This week, the Joint Committee on Aging and Independence (AGE) held a public hearing on 23 bills related to long term care, nursing homes and assisted living facilities. The bills, many of which were filed at the request of Dignity Alliance, call for changes in nursing facility governance and decision making, as well as mandating single occupancy rooms within three years and making medical director certification mandatory. Mass Senior Care provided testimony on the following bills:
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House Bill 790, An Act to Support Quality Improvement in Nursing Homes – modeled after a program in New Jersey and a 2016 successful Massachusetts initiative, would establish Long-Term Care (LTC) Quality Improvement Teams to be strategically deployed – outside of the survey process – to struggling nursing facilities to provide and implement evidence-based strategies, and sustained support to strengthen operations and, most importantly, enhance the quality of care for residents. By bringing together administrators, nurses, social workers, infection preventionist, quality improvement specialists and staff developers, the teams would be an early intervention tool to provide struggling facilities with hands-on technical assistance to help stabilize operations and maintain safe, consistent care for residents. Mass Senior Care testified in support of the bill and continued collaboration to improve resident care outcomes and experience.
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House Bill 795 and Senate Bill 480, Acts Promoting Infection Prevention and Privacy for Residents of Nursing Homes, Senate Bill 479, An Act to Improve Transparency and Accountability for Residents in Nursing Homes and Rest Homes and House Bill 798, An Act Requiring Dignity, Privacy, and Safety for Residents in Nursing Homes and Rest Homes – would require DPH to issue regulations effectively mandating the conversion of all rooms to single occupancy within three years. Mass Senior Care testified that the legislation, as drafted, would cost the Commonwealth about $1 billion in new capital and operating costs, and would jeopardize access to nursing facility care by forcing facilities to displace thousands of current residents.
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House Bill 794 and Senate Bill 496, Acts Clarifying Responsibility for Decision-Making in Nursing Homes – would require nursing home administrators and medical directors to annually certify, under penalty of perjury, that the facility’s budget and staffing are sufficient to meet the operational and care needs of all residents. Mass Senior Care testified in opposition as we believe this legislation is unnecessary and will lead to further shortages of licensed nursing home administrators in the Commonwealth. Mass Senior Care further noted that the single biggest challenge impacting quality resident care and well-being is not our dedicated, capable nursing home administrators, but the fact that there remains a significant shortfall between state Medicaid funding and the cost of providing quality resident care.
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House Bill 759, An Act Improving Oversight in Long-Term Care Facilities – would require a nursing home, rest home, or other long-term care facility to permit residents to place monitoring devices—like two-way cameras—in private single occupancy resident rooms under specific conditions. Mass Senior Care noted our strong support for transparency and accountability that strengthen resident dignity, privacy, and trust, but are concerned that this bill would have unintended consequences and may jeopardize resident dignity, erode trust between families and caregivers, and divert attention and resources from direct care, if caregivers refuse to accept assignment in rooms with cameras. In addition, Mass Senior Care noted that continuous video monitoring could create a climate of suspicion that would harm staff morale, as well as data security risks inherent in producing sensitive recordings of people at their most vulnerable moments.
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House Bill 768, House Bill 797, Senate Bill 483 and Senate Bill 488, Acts Requiring Certification of Medical Directors in Skilled Nursing Facilities – would require certification and reporting requirements for medical directors in nursing facilities. While Mass Senior Care supports the intent of this legislation to elevate standards of care, enhance transparency, and strengthen accountability in nursing facilities, we urged consideration of the potential challenges and unintended consequences of these proposed requirements. We recommended that any new requirements be aligned with existing federal regulations and accompanied by workforce supports to avoid unintended impacts, such as financial penalties or shortages of medical directors, which could compromise resident care.
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House Bill 761 and Senate Bill 493, Acts to Strengthen the Long Term Care Workforce and Capital Trust Fund – would narrow eligibility for no-interest or forgivable loans through the fund by limiting eligibility to non-profit entities. Mass Senior Care testified in opposition noting that the need for these funds is universal for all nursing facilities – given that 70% of our residents have their care paid for by MassHealth – to enable facilities to develop career ladder programs to increase direct care staff and invest in modernizing the aging infrastructure of our nursing facilities.
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House Bill 760, An Act to increase access to the flu vaccine for older adults – would require hospitals to offer influenza vaccinations to all inpatients age sixty-five and older, prior to discharge. Mass Senior testified in agreement that ensuring eligible patients are vaccinated before leaving the hospital is a critical and efficient intervention that strengthens patient safety, reduces preventable readmissions, and lowers the burden on the health care system.
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House Bill 773, An Act Relative to Transparent Name Changes in Nursing Facilities – would require that when a nursing facility or assisted living residence changes its name, its safety and disciplinary record must carry over to the new name and be posted on both the Department of Public Health (DPH) and new licensee’s websites. Mass Senior Care testified that both state and federal regulations and law already require nursing facilities to notify the Department of Public Health (DPH) of any name or ownership changes. In addition, DPH makes inspection results and enforcement actions for the last 3 survey cycles publicly available through its DPH Nursing Home Survey Performance Score online database, regardless of a change in name.
- House Bill 793 and Senate Bill 492, Acts protecting the rights of older adults and people with disabilities – would require the Department of Public Health to develop regulations by July 1, 2027, aligning existing nursing facility resident rights with rights consistent with Department of Mental Health and the Department of Developmental Disabilities and would require nursing facilities to establish a Human Rights Committee in each nursing facility. Mass Senior Care emphasized that both state and federal law require nursing facilities to uphold the rights of all residents by ensuring dignity, respect, and quality of life in every aspect of care, but are unclear as to the intent of linking Department of Public Health regulations and oversight to the Department of Mental Health and the Department of Developmental Disabilities.