PROPOSED REGULATION CHANGES TO DISRUPT D.C.’S CAREGIVING AGENCIES, AGAIN

D.C.’s Board of Nursing’s mission statement reads:

The mission of the Board of Nursing is to safeguard the public’s health and well-being by assuring safe quality care in the District of Columbia. This is achieved through the regulation of nursing practice and education programs; and by the licensure, registration and continuing education of nursing personnel.”

In addition to other titles, D.C.’s Board of Nursing oversees certified nursing assistants (CNAs) and home health aides (HHAs). These are certifications to people that caregiving companies hire, and each certification corresponds to a different degree of responsibility. Within Washington D.C., CNAs are only allowed to provide personal care in senior living communities, while HHAs can provide personal care in communities and in the homes of their clients. Home care firms hire CNAs and HHAs depending on their business’s needs.

In D.C., caregiving firms were under the impression that they may apply for two types of licenses, a Nurse Staff Agency license and a Certificate of Need. The Nurse Staff Agency license is a license that a registry uses to refer caregivers to homecare agencies and facilities, such as assisted living and skilled nursing facilities. It’s useful for a company that staffs senior living communities with caregivers. There’s also the Certificate of Need, which is required for an agency who would like to provide care, including skilled services to patients in their home. D.C. takes precaution with administering these licenses due to the complexity of the services which may be provided. On average, it takes an agency two years to get approved for a Certificate of Need (CON). A homecare agency license or a homecare license in addition to a Certificate of Need is required to provide skilled services.

Approximately 12 years ago, D.C.’s Board of Nursing sent a ‘Cease and Desist’ letter to the homecare agencies that did not hold a healthcare license. The letter instructed agencies to apply for a homecare license or stop providing care.  As a result, homecare agencies were directed to apply for either a Nurse Staff Agency license or a Homecare License. However, D.C. was not issuing new CONs at that time.

A few years later, D.C. stated that NSAs should not be providing care to patients in the home, but should only be functioning as a staffing agency for homecare agencies and facilities. Trade associations and other long term care groups met with D.C. and requested that they work together with D.C to create a strategy for appropriate licensure. The concern was for the patients being served and the caregivers as their clients, mostly seniors, would lose their caregivers. In addition, many businesses may end up in bankruptcy, which may cause a spike in unemployment. However, nothing happened for years.

About three months ago an alert went up on the D.C. Department of Health’s website that reignited the issue. The alert said that caregiving agencies who held an NSA license but were providing care in the home were operating in violation of the law. Agencies were advised they must obtain a homecare license and Certificate of Need if they want to continue to operate by providing care in the home. Once again the trade associations and their members gathered to discuss the impact with the Board. This time, it appears the Board is working with the caregiving agencies to smooth the transition. As a result of these discussions, emergency legislation was passed by DC and a new Home Support Services licensure has been created. This allows for personal care services only, to be provided by DC HHAs.

However, it’s going to be tougher for the agencies to continue to do business in DC as they had once done. In addition to licensing requirements, the Board is placing more mandates on D.C. caregiving agencies, which may reduce the number of firms that conduct homecare in D.C. One notable proposed change is that agencies must have office space within D.C. that is staffed 40 hours per week. How firms have been reacting to this proposal shows that the Board is serious about its policy changes this go-around. Already, homecare agencies have been partnering with senior living communities to secure office space in their buildings, in addition to leasing spaces of their own. Some agencies may drop out of the DC market as rental rates and additional staff push their costs too high to justify operating in D.C. Fewer firms in D.C. may mean fewer available caregivers to care for seniors at their homes.

Another requirement is that the Home Support Agencies can only use DC HHAs to provide care. Currently, many agencies are using DC CNAs, these aides must transition to DC HHAs if they are to continue working in client homes.  There is normally 32 hours of education followed by an exam in order to make that transition. The association is currently working with DC DOH to see if there is any way to expedite the process so that clients continue to be served.

​Stay tuned for updates.

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