics.

HCAOA sings a similar tune. It advocates for nationwide licensure requirements and requires members follow certain rules and best practices.

“I certainly would love to work with states that are not currently regulated to put together effective and fair licensing,” Peter Ross, former HCAOA president and current board member, said on a recent HHCN webinar.

But not all licensure requirements are created equal, according to Ross, who is also the CEO and co-founder of Senior Helpers.

As such, it’s important for states to work with local and national associations to make sure sure any licensure requirements are helping, not hurting, the nonmedical home care industry. For example, copying home health licensing requirements and imposing them on home care providers isn’t the answer, as the industries are marked by important differences.

“The last thing you want to do is make [licensure] … something that’s going to drive cost into the business that’s going to make it harder for people to afford what we do,” he said. “You want to draw the line.”

Darby Anderson, a vice chairman for the Partnership for Medicaid Home-Based Care (PMHC) and chief strategy officer at Addus HomeCare Corporation (Nasdaq: ADUS), agreed.

Like Ross, Anderson voiced his thoughts on HHCN’s recent webinar. While neither stakeholder spoke to the likelihood of whether COVID-19 could lead to more licensure requirements, they made their hope clear.

“At the very basic level, you need some consumer protections, and licensing allows that,” Anderson said. “It can’t be overreaching. It can’t be putting in place regulations that don’t improve the quality of homecare or aren’t relevant to home care. But, certainly, knowing who your providers are … should be done across the board.”

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