A step toward ending nursing home horror stories - Opinion, The Boston Globe
DATE: October 8, 2024
The state Legislature on Thursday took an important step toward reforming the problem-plagued nursing home industry by passing a bill that, if signed into law, should improve staffing levels and care quality at the institutions so many frail and elderly residents rely on.
Importantly, the bill includes both carrots and sticks for nursing homes — more money to attract and retain staff combined with stiffer penalties for violating state standards and stricter oversight of operators.
It comes against the backdrop of horror stories about abuse and neglect at the state’s nursing homes. One of the latest was a recent MassLive story about Highview of Northampton, which contained reports of walls covered in mold, feces in showers, a broken heating system, and delayed treatment for patients.
The bill, which emerged from a committee of House-Senate negotiators Wednesday, drew praise from the Massachusetts Senior Care Association, which represents nursing homes, and a union representing nursing home staff.
Tara Gregorio, president of the association, called it “comprehensive and historic legislation” that “represents a profound commitment to the well-being of our seniors and the dedicated professionals who care for them.” Tim Foley, executive vice president at 1199SEIU United Healthcare Workers East, said the bill, if signed, “will start the important work of addressing the safety and staffing issues that our state’s nursing homes face, so we can lower costs, improve health care access, and reduce health inequities.” Paul Lanzikos, coordinator of Dignity Alliance Massachusetts, which has called for reforms of nursing homes, said the bill provides a “strong start” toward reform, as long as it is paired with effective regulations and enforcement.
Governor Maura Healey should sign the bill so state health officials can begin work implementing and enforcing it.
One of the root causes of dysfunction at nursing homes is that, particularly since the COVID-19 pandemic, they have struggled to attract and retain enough staff. According to the Center for Health Information and Analysis, 20 percent of nursing home direct care positions are vacant. Around one-third of direct care staff working in nursing homes leave each year.
The bill would tackle that problem by giving nursing homes more money to put toward staffing and workforce development. It creates a Long-Term Care Workforce and Capital Fund funded by penalties levied on nursing homes found to have allowed abuse or neglect and by potential future legislative appropriations.
That money would be available for building and capital projects, like developing specialized care units, and for workforce training so people employed in nursing homes can gain new certifications.
It also creates a new position of certified medication aides for nursing homes, who are trained to administer medicine. The bill updates MassHealth’s payment formula to ensure nursing homes are reimbursed based on recent, rather than outdated, costs. There would be additional add-on rates for patients who need specialized care.
Combined, these provisions should help nursing homes recruit staff by paying higher wages and retain staff by giving workers paths to advance in their careers.
But money is not sufficient without oversight to ensure nursing homes are spending their money to improve care. There are too many homes with chronic low quality where violations of health and safety standards pile up and residents live in dismal conditions.
The bill would give state regulators greater authority when licensing a nursing home or approving an ownership change to determine the suitability of an owner, operator, or management company based on their finances, past litigation, and history of operating long-term care facilities. It would require additional financial reporting by nursing homes and would require the state to inspect nursing homes annually. It would increase financial penalties for homes where residents are abused or neglected and would give the Department of Public Health new administrative sanctions to enforce state standards, including the potential appointment of a temporary manager to run a nursing home if operators repeatedly violate state or federal rules.
Having a healthy nursing home industry is important not just for seniors needing long-term care, but for the entire health care system. One reason hospitals today are struggling with capacity is because they cannot quickly discharge patients to other facilities. In June, 38 hospitals reported having nearly 1,800 patients awaiting discharge, of whom nearly 900 were waiting for a bed in a skilled nursing facility, according to the Massachusetts Health and Hospital Association.
The bill would simplify the process of hospitals obtaining insurance authorization to move patients to nursing facilities by requiring the creation of a uniform form for prior authorization requests that all insurers will use, and also by limiting the time insurers have to respond to requests.
Seniors who need nursing home care depend on having a safe, well-staffed environment to call home. This bill, if implemented and enforced well, will help move the industry in that direction.
Editorials represent the views of the Boston Globe Editorial Board.