Nursing home bill calls for major reforms
Transparency urged amid widespread staffing shortages
Lawmakers have introduced an ambitious and wide-ranging bill to address what they describe as deficiencies across the state’s more than 200 nursing homes, which are struggling to staff their facilities and keep up with inflation.
The measure would boost the mandatory minimum staffing hours — time that a nurse or certified nursing assistant spends directly with a resident — from 3 to 4.1 per person each day, a level that nursing home representatives said would be difficult to meet.
From February 2020 to December 2022, the nursing home industry lost 210,000 jobs nationally, and staffing fell to levels not seen since 1994, officials with the American Health Care Association and National Center for Assisted Living have said.
Facilities added an average of 3,700 jobs per month over the last nine months. At the current pace, staffing would not return to pre-pandemic levels until 2027, AHCA noted.
The bill also would require nursing home operators to provide greater transparency in their annual spending. Beginning this year, the operators would have to submit narrative summaries of expenditures along with the cost reports they already must file.
By January 2024, the state’s social services commissioner would have to post links to yearly cost reports and the plain-language explanations prominently on the department’s website and include comparisons between nursing homes’ spending and summaries of the average reported expenditures by facility. The operators must also provide a glossary and explanation of the terms they use.
Nursing homes that fail to do so may be fined as much as $10,000 for each violation.
In addition, if a private equity firm owns any portion of the nursing home, operators would be required to disclose the name of the firm’s investment advisor and a copy of the most recent quarterly statement to investors, including any fees and expenses and the performance of the firm.
“Private equity firms and owners who prioritize profits over people have had a devastating impact on the lives of residents and the overall quality of care in these facilities,” said Mairead Painter, Connecticut’s long-term care ombudswoman, at a press conference Friday. “Poor staffing levels, impacted by inadequate wages and a lack of maintenance to these facilities, has resulted in subpar living conditions and substandard care for those who need it most.”
Under the bill, nursing homes that fail to comply with staffing level mandates
must pay the civil penalties imposed within seven days of the violation and must use funds from management fees or money assigned for administrative or general costs.
The measure also requires chronic and convalescent nursing homes and rest homes to provide air conditioning in all resident rooms. A revolving loan fund would be created to cover the expense.
“It is unacceptable to see residents who are ill and unable to get out of bed to get a drink go without air conditioning in the summer,” Painter said. “Then when we go in to respond to the calls for help and investigate these types of issues, we often find management staff in air-conditioned offices while the residents suffer.
“This is not the long-term care system that residents deserve or that we as taxpayers have paid for.”
John Balisciano, a resident at Apple Rehab Hewitt in Shelton, said he does think there are not enough staff members on hand at his nursing home to fully care for residents.
“It becomes difficult for us to receive the care and attention we need to live with dignity and independence,” he said Friday. “I have heard from my peers about the difficulties they face when it comes to completing their activities of daily living, such as getting up out of bed, getting showered or getting assistance to the bathroom.
“One particular instance that stands out to me was when a resident waited for two hours to be assisted onto the toilet. This is not an uncommon complaint. Can you imagine the embarrassment and discomfort individuals must have felt during that time? This is just one example of the challenges residents face when there are staffing limitations.”
In Connecticut, understaffing has led to widespread problems in some facilities. Athena, one of the largest long-term care providers in the state, has come under the scrutiny of officials in three New England states after receiving consistent complaints about conditions in its nursing homes.
An Athena facility in Newtown recently received a designation of immediate jeopardy, meaning violations in the home caused or were likely to cause serious injury or death to a resident.
Inspectors with the state Department of Public Health concluded the facility failed to provide adequate staffing levels to ensure residents received timely care, resulting in neglect to 20 residents they observed. Athena corrected the issues and the order was lifted after two days.
“As our state officials begin to debate meaningful action to ensure Connecticut’s older adults and families have access to quality aging services and nursing home care, Leadingage Connecticut stands ready to work in partnership in this effort,” Mag Morelli, president of Leadingage Connecticut, said in statement. “On behalf of our nonprofit, mission-driven members, it is imperative that during this time of severe workforce shortages, we prioritize workforce development and adequate Medicaid and Medicare reimbursement.
“This is how we ensure that, as providers, we have the resources available to serve the growing number of older adults who are in need of aging services, support and long-term care.”
Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, said facilities share the goal of increasing staff but face substantial hurdles in recruiting workers.
“Providers are already doing everything they can to recruit and retain staff with the resources they have,” he said. “Unfortunately, an expanded staffing mandate simply will not work for Connecticut at this time. The needed workers are simply not available.
“The staffing shortage is even worse than it was in 2021 when the state legislature directed the Department of Public Health to adopt regulations to significantly increase staffing minimums for direct care staff from 1.9 to 3.0 hours per patient per day. Today many nursing homes will have challenges even meeting the 3.0 requirement, let alone going to 4.1 as proposed this session.”
The bill also would require the long-term care ombudsman’s office to be notified when a nursing home plans to involuntarily transfer or discharge a resident and would establish a grant program for the transportation of non-ambulatory residents to the homes of family members.
It will be considered in the Human Services Committee.
“I think we have a real question right now about how to improve quality and how to improve transparency over where public dollars are going … in our nursing home system,” said Sen. Matthew Lesser, D-middletown, a co-chairman of the committee. “What can we do to make sure folks are safe, that we have a world class workforce, and that we have real accountability and transparency for public dollars?”