Community college students are no doubt excited about the prospect of a tuition-free college education, and regular Massachusetts State Lottery players are probably salivating at the prospect of online access to lottery tickets.
However, unless an unlikely breakthrough is achieved in the remaining informal sessions, nursing home residents and their families, who have arguably suffered more than others from the tragedy of the Covid-19 pandemic, must now once again pin their hopes on the next legislative session, which begins in January 2025.
At that time, two years ago, formal legislative sessions were ending as a nursing home reform bill languished in the House Budget Committee. This session, a reform bill, a heralded priority of House Speaker Ron Mariano (D-Quincy), passed the House in November 2023 but stalled in the Senate Budget Committee until it was tabled in mid-July 2024.
Senator Pat Jehlen (D-Somerville) and Representative Tom Stanley (D-Waltham), along with their colleagues on the Senior Citizens’ Affairs Committee and other lawmakers, deserve great credit for crafting bills in their respective branches that could have advanced nursing home and long-term care reform. While neither bill contained everything needed for fundamental reform, a final version negotiated by the conference committee could have been an important step forward in improving the quality and safety so desperately needed in most Massachusetts nursing homes.
The themes that emerged in the long-term care bills:
1. Consumer control and choice
- Involvement of local councils and consumer advocates: Ensuring that advisory bodies also include members of local councils and consumer advocates.
2. Cooperation with all stakeholders
- Establishment of a personnel and capital fund with advisory committee: Involvement of stakeholders and consumers as well as Mass. Senior Care and SEIU 1199 for consultation.
3. Transparency and accountability
- Review of grants and loans with clawback clauses: Ensure that funds are used for their intended purpose and can be reclaimed in the event of misuse.
- Detailed reporting of owner information: Extension of reporting obligations to include private equity investments or participation in real estate investment funds.
4. Implementation and feasibility concerns – tiny houses and emergency preparedness
- Regulations for small-scale nursing homes: The requirement for specific design and culture aspects in the business plan indicates concerns about practical implementation and effectiveness.
- Outbreak response planning and financial performance: Require detailed outbreak response plans and examine cost trends to ensure facilities can effectively manage emergencies.
5. Introduce fines and fees that achieve the intended results
- Increased penalties for violations: Address potential problems by setting higher fines for non-compliance and abuse.
- Guardianship fees and financial eligibility: Concerns about financial burdens and ensuring fair access to services.
6. Maintenance and improvement of existing systems
- Tariff structure and specific program extensions: Ensure that staff have the appropriate skills and that existing programmes are strengthened rather than replaced.
- Uniform forms for prior authorisation: Rationalisation of approval procedures and ensuring rapid responses from payers.
7. Cultural competence and training
- Training programs for employees: Emphasizing the need for comprehensive training in infection prevention, resident care and staff safety.
9. Performance measurements and quality control
- Inspection and licensing requirements: Annual inspections, provisional licenses and enhanced oversight to ensure quality care.
- Corrective action plans for violations: Establish schedules for corrections and assign temporary managers to address chronic problems.
10. Potential impacts on community and hospital services
- Possible job losses and financial burdens: Consider potential job losses in current community-based programs and ensure the financial stability of community programs.
- Impact on hospital throughput and discharge planning: Establishment of task forces to address potential bottlenecks in hospital discharges from long-term care facilities.
These are all important issues that need to be addressed in a revised bill for the next term. Hopefully House and Senate leaders can continue to craft a new bill based on the versions passed by each branch. Given the role that nursing home owners, even those with modest ownership stakes, play in staffing and the delivery of care, ownership stakes of any size, not the proposed 5%, should be publicly disclosed, as should the role of related and unregulated third parties.
There were a few bright spots in the last official session. The Affordable Homes Act, which is critical to meeting the state’s obligation to release residents from nursing homes and return them to their communities.
Affordable and accessible housing and more supportive services are key components of the recent settlement in the Marsters v. Healey class action lawsuit. In the final decision, Massachusetts committed to helping at least 2,400 residents discharge from nursing homes over the next eight years.
Another bright spot at the end of the official sessions is the passage of veterans services reforms that will benefit older people and people with disabilities who have served their country in the armed forces.
Failure to improve nursing home oversight and accountability may well lead to an increase in the number of nursing home residents seeking to return home. Even if the reforms were passed, helping more nursing home residents leave the crisis-ridden long-term care system would be a good thing.
Richard T. Moore is a former member of the Massachusetts Senate and served as chair of the Health Care Financing Committee. He is co-founder and chair of the legislative branch of the Dignity Alliance, which advocates for the elderly, people with disabilities, and their caregivers. James Lomastro has been a health care administrator for 35 years and is a member of the Dignity Alliance Coordinating Committee.
