Request for Reform in Massachusetts Group Adult Foster Care Program Regulations

Dear MassHealth Officials,

I hope this letter finds you well. I am writing with heartfelt concern regarding the current structure of the Group Adult Foster Care (GAFC) program under MassHealth. The program is designed to help individuals like me, who require assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), maintain independence and dignity. However, the way the program is structured—particularly the daily service requirement—has led to significant inefficiencies that impact both caregivers and participants in ways that I believe could be avoided.

The current system requires caregivers to visit daily, regardless of whether the participant needs help that day. I understand the intention of ensuring that care is available when needed, but for many of us, like myself, assistance is only necessary a few times a week for essential tasks such as showering, grocery shopping, or personal hygiene. The daily visits often become unnecessary, and caregivers, under the pressure of meeting billing requirements, are sometimes forced to visit for as little as 15 minutes.

This brief visit isn't because the caregiver's assistance isn't needed or wanted—on the contrary, the caregiver has already provided crucial support on previous visits, helping with essential tasks that cannot be left incomplete, such as hygiene or grocery shopping. But after providing care for these necessary tasks, there is often very little time left in the day's allocated hours. Still, the caregiver must visit for those final minutes—just to ensure that the agency and caregiver are paid for their time. It's an inefficient use of resources, and it's burdensome for the caregiver, who is just doing their best to meet the program's requirements, even if it means making a short, often unnecessary visit.

One of the most time-consuming tasks that aides assist with is laundry. Many participants, like myself, rely on caregivers to handle laundry, which can take over two hours to complete. In many cases, the only available laundry machines are in the basement of the building, with limited access. Some caregivers even have to take the laundry off-site, making the process even longer. The current daily visit requirement does not account for the reality of these longer tasks, further underscoring the need for a more flexible billing structure.

The impact of this system is not just on the caregivers, but also on participants like me. The current structure leaves us with a sense of being bound by a system that doesn't reflect the reality of our care needs, which can vary greatly day-to-day. While I rely on help for personal care, I don't need someone at my door every day. The pressure on caregivers to make those visits, even when unnecessary, doesn't feel right, and it leaves us all with the sense that we're being forced into a routine that doesn't truly serve us.

MassHealth needs to hear from those of us in the program. Too often, when participants raise concerns or caregivers voice frustrations about this daily requirement, the suggestion is made to simply find another program. But the GAFC program is the only one in Massachusetts that truly supports people who need help with ADLs and IADLs, and for many of us, it's essential.

I believe a change is needed. I respectfully propose that MassHealth consider restructuring the payment model to reflect the actual care needs of participants. Instead of requiring daily visits, I suggest splitting the daily rate into four 15-minute billing units. This would allow for more flexibility in scheduling and ensure that caregivers are compensated fairly for the time they actually spend with participants, while eliminating the pressure to make daily, unnecessary visits.

This reform would create a more efficient, compassionate, and responsive program—one that better reflects the true needs of its participants and the real demands on caregivers. I ask that MassHealth take this opportunity to listen to those of us who rely on this program and work with us to find a solution that truly serves the people it was meant to help.

Thank you for your attention to this matter, and for considering this necessary change.

Sincerely,
A Concerned MassHealth Participant