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The following was submitted by the office of Sen. Patricia Jehlen:
Recently, state Sens. Patricia Jehlen and Jason Lewis and state Reps. Michael Day and Michelle Ciccolo joined their colleagues in the Massachusetts Legislature to pass a bill to improve quality and oversight of long-term care which was signed into law by Gov. Maura Healey.
This legislation incorporates numerous bills relative to long term care and assisted living which Jehlen and the Joint Committee on Elder Affairs have worked on for several sessions. This comprehensive law is expected to make much needed improvements to quality of life and safety of care for both residents and staff in those sectors.
“I am so grateful to the chair of Senate Ways and Means and his staff as well as to the Senate President and her staff,” said Jehlen. “Little happens without strong and persistent advocacy and collaboration. I want to recognize particularly AARP, Alzheimer's Association, Leading Age, Mass Senior Care Association, MA Advocates for Nursing Home Reform, Mass Assisted Living Association, Mass Home Care, Mass Nurses Association, Mass Senior Action, MA Elder Law Attorneys, SEIU 1199, MA Association of Residential Care Homes (MARCH) and the recently formed Dignity Alliance. As well as both the Baker and Healey administrations.
“We don’t all agree on everything, but we’ve been able to reach an agreement that will help so many people,” she continued. “Thanks are also due to the many people who have called, written and testified about the conditions they’ve seen in too many nursing homes. And finally, this would not have happened with the press covering stories of neglect and abuse.”
“We should do everything possible to ensure that seniors and individuals with disabilities who reside in nursing homes and other long-term care facilities are getting high-quality care at all times,” said Lewis. “I’m proud that the Legislature has passed this important and comprehensive legislation.”
"These much-needed reforms will go a long way to improving the quality of life for some of the Commonwealth's most vulnerable residents,” said Ciccolo. “I am so thankful for the diligence and advocacy of Chair Stanley and my colleagues on the Elder Affairs committee for their tireless work on this bill as well as the committed advocacy and support from people across all walks of life. May we continue to strive for a Massachusetts that allows all people to age comfortably and with dignity."
“I was proud to support and help pass legislation that takes a comprehensive approach to reforming the long-term care industry,” said Day. “This law will support and expand the long-term care workforce, enhance oversight of facilities and ensure greater access to these services, all while prioritizing quality of care.”
Included in the bill are provisions that will make permanent the temporary allowance for Assisted Living Residences (ALRs) to offer basic health services. ALRs are certified by the Executive Office of Elder Affairs and are generally considered non-medical facilities.
They all have a nurse on staff, but weren’t allowed to do simple things, like administering eyedrops or insulin injections. This meant that when someone needed those things, that most people can do for themselves, family members had to come in or a visiting nurse had to be hired to help them. If the medication was something like insulin, that would be more permanent, however, residents usually had to move to a nursing home at more expense to themselves and eventually the state, as well as the disruption and disorientation of moving. That kind of displacement and disorientation is dangerous to the physical and mental health of residents.
When an ALR applies for or renews its certification, they must disclose the details of each officer, director, trustee, and limited partner or shareholder. The bill changes that threshold from at least 25 per cent interest to a 5 per cent interest.
It also requires that applicants demonstrate that prior multifamily housing, ALR, or health care facilities in which they had an interest met all the licensure or certification criteria.
The bill gives EOEA new powers to penalize non-compliance by allowing them to fine ALRs up to $500 per day. This is in addition to existing EOEA powers to modify, suspend, or revoke a certification, or deny a recertification. Residences will also be reviewed annually if they are certified to provide basic health services.
The bill also adds whistleblower protections for staff and residents who report anything happening at an ALR that they reasonably believe is a threat to the health or safety of staff or residents.
“Anyone who has ever had a relative in a nursing home knows how vital good care is,” said Jehlen. “And how crucial and often under-appreciated and under-compensated individual caregivers are. I’ll always remember Linda Ngandu, the CNA who helped my father’s life more meaningful in his last year. This bill addresses many gaps in the ways we ensure people are receiving quality care.”
This bill will increase capital funding for nursing homes to provide training and career ladders for staff, and to adjust their buildings to different needs. It will require updating the base rate every two years.
The bill creates a Long-Term Care Workforce and Capital Fund which allows the funds to be used for the administration of a capital loan program and workforce training program.
A Certified Medication Aide program will also be created by DPH for the certification, training and oversight of CMAs who shall be authorized to administer medications to residents of long-term care facilities.
This bill will expand DPH tools by allowing more oversight and includes suitability standards. Those standards will allow DPH to limit, restrict, suspend, or revoke a license; or deny a license or license transfer. It requires each facility be inspected every 9 to 15 months to assess quality of services and compliance.
The department can also appoint temporary facility managers for troubled facilities and review the financial capacity of an applicant including its history in providing long-term care in other states and if they have undergone financial distress.
The bill requires long-term care facilities to submit outbreak response plans to DPH with clear protocols for the isolation of residents, lab testing, visitor screening, preventing spread from staff, and the notification of residents, family, and staff in the event of a contagious disease outbreak. It also requires clear standards for special care units.
If a long-term care facility is found to be non-compliant with standards and regulations, they can be fined. This bill increases civil penalties the Attorney General can seek by 10 times (e.g. $250,000 for a death) and doubles the statute of limitations to four years. It increases fines that DPH can levy for noncompliance with regulations by 10 times. The current max fine is $50 per day, the same as the minimum fine for a speeding ticket.
The bill directs DPH to develop regulations for small house nursing homes — a newer model of smaller long-term care facilities that aim to create a house-like environment. Several task forces and special commissions are established to review, study, report on, and propose recommendations to address issues in this sector.
These studies and task forces would examine issues like hospital throughput, Mass Health long-term care eligibility, Medicare ACOs, rest homes, Continuing Care Retirement Communities and further reforms for ALRs in order to strengthen all the pieces of the entire care continuum.
Yet another bill incorporated here is the LGBTQI bill of rights for residents, banning discrimination based on LGBTQI identity or HIV status and requiring training of staff on preserving LGBTQI rights and care.
Another important provision addresses special needs pooled trusts for those over 65 living with disabilities. Just as people with disabilities under 65, those over 65 who have modest means will be able to transfer some savings to a special needs pooled trust without counting against their MassHealth eligibility. That fund can be used for needs like home care, home adaptations, personal items, assisted living expenses.
Finally, the bill limits estate recovery from Medicaid and Commonhealth recipients to the Long Term Services and Supports (LTSS) spending federally required. Estate recovery in Massachusetts has exceeded the federal requirements. This will prevent family members from losing the homes where they had cared for their disabled relatives and prevent generational impoverishment.
