"Overdue Changes" in Long-Term Care Eyed For Early House Action

Elderly Women Sitting in Nursing Home Window

Photo: Getty Images

BOSTON (STATE HOUSE NEWS SERVICE) - Nearly three years after the COVID-19 pandemic thrust problems at nursing homes and similar facilities into public view, elder care advocates are optimistic that a sweeping reform bill high on the House's agenda will address conditions that contributed to the devastation.

House Speaker Ron Mariano gave an early signal last week of where his leadership team will turn its attention as lawmaking gets underway for the 2023-2024 session, identifying legislation from returning Elder Affairs Committee Co-chair Rep. Tom Stanley as his most likely pick for the first major piece of business.

The 26-page bill that Stanley filed this term and a nearly identical one his co-chair Sen. Patricia Jehlen filed on the Senate side (HD 2564 / SD 1244) cut across many of the issues long-term care facilities and their residents face, from infection management to staffing shortages to enforcement mechanisms.

Those facilities -- which were home to some of the most dire and damaging COVID-19 outbreaks -- would be required to craft new outbreak response plans, including steps for isolating infected and at-risk patients, reporting outbreaks to the state, and communicating with residents, families, visitors and staff.

"Long-term care facilities are really a critical component of the continuum of care," Stanley said in an interview. "The pandemic really underscored the need for overdue changes in long-term care. Having a large number of residents in the same room is just obviously not the way to go any longer with the outbreak of the pandemic and concerns of future disease outbreaks"

The bill also aims to strengthen enforcement mechanisms that can be deployed against facilities that fail to comply with public health regulations, and it both boosts fines for abuse in long-term care facilities and lengthens the statute of limitations for such cases.

Other sections would launch new training programs about Department of Public Health expectations, subject facilities to additional financial reporting requirements, and roll out new regulations for "small house" nursing homes.

While the long-term care industry struggles to attract workers amid an economy-wide labor shortage, Stanley said the bill emphasizes "incentives for employees to pursue a career in this field and to stay in it" through a combination of grant, career ladder and tuition reimbursement programs.

A similar bill made it partway through the legislative process last session, winning the support of both the Elder Affairs Committee and the Health Care Financing Committee before failing to emerge from the House Ways and Means Committee for a vote in the final months of formal business.

Stanley attributed that stalled progress not to any particular opposition or concern with the legislation, but instead to "just the nature of the legislative process."

"We have to compete with all the other issues and interests that pop up, and as you know, things happen. Last year, when the Supreme Court made their decision on abortion, that just kind of sucked all the oxygen [and] energy out of the building," Stanley said.

Now, supporters are already lining up in the seven-week-old term to add to momentum behind the omnibus proposal.

"We applaud the speaker in making this a priority issue as we have made it a priority issue at AARP. It will go a long way in improving the conditions for the residents of long-term care facilities, addressing problems such as staffing shortages, obviously infection control, transparency and accountability," Mike Festa, state director for AARP Massachusetts, said. "There's a lot in the bill, and we are really enthusiastically supportive."

In mid-February, AARP Massachusetts urged its members to get in touch with lawmakers and voice support for the Stanley-Jehlen bill as well as a third proposal from Rep. Ruth Balser dealing with wages for long-term care workers (HD 3443).

Festa said that message alone "generated almost 900 actions," a sign of enthusiasm behind the issue.

He added that tackling issues in long-term care facilities is one of the top three legislative priorities for AARP Massachusetts this session, alongside boosting supports for caregivers and strengthening financial security for people approaching retirement.

"There have been decades-long challenges with long-term care facilities. There have been a number of circumstances with tragic consequences," Festa said. "The cumulative effect of that was in fact to shine a light on these concerns and deficiencies and opportunities to address them."

"What we're really saying, frankly, is that after three years [of COVID], what we need to do is be sure we learn those lessons and incorporate those lessons into permanent legislative fixes and ways to improve the conditions of these facilities and to ensure that the quality of life for those residents is protected," he added.

Stanley said the bill aims to address several lingering points highlighted in a report a Nursing Facility Task Force filed in January 2020, just weeks before the COVID-19 emergency began, including recommendations for enhancing DPH suitability standards and creating new tools for the state to monitor and take punitive action against facilities.

Mariano and Senate President Karen Spilka re-appointed Stanley and Jehlen to lead the Elder Affairs Committee after the pair co-chaired that panel last term. After unveiling his list of committee assignments, the speaker named Stanley's work on the omnibus bill as unfinished business.

"Tom Stanley's committee had a piece that he had worked on for most of the session last year and we just never got to it," Mariano said last week. "I kept him on the committee because I do want to tackle it. It's around nursing homes, it's around care for the elderly. So I think that if I had to pick something first, that would probably be it, because he put a lot of time and a lot of effort into it and I think it's worthy of bringing before the membership."

It's still not clear when House leadership will push to bring the bill forward for a vote or how long it will take to move through the committee process after the substantial work last session, nor where it ranks on the to-do list for top Senate Democrats.

"The Senate will review any proposal that comes before the body," a Spilka spokesperson said in a statement. "The Senate President looks forward to this proposal going through a transparent legislative process, and will confer with her members on this and other issues that come before the Senate this session."

Written By Chris Lisinski/SHNS

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