Lawmakers in Connecticut and Vermont have recently introduced legislation aimed at protecting hospice and home health workers.

Some stakeholders worry that the laws may impact care continuity among vulnerable homebound terminally ill populations lacking end-of-life support.

Legislators in Vermont recently passed an act related to mental health response service guidelines and social service provider safety, which include community-based hospice providers and home health workers.

However, the bills — if enacted — could come with unintended consequences, according to Lindsey Owen, executive director of Disability Rights Vermont. For instance, some patients may be left with unmet needs due to temporarily discontinued services, discharges or revocations, Owen said.

“This is very much about meeting people where they’re at and meeting their needs in the least restrictive settings. Because when we start talking about taking away somebody’s services either in whole or in part, their needs are no longer to be met. They could deteriorate; they could be at risk of a greater restrictive setting and maybe there would be other bad outcomes …,” Owen said in a recent Vermont House of Representatives hearing. “Without fail, if you take something away, harm is going to result just by the fact that these are needed services.”

Vermont bill passes

Introduced in January, the Vermont legislation passed Thursday after a third round of bipartisan review and approval by the state’s House and Senate Committees on Health and Welfare.

The law requires the establishment of a group that will create statewide mental health response service guidelines and social service provider safety protocols. The guidelines will provide best practices for mental health responsiveness and de-escalation processes in crisis situations.

The guidelines will be developed with input from various state agencies including the Department of Health, the Department of Disabilities, Aging and Independent Living and the Vermont Criminal Justice Council, among others. The Vermont Care Partners, Vermont Psychiatric Services and Disability Rights Vermont will also provide insight.

When mulling similar home-based care worker bills, lawmakers need to be thoughtful about ensuring continued access to services among vulnerable patients, Owen said. Striking a balance between provider safety and care continuity involves structuring policies that have sufficient safeguards to minimize the chance of patient and provider harm, including disruption of services, she indicated.

“Our health care workers are absolutely invaluable, but so are the people that they’re serving,” Owen said. “We really should be balancing that scale and giving the person who is now going to not be receiving needed services the opportunity to advocate. Many of the situations that might fall under this criteria involve individuals who might not be able to control the behavior that led to the safety risk, and sometimes that’s because there aren’t enough services in place already,”

Connecticut’s legislative action

Similar legislation has been introduced in Connecticut. A bill introduced in February proposes to expand limitations within the Freedom of Information Act that prohibit the disclosure of certain personal and background information of state and public agency employees, including health workers.

If enacted as proposed, it would loosen restrictions around accessing employees’ personnel, medical and residential information. The legislation would also broaden the scope of background checks by allowing requests around suspected criminal activity and ongoing investigations. Receiving favorable support thus far, the bill would take effect Oct. 1, 2024 if enacted.

Similar to the Vermont legislation, forces driving the Connecticut bill forward include the aim to protect home-based health care workers from threats of violence or abuse.

An emerging debate

The legislation pieces have raised similar concerns among hospice and home health providers around patient access and continuity of care.

The Connecticut Hospice was among those providers. Established in 1974, the nonprofit’s more than 200 employees provide care to upwards of 50 hospitals, assisted living and skilled nursing facilities, as well as in the home. The organization was the first established hospice in the United States.

Connecticut Hospice CEO Barbara Pearce stated in a Public Health Committee testimony that the proposed new rules regarding background checks are unclear, redundant of some Medicare regulations and could also pose barriers for patients in need of end-of-life care.

“This bill is too broad, too unclear as to requirements, not guaranteed to achieve its aims, duplicative of other procedures required in hospice care and contradictory to certain regulations of Medicare,” Pearce said. “If a law or regulation were imposed that in any way impeded our ability to admit urgently, we would see a huge drop in patients and families served.”

However, concerns have also mounted around the proliferation of workplace violence and abuse among home health workers, boosting a need for improved safety protocols and guidelines.

Community-based health providers navigate a range of unknown risks when entering patients’ homes, according to Jill Mazza Olson, executive director of the Visiting Nursing Association (VNA) of Vermont.

“Home health nurses go into homes, unknown homes, by themselves all the time. So, we really need to be able to protect them,” Mazza Olson told local news. “We’re talking about weapons and we’re talking about people being chased in their cars by family members. It’s rare, but it’s serious when it happens.”