Families and advocates testify that home‑care agencies abandon difficult 24‑hour cases; witnesses urge accountability and waiver changes

Family members, ombudsmen and advocates told a March 26 joint D.C. Council roundtable that home‑care agencies are abandoning some of the district's most vulnerable clients — specifically beneficiaries authorized for 24‑hour personal care aide (PCA) services — and urged the council to require stronger enforcement and to expand self‑directed care options.

Holly Eaton, senior attorney for the D.C. Long Term Care Ombudsman Program, summarized interviews and video evidence indicating home‑care agencies sometimes allow aides to “cherry pick” easier shifts and refuse the most difficult 24‑hour cases. Eaton said agencies have tolerated aides who show up to overnight shifts with the apparent intent to sleep. "When the beneficiary or family member expresses alarm and insists they remain awake to provide the care and monitoring they are being paid to provide, the aide refuses to return to the job," Eaton testified.

A family example: Angela Fisher, power of attorney for her brother Charles Fisher, described a case she said illustrated the problem. Her brother, a 2019 stroke survivor authorized for 24 hours of PCA services, received split coverage from home‑health agencies that Fisher said suspended services after episodes of abuse and assault. Fisher described one incident in which an aide allegedly assaulted her; she said the agency stopped staffing overnight coverage and that, as written, District rules require 8 of 24 state plan hours to come from a home health agency. She asked the council to require DC Health and the Department of Healthcare Finance to hold agencies accountable and to expand the EPD waiver’s Services My Way option so beneficiaries can staff the full 24 hours themselves.

"This precedent of abandoning vulnerable 24 hour beneficiaries is now seen as a viable way for them to get rid of cases that require aides to do work and are not able to sit and sleep," Fisher said. She requested: (1) stronger enforcement so agencies that suspend without good cause are not permitted to receive new referrals until current cases are staffed, and (2) expanded Services My Way access so beneficiaries may hire participant‑directed workers for a full 24‑hour period.

Ombudsman and legal testimony: Eaton and other witnesses described specific risks to bed‑bound clients who require repositioning, feeding and toileting; they said family oversight or remote video monitoring makes some aides reluctant to accept or continue those cases. Eaton asked the council to permit D.C. to use Medicaid’s 1915(j) authority in targeted ways to allow participant‑directed care to fill gaps in overnight coverage.

Provider and government responses: Home Care Partners’ executive director Marla Lahad and scheduler Jackie Cabaye described their agency’s operational strain: many applicants lack required qualifications; aides’ schedules and travel impose practical limits; and workforce shortages make it hard to staff even modest homemaker slots. Lahad said Home Care Partners’ average wage is about $21 per hour but that workforce shortages persist despite that level. Cabaye, a licensed home health aide and scheduler, called for free, accessible training and for combining CNA and HHA licenses to ease movement between facility and home work.

DACL and program context: Joan Williams of the Department on Aging and Community Living (DACL) described the Homemaker Program, a gap‑filling grant‑funded service that provides light personal care for low‑income seniors who do not qualify for the EPD waiver. Williams said the program currently serves about 161 clients with roughly 133 aides on staff, about 80 of whom are licensed in D.C.; she said the current homemaker wait list is under 100 and that the program is funded with a mix of local funds and federal Older Americans Act grants.

Requests for enforcement and waiver changes: Family members and advocates asked the council to (a) direct DC Health and DHCF to more rigorously enforce agency obligations when agencies accept cases, (b) consider temporary or pilot use of 1915(j) authority to broaden participant‑directed options, and (c) expand Services My Way to allow beneficiaries to hire participant‑directed workers for full 24‑hour coverage where agencies are unwilling or unable to staff shifts.

Council follow‑up: Committee chairs said they would accept written testimony through April 9 and promised continued oversight. Members asked agencies for additional details on program funding, wait lists and enforcement options.