To Treat Retirement Homes, State Lawmakers Adopt A Series Of Approaches To Improve Care And Financial Solvency | Local news

Massachusetts needed nursing home reform even before the pandemic, people say. Now the stakes are higher.

State Senator Patricia Jehlen, a Democrat from Somerville who co-chairs the Joint Committee on Seniors’ Affairs, said she believes the pandemic has prompted legislative leaders to seek change.

Even so, solving long-term care problems in Berkshire County – and across the state – requires different solutions.

Better wages for workers, better reimbursements for facilities and increased support for alternatives to nursing homes are all on the table, Jehlen said.

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“I definitely want to do something, and I think it all ties together,” Jehlen said. “This is the time when we have a chance because of what happened at the start of the pandemic. “

Jehlen and State Representative Ruth Balser, D-Newton, worked with SEIU Local 1199 and the AARP Massachusetts Chapter to introduce a bill that tackles low house numbers head-on nursing, which predated the pandemic.

Their proposal would require facilities in Massachusetts to meet the minimum of 4.1 hours of care per resident per day and 0.75 hours of RN care recommended by the Centers for Medicare and Medicaid Services. In addition, the proposal would require facilities to adopt epidemic response plans and policies to prevent social isolation.

And it would launch a “career ladder” program to improve worker retention and quality of care.

Still, Jehlen and Balser say their proposal should accompany additional legislation covering wages, reimbursement rates and other matters.

“It doesn’t just require more hours, which is a necessary reform but not sufficient,” Balser said. “There is a big problem with the salaries of people who work in retirement homes, and there are also working conditions. There are many problems.

The decline of the industry

Jehlen said she hoped two categories of laws could be passed this session. One would expand Massachusetts residents’ access to nursing home alternatives on the long-term care “continuum,” which includes assisted living, home health care and others. options offering greater independence. The other would be for the retirement homes themselves.

Dignity Alliance Massachusetts, a coalition of high-level and disability advocacy groups, has approved 67 bills in the legislature this session, including Jehlen and Balser’s proposal to increase membership, it says. her on her website.

The group representing the state’s retirement homes expressed reservations, however.

Massachusetts Senior Care Association president Tara Gregorio warned at a hearing in June that proposals to the Seniors’ Affairs Committee would create “unfunded mandates,” although she added that senior executives industry “agree on the concept” with the reforms.

Gregorio estimates that Jehlen and Balser’s proposal to increase staff would cost $ 170 million a year, she said in an email to The Eagle.

“Nursing facilities simply cannot afford these increases under the state’s current reimbursement formula,” said Gregorio, adding that staff costs for temporary nursing agencies have increased. “We continue to believe that any endowment mandate must be accompanied by a legal provision that requires recognition of the new costs by MassHealth.”

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The Seniors Affairs Committee is evaluating the association’s testimony as well as the support the Dignity Alliance and its member organizations have given to the bill, said State Representative Thomas Stanley, D-Saugus, who co-chairs the committee with Jehlen.

“That’s the committee’s job, and that’s what we’re doing right now,” Stanley said. “One side says one thing, another side says another. And it’s our job to dig into the arguments and find out what’s right and what can be changed to make the system work better.

The Massachusetts Senior Care Association’s top priority is “building a stable and skilled workforce,” said Gregorio, identifying two bills as “critically needed.” These proposals are referred to the Joint Committee on Health Care Financing, which heard testimony on them in September.

While 70% of nursing home residents are paid by MassHealth, the state’s Medicaid program provides reimbursements of less than $ 30 per day to cover the cost of care for each resident, Gregorio said.

A “quality nursing home jobs initiative” would require MassHealth to fund a “living wage supplement” for healthcare workers, and another bill seeks to stabilize the finances of nursing homes.

Former state senator Richard Moore, who chairs the Alliance for Dignity, said the coalition had considered these proposals and refused to support them because of the potential for “cost shifting” that would increase operator profits. facilities.

“If MassHealth picked up the cost, will the savings flow through as a profit to the owners?” Moore asked. “We’ve worked with SEIU members who represent some of the nursing home workers, and I think they tend to think more in the interests of workers than management.”

The virus has spread heavily in nursing homes in Mass.  (copy)

Christopher Potash and his friend, Noah McDonald, chat with Potash’s mother, Gertrude, 84, during a 20-minute visit in July 2020 to the Greylock Extended Care Facility in Pittsfield.

Continuum of long-term care

Even before the pandemic, people in Massachusetts were showing a greater interest in alternatives to nursing homes.

More and more seniors are choosing to “age in the community” or “age in place” rather than seeking institutional care in nursing homes, the Executive Office of Health and Social Services reported in 2019 One in six nursing homes in the state, he found, had a low occupancy rate, defined as filling less than 80 percent of available beds.

Still, some regulations and restrictions prevent people who may not need nursing care from accessing more independent alternatives, Jehlen said.

“There are people in nursing homes who don’t need to be there if we’re strengthening the rest of the continuum,” she said. “In order to pay adequate rates for people who need this care, we need to strengthen the cheapest and least restrictive services. “

Stanley worked on a commission that made recommendations to establish a statewide licensing process for home health care providers. Licensing more home care providers can provide quality assurance for families, as well as ‘resizing’ the nursing home industry so that it can be financially viable, he said. declared.

“We need to reduce excess bed capacity in the system and put money into the direct care workforce and expanding community services,” Stanley said. “I think it’s incredibly frustrating for consumers to find the right and appropriate care for their loved ones when the time comes, and we want to make sure home care agencies are licensed and trained properly and that consumers know what is needed. ‘they get.”

Jehlen has introduced a bill to improve reimbursements for home health care services, but regulation can also be a barrier.

Many people living with HIV or AIDS, for example, have to enter nursing homes if they are not old enough to qualify for home care, Jehlen said. While most residents must be 60 years of age or older to be eligible for home care – people diagnosed with Alzheimer’s disease are eligible if they are under 60 – a Jehlen bill would make home care accessible to anyone diagnosed with HIV or AIDS, regardless of their age.

Another Jehlen bill would allow assisted living staff to provide “common sense health services,” such as giving injections and applying ointments or drops. Some families have had to go to assisted living facilities to administer insulin injections themselves because staff were not authorized to do so, Jehlen said. Assisted living facilities have a temporary authorization to provide these services, but the authorization is due to expire on February 1.

Jehlen said she expects the complexity of the issues facing long-term care facilities will require continued attention from lawmakers beyond this session.

“It’s rare that we solve all the problems at once,” she said.

About Bradley J. Bridges

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