HealthCareisMovingHome

HOWMASSACHUSETTSMUSTRESPOND

TheHomeCareAllianceofMAisastatewideorganizationwithamission
tounitepeopleandorganizationstoadvancecommunityhealththrough
qualityhealthcareandsupportiveservicesinthehome.
Withmorethan180providermembers,aswellasalliedandindividual
members,HCAofMAisthedefinitivevoiceforhomebasedcarein
Massachusetts.

WHYHOMECARE?
Thefutureofhealthandlongtermcareismovinghome.Simplyput,thereishighvaluein
providingcareathome,forallofthefollowingreasons:

Beingcaredforathomeispatientpreferred.Consumersatisfactionscoresarehigh.
InMassachusetts,82%ofhomehealthusersreportthattheywouldrecommendtheirhome
healthagencytoafamilymemberorfriend.(MedicareHomeHealthCompareData,Jan2016)

Homecaredeliversgoodoutcomes.ForpatientsinMassachusettsreceivinghomehealth
carethroughMedicare,92%reportedthatwoundsimprovedorhealedafteranoperation
and71%reportedlesspainwhenmovingaroundasaresultofhomehealthtreatment.These
dataaresignificantgiventhatdemographicsindicatethat83%ofhomehealthuserssuffer
from3ormorechronicconditionscomparedtojust60%ofthegeneralMedicarepopulation.
(MedicareHomeHealthCompareData,Jan2016)

Homecareiscosteffectivecomparedtoinstitutionalcare.AstudybyAvalereforthe
national Alliance for Home Health Quality and Innovation indicates that for one of
Medicares costliest procedures major joint replacement sending a patient directly to
homecareratherthantoarehabilitationcenterorskillednursingfacilitycostsonaverage
$5,000lessperpatient.TheMAExecutiveOfficeofElderAffairsestimatesthattheirhome
careclientsareeligibletobeinacostliersetting(nursinghome)foranaverageof10months
thattheyaregettingcare.Theirabilitytobecaredforathomeproducesasignificantcost
avoidance to the states Medicaid budget. (AHHQI, Clinically Appropriate and Cost

EffectivePlacementProject,(CACEP)December2013)

Homecaresupportsfamilycaregivers. Estimatesarethatmorethan650,000residents
oftheCommonwealthareprovidingcaretoanillordisabledlovedone.Yet,caregiverswho
getsomeformofhelparelesslikelytoburnoutandarebetterabletoprovidelongterm
supportfortheirparents.Homecareisthathelp.

HomecareisthesectorthatmostreflectsthehealthcareTriple
Aimofabetterpatientexperience,inamoreaffordablesetting,
withsupportforimprovedpopulationhealth.

DEFININGHOMECARE
HomeCareencompassesawiderangeofhealthandsocialservices.Theseservicesaredeliveredto
recovering,disabled,chronicallyill,orterminallyillpersonsinneedofmedical,nursing,socialor
therapeutic treatment and/or assistance with activities of daily living. Home care agencies in
Massachusettsprovideservicestopeopleofallagesandwithvaryinglevelsofneed.Manyofthose
receivinghomecareareelderly.DataforthefederalMedicareprogramindicatethat1in10people
inMAovertheageof65willusehomehealthservicesinagivenyear.ThosewhouseMedicare
homehealthservicesareamongthefrailestresidents:65%ofMAMedicarehomehealthusershave
5ormorechronichealthconditions,comparedwithonly13%ofthegeneralMedicarepopulation.
ManyadultsandchildrenalsodependonhomehealthcareprovidedthroughthestateMedicaid
program,MassHealth.Seechartbelowforabreakdownbyage.

MassHealthHomeHealthUsersbyAge

2,487
4,230
7,193
5,522

13,859

021

2240

4160

6175

76andup

Homecareisoftendefinedasencompassingthesefiveoftenintertwinedoroverlappingsectors:

homehealthcare,whichmaybecoveredbyMedicare,Medicaidorotherinsurers,andmost
oftenincludesepisodesofshorttermskilledcarebyateamincludinganurse,therapistand
an aide. Home health care may also include high medical intensity services of a longer
durationformedicallycomplexadultsandchildren.

supportivehomecare,whichincludeshomemakerandpersonalcareserviceswhomeetthe
states clinical/functional need and income qualifying criteria through the states Aging
ServicesAccessPoints(ASAPs).

privatehomecare,whichispaidfordirectlybytheconsumerorfamily(orinsomecasesa
long term care insurer) and consists generally of assistance with activities of daily living,
suchasbathing,dressing,shoppingandpreparingmeals.

advanced illness or palliative care, which is comprehensive care for people who are
chronicallyunstableandgenerallyfocusesonalleviatingdistressingsymptoms,suchaspain,
shortness of breath, fatigue, nausea, loss of appetite, sleep problems, as well as shared
decisionmakingaroundpatientvalues,goalsandinformedpreferencesforcare.

hospiceorendoflifecare,whichisamultidisciplinarycareapproachprovidedtoaperson
whohasbeendiagnosedwithaterminalillness.

In2015,110,000Medicarebeneficiariesusedhomehealthservices.44,290MAeldersreceived
home care assistance from state Executive Office of Elder Affairs home care and waiver
programs.39%ofthem(17,104)arenursingfacilityeligible,butareinthecommunity.

InvestinginHomeCarepaysdividendstothestate.Between
FY2000and2014,thenumberofnursinghomepatientdayspaid
forbyMassHealthdroppedby4,500,000,or34percent.
(seechartnextpage)

MassHealthNursingHomePatientDays
(inmillions)
14

13.1

12.7

12.3

12

11.9

11.4

11

10.86

10.3

10

9.88

9.54

9.45

9.32

8.86

8.71

8.6

8
6
4
2
0
2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

HOMECAREISAJOBCREATIONINDUSTRY

Home care is a $1.3b dollar industry in the Commonwealth and home care agencies are
economicdriversintheircommunities.ThehomecareindustryinMAemploysmorethan
35,000people,includingmorethan20,000homehealthaides.ThefederalDepartmentof
Laborplacespersonalcareandhomecareaidejobsamongtheoccupationsexpectedtohave
thelargestemploymentgrowthinthenextdecade.Massachusettshasahistoryofoffering
strong workforce protections, including minimum wage and overtime protection for all
homecareworkers.

HOMECAREISADVANCINGTECHNOLOGYANDTHEDIGITAL
HEALTHMOVEMENT

According to the Massachusetts eHealth Institutes 2014 Provider and Consumer Health
Information Technology Research Study, 74% home health agencies in MA are using
ElectronicHealthRecordsdespitethefactthatagencieshavenotbeeneligibleforfederal
incentive payments for adoption of health information technology. The challenge for
agencies,asforphysicianpracticesandotherproviders,remainsconnectingthroughhealth
information exchanges in order to share information with referral sources and other
partners.

2014

Homehealthagenciesarealsohighutilizersoftechnologyincaregiving.Closetohalfof
the certified home health agencies use some form of remote vital signs monitoring
(telehealth)forinhomemanagementofrecentlyhospitalizedMedicarepatients,orpersons
with chronic disease. Such daily monitoring of disease conditions allows immediate
recognition of key indicators,such asmedication noncompliance,that put an individual
patientatriskforreadmission.

Both certified home health and private home care agencies use automated time and attendance
systemstoverifytimeinaclientshomeandtasksperformed.
Privatehomecareagenciesarealsoincreasingadoptingnewfamilyportaltechnologiesthatallow
lovedonestotrackandbeengagedintheclientscareplan.

HOMECAREMOVINGFORWARD
Despite the strong consumer preference and the documented savings associated with providing
homeandcommunitybasedservices,thereremainpolicychangesthatmustbemadeinorderfor
Massachusettstopreparefortheagingdemographicsandassurethatpeoplehaveequalaccessto
servicesthatenablethemtoremainasindependentaspossibleathomeandintheircommunities
ofchoice.

Thefollowingpagespresentasetofrecommendationsforthe
GovernorandLegislaturetoconsiderinmakingMassachusettsa
truebeaconoflightintermsofofferingresidentsthepreferred
andfiscallyresponsiblechoiceofcareathome.


Recommendation1:

AssureanAdequateandQualifiedWorkforcetoMeettheNeeds
ofaGrowingElderlyPopulation
Havinganadequateworkforcemeansmoreattentiontoeducation,trainingpayand
scopeofpractice.
a. EstablishaprocessthatadjustsandtiesstateMedicaidratestohealth
caresalaryinflation.AsofJan2016,homehealthpaymentforMedicaid
nursing,therapyandhomehealthaideserviceshasnotbeenadjustedin
8years.Restorethe2008ratecutfornursingservicesafter60days
ofcare.
b. Developsupportforinagencynurseresidencyprogramsthatallownew
graduatestobeabletoworkinhomecaredirectlyfromnursingschool
c. Explorewaystocreatecareerladdersandaidetraining(James
testimony)inareassuchasdementiaandEOLcare
d. Supportlegislationthatallowsnursesinhomehealthcareandhospice
todelegatetotrainedaidestheadministrationofcertainmedications.
Thissupportsnursesoperatingatthetopoftheirlicenseand
encouragesexpandedrolesandresponsibilitiesforaides
e. Providesufficientfundingtosupportwagesandbenefitsequalto$15per
hourforhomemakersinstateelderserviceprogramsbyFY2018

Recommendation2:

ProvideBetterSupporttoFamilyCaregivers
Familycaregiversaretheunsungheroesofthehomecarestory.Agenciesoftenwork
closelywiththosecaringforagingparents,spouses,andotherlovedonessotheycan
remainintheirhomes.
a. Createastatelicensureprocessforbothhomehealthandhomecare
whichassurescertainlevelsoftrainingforworkersandconsumer

protectionsforclients.MAremainsamongonlyahandfulofstates
withoutsuchoversight
b. Supportlegislationthatallowsnursedelegationofmedication
administration.Forfamilies,thecurrentstatepolicyisabarrierto
access.
c. ExpandedASAPeligibilityforstatehomecaresupportservicesto300%
ofthefederalpovertylevel($35,000).Thiswouldallowapproximately
9,000additionalfamiliestoreceivesupportivehomecareservices.

Recommendation3:

RewardandScaleUpInnovationinCommunityBasedLong
TermServicesandSupports(LTSS)
Thestateneedstoinvestinactivitiesthatdriveallhomecareproviderstowards
betteroutcomes.
a. ImplementremotepatientmonitoringreimbursementofMassHealth
homehealthasmandatedintheFY2015budget
b. HostabestpracticessharingsummitonCommunityBasedLTSSthat
identifiespromisingpracticesincommunitycareandcaretransitionsfor
stateinnovationfundsupport
c. ExpandthroughtheMasseHealthInstitutefundingandtechnical
supportforhomehealthelectronichealthrecordintegration
d. SupporttheHomeandCommunityBasedServicesPolicyLabfundingto
reexamineefficacyofcommunitybasedservices.

Recommendation4:

RethinktheStatesDefinitionofSafetyNetProviders
Inlightofhowessentialhomecarehasbecomeinthecontinuum,thestateneeds
torethinkwhatconstitutesasafetynetoressentialcommunityprovider.Atthis
point,thedefinitionisprimarilylimitedtocertaincommunityhospitalsorhealth

centers.Manyhomehealthagenciesprovidesignificantfreecare(thatisnot
trackedinanydatabase),conductingpublichealthclinics,administeringflu
shots,andsupportpopulationhealthwithclinicsandcommunityeducation.
a. Conductinventoryofthescopeandvalueofcommunityhomehealth
populationhealthinitiativesandfreecare
b. Develop state regulatory constructs for Accountable Care
organizations and managed Medicaid that include appropriate
credentialing of, and assure a quality network of, home health care
providers, inclusive of agencies with competencies in care of dual
eligibleandMassHealthpatients

CONCLUSION

StevenLanders,MD,CEO,VNAHealthCare
SpeakingattheInstituteofMedicineSummiton
TheFutureofHomeHealth,2014

Evenwithtodaysclinicalandtechnologicalsophistication,thevaluepropositionofhomecareismuchas
itwasmorethan100yearsagowhennursesfirststartedvisitingthehomesoftheillanddying.

OurPatientStories

Patient:MariaB(Lastnamewithheld)
Agency:CommunityNurse&HospiceCare,Fairhaven
MassHealthPaysforAides,CommunityNurseDoesMuchMore

MariaB,aretiredseamstressfromDartmouth

Beyond what MassHealth insurance would

MA, was referred to Community Nurse after

cover, Community Nurse brought in a

having been diagnosed with Alzheimers

bilingual social worker to assess the familys

Disease. Mrs Bs husband had been her

needs. She assisted in getting Maria some

primary caretaker. Her daughter sought out

time in an Adult Day Health so that Marias

CommunityNurse.Workingfulltimewitha

husband

familyofherown,shewasconcernedaboutof

Alzheimer family support groups hosted by

thestrainofcaregivingonherfather.Shealso

CommunityNursestaff.Theyalsoregistered

worriedthathermotherwouldberesistantto

Maria with the communitys Alzheimer

help as she had shown some aggression to

Associationssafereturnprogram.

and

daughter

could

attend

strangersinthepast.
Life for Maria and her family became more
An initial assessment was done by a nurse

manageablewiththeaddedresourcesbothin

from Community Nurses Memory Loss

the home and in the community. They also

Programwhousedherdementiacaretraining

tookadvantageoftheCommunityNurse24

to put Mrs B and the family at ease.

hourhotlinewhenevertheyhadquestionsor

ImmediatelyidentifiedwasthatMariaanddid

needed additional support. As the disease

not have health insurance, and had limited

progressed,

financialmeans.ItwasalsoveryclearthatMr.

Community Nurse into a hospice program

Bwasstrugglingwithhisownheartcondition.

thatallowedmanyofthestaffandvolunteers

Maria

was

counselled

by

whohadalreadybeeninvolvedinhercareto
With a referral to a local community service
agency,CommunityNurseassistedthefamily
in obtaining MassHealth insurance, which
allowed Community Nurse to provide home

remain part of her team. She was able to

remain home through the course of her
illness.

health aide and homemaker services to take

After her death, Marias family found some

on some of the duties that her husband had

peace by attending bereavement support

been struggling with. An occupational

groups through the Community Nurses

therapist from was brought in to install

program.

adaptiveequipmentincludingashowerseat.

Patient:JamesBoulanger*(nameusedwithpermission)
Agency:MaximHomeHealth
TheseSpecialNursesAreHeroestoManyFamiliesLikeOurs,saysMom
At36yearsold,JamesBisahappyyoungman

hisfamilycaregiverswhentheyfeelstretched

who has defied the odds. His medical needs

totheirlimitsbasedoncomplexofJamescare

arecomplexandmany.Foralloflife,hehas

needs.Thedrasticreductionsinhisratesof

lived with cardiac, renal, skeletal, endocrine

hospitalizationsare,accordingtohisprimary

and neurological issues. His 22 different

caregiver and mother Lisa Burgess, a direct

medicaldiagnosesrequirethathesleepwitha

result of the stabilizing effect of the weekly

biPAP machine; he also requires an O2

nursing care. With Maxims help in patient

saturationmonitor,asuctionmachineanda

management, James actually uses less home

CPT vest for chest physiotherapy. His

nursingthanhemightbeentitledtogiventhe

medications now number 14 a day; with 8

scopeandcomplexityofhisillness.

additional prescriptions given as needed

accordingtomedicalevaluation.Hehasbeen
hospitalizedatChildrensHospitalinBoston
closeto500timesoverthecourseofhislife;
butmostofthesehospitalizationswerebefore

ThenursesprovidingcareforJamesarehighly
qualifiedandspecialtytrainedandaccording
tohismotherinvaluable.Yet,theratespaid
for services they provide have been frozen
since2007.Costsfornursingsalaries,travel,

theageof13.

andbenefitshavecontinuedtorisesteadily.
Jameshasalovingfamilywhoisactiveinhis
care, devoting hundreds of hours weekly.
James also receives 46 hours a week of in
home nursing care. The nurses track and
administer medications, as needed, help to
managehiscomplexequipment,andsupport

With the competition for nurses exceeding

thesupply,Jamesfamilyisvulnerabletoaloss
of support and the agency that employs the
nursesisinafinancialdownwardspiral.

Thedrasticreductionsinhisratesofhospitalizationsare,
accordingtohisprimarycaregiverandmother,adirectresultof
thestabilizingeffectoftheweeklynursingcare."

10

ServicesProvidedbyHomeCareAgencies
AdaptiveEquipment,suchas:grab
barsandelevatedtoiletseatstohelp
peoplewithlimitedmobilityand
strengthtoperformdailyactivities.
AdultDayHealth:onsitecongregate
careduringtheday.

Nursingforskilledassistancewith
health&medicalissues.

Alzheimers/DementiaCare:
specializedservicestomeettheneedsof
peoplewiththeseconditions.

Nutritionalsupportbyregistered
dietitianswhoofferdietary
recommendationsbasedonmedical
needs.

AppointmentEscortstohelpclients
gettohealth&medicalappointments.

OccupationalTherapytosupport
improvementinfinemotorskills

CareManagementbyalicensed
professional,oftenasocialworkeror
nurse.

Pain/PalliativeCaretoalleviateor
managechronicpain

Chores&Cleaning,suchas:tidying,
cleaning,lifting,etc.
Companionstoalleviatelonelinessand
encouragesocialization.
CertifiedWound&OstomyCareafter
asurgicalprocedure
DurableMedicalEquipment,suchas:
wheelchairs,etc.,canbepurchased
through
thisagency.

PediatricNursingforchildren
PersonalCare/HomeHealthAidesto
assistwithtoileting,bathing,
transferringto/frombed,etc.
PersonalEmergencyResponse
Systemstocontactmedicalhelp
automaticallyviatelephoneinan
emergency
PhysicalTherapytoimprovestrength
&mobility

HomeModification,suchas:ramps&
wideneddoorways,improvesmobility.

PrivateDutyNursingformorethan
twohoursatatimeforpatientswho
requireclose,constantmonitoring

Homemakingtohelpwithlaundry,
lightcleaning&mealpreparation.

PsychiatricNursingformental
disorders

Hospiceforendoflifecare&
counseling.

RespiratoryTherapytoaddresses
breathingdisorders

IntravenousTherapyprovidedbya
nursewithspecialtraininginIVuseand
medicationadministration.

Speech&LanguageTherapyto
improvecommunicationskills

LiveinAidesforaroundtheclock
assistanceandreassurance.

TelehealthMonitoringusingweb
basedandtelephonetechnologytohelp
individualsmanagetheirowncare

Maternal&ChildHealthprogramsfor
newmothersandinfants.

Transportationtohelpclientsgetto
regularappointments

MedicationManagementor
assistanceintrackingandtaking
prescriptionmedications.

11

MemberAgenciesoftheHomeCareAllianceofMA
24HoursCare
AbbottHomeHealthCare,Inc.
ABCHomeHealthcareProfessionals
AberdeenHomeCare,Inc.
AbleHomeCare,LLC
ABPBestHomeCareAgency
AcclaimHomeHealthCare
AceMedicalServices,Inc
ActiveHomeCare
ActonPublicHealthNursingService
AdditionalCare(GMVNA)
AdvantageHomeHealthCareServices
AfyaHomeCareLLC
AllCareResources,Inc.(AllCareVNA&Hospice)
AllCareVNA&Hospice
AlphaCareHomeHealthAgency
AlternativeHomeHealthCare,LLC
AlwaysBestCareSeniorServices
AlwaysHereHomeCare,Inc.
AmadaSeniorCare
AmedisysHomeHealth
AmericaatHomeHealthcare&NursingServices
AmigosHomecare
ApexHealthcareServices,Inc.
AroundtheClockHomeHealthcare
AssistedDailyLivingInc.
AtHomeElderCareInc.
AvivHomecare
AZACareManagementandHomeCare
BayadaAssistiveCare
BayadaHomeHealthCare
BaystateVNA&Hospice
BaystateWingVNA&Hospice
BeneficenceHomeHealthcareInc.
BerkshireVNA&Hospice/BerkshireMed.Ctr
BestHomeCare
BrightStarCareofMilford&Worcester
BrocktonVNA
BrooksbyVillageHomeSupport
BrooksbyVisitingNurseService
CahoonCareAssociatesLLC
CapuanoHomeHealthCare,Inc.

CareFromTheHeart
CareGroupParmenterHomeCare&Hospice,Inc.
Caretenders
CaringCompanionHomeCare,Inc.
CCBCHomeHealth
CircleHome,Inc.
CollectiveHomeCareInc.
ComfortHomeCareLLC
ComfortKeepersofSouthShore&CapeCod
CommonwealthCaregivers,Inc.
CommonwealthClinicalServices,Inc.
CommonwealthRegistryofNurses,Inc.
CommunityHealthNetwork,Inc.
CommunityNurseHomeCare,Inc.
CommunityNursePrivateCare,Inc.
CommunityVNAPrivateCare(CommunityVNA,Inc.)
CommunityVNA,Inc.
ComprehensiveHomeCare
DeaconessAbundantLifeServices
DodgeParkatHome
ElderAchievers
EmersonHospitalHomeCare
EPICHealthServices,Inc.
ExcelHomeCareServices
ExcellaHomeHealth,AnEncompassCompany
EzraHomeCare,LLC
FamilyCareExtended
FrancesHealthServices
GildaandBobRichmanPersonalCare
(ManuelR.GrellHomeCare)
GlenmeadowatHome
GreaterMedfordVNA
GuardianAngelSeniorServices,Inc.
GuardianHealthcare,LLC
GuardianHomeHealthCare
GVNAHealthcare,Inc.
HabilitationAssistanceCorp.
HahnHomeHealthCare,Inc.
HallmarkHealthVNA&Hospice,Inc.
HampdenCountyVisitingNursesandHomeCareServices
HappierinMyHome,Inc.
HebrewSeniorLifeHomeCare

12

HolyokeVNA&HospiceLifeCare
HomeCareAssistance
HomeCare,Inc.(HomeHealthVNA)
HomeHealthVNA,Inc.
HomeInsteadSeniorCareHearthside,Inc
HomeInsteadSeniorCareNorthDartmouth
HomeInsteadSeniorCareofBerkshireCounty
HomeInsteadSeniorCareofBostonNorth
HomeInsteadSeniorCareofCapeCod
HomeInsteadSeniorCareofLexington
HomeInsteadSeniorCareofNorthAndover
HomeInsteadSeniorCareofN.BristolCounty
HomeInsteadSeniorCareofNorwell
HomeInsteadSeniorCareofNorwood
HomeInsteadSeniorCareoftheSouthShore
HomeResources,Inc.
HomeStaff,LLC(VNACareNetwork)
HouseWorks,LLC
HumanaatHome/SeniorBridge
IntegraHomeHealthAgency
InternationalHealthSolutions
IPVisitingNursesAssociation
JHCHomeCare&Hospice
KindHandsCareatHomeLLC
LaheyHealthatHome
LifeCareatHome
LifodHomeHealthCareLLC
LivHOME,Inc.
ManuelRGrellHomeCare
MasterPeace,Inc.
MaximHealthcareServices
MedicalResourcesHomeHealthCorp.
MercyHomeCare
MetropolitanHomeCare,Inc.
MetropolitanHomeHealthServices,Inc.
MetroWestHomeCare&Hospice,LLC
MinuteWomenHomeCare
MulticulturalCommunityServices
ofthePioneerValley,Inc.
MulticulturalHomeCare,Inc.
NashobaNursingService&Hospice
NatickVNA,Inc.

NewEnglandHomeHealthServices,Inc.
NewOutlookHomecare,LLC
NizhoniHealthSystems
NorthHillHomeHealthCare
NortheastClinicalServices,Inc.
NVNAandHospice
NVNAWorks(NVNA&Hospice)
O'ConnellCareatHome
OneSolutionHomeCareLLC
OptimalHomeCare,LLC
OverlookCareatHome
PartnersHealthCareatHome
PartnersHealthCareatHomePrivateCare
PersonalTouchHomeCare
PorchlightHomeCare
PorchlightVNA
PrimeHomeHealthandCompanionCare
ProfessionalNurse&HomeCareofCapeCod,Inc.
PSAHealthcare
QualityHomeCareServices,Inc.
RoyaleCare,Inc.
RSSIHomeCare
SalmonVNA&Hospice
SamaritanHealth&HomeCare(VNAofSWC)
SanbornPlaceHomeCare&DayServices
SecureHomeHealthCare,Inc.
SeniorComfortServices
SeniorHelpersBoston
SeniorHelpersoftheSouthShore
SeniorHelpersofWestford
ServiceNetHomeCare/ServiceNet,Inc.
SouthShoreVisitingNurseAssociation
SouthcoastVisitingNurseAssociation,Inc.
SpectrumHomeHealth&HospiceCare
StewardHomeCare
StoughtonPublicHealth&VNA
SuburbanHomeHealthCare,Inc.
T.L.Connections,Inc.
TributeHomeCare
Upham'sHomeHealthCare
VisitingAngelsofActon
VisitingAngelsofCapeCod

13

VisitingAngelsofChelmsford
VisitingAngelsofDanvers
VisitingAngelsofNewtonandCanton
VisitingAngelsofNorthAttleboro
VisitingAngelsofNorthReading
VisitingAngelsofWestSpringfield
VisitingAngelsofWorcester
VNA&HospiceofCooleyDickinson
VNACareNetwork&Hospice
VNAofBoston&Affiliates(VNACareNetwork)

VNAofCapeCod,Inc.
VNAofEasternMassachusetts
VNAofMiddlesexEast&VisitingNurseHospice
VNAofSouthernWorcesterCounty,Inc.
VNSofNewport&BristolCounties
WalpoleAreaVNA
WhittierHomeHealthCareAgency
WinchesterHomeCare
XanaduHomeHealth

HomeCareAllianceofMA75KneelandSt.,Suite709,
Boston,MA02111
6174828830
www.thinkhomecare.org

14