Legislature misses opportunity with nursing home reform

MUCH HAS BEEN WRITTEN about the legalization of sports betting in the Commonwealth. The introduction of this much-debated and formerly illegal pastime is a tribute to the power of the gambling industry in Massachusetts.

Meanwhile, with the conclusion of the Legislature’s formal sessions, a bill that would have taken some of the gamble out of receiving quality care for residents of nursing homes across the state languished without action for nearly two months in the House Committee on Ways and Means. The lack of movement of this vitally important bill is a testament to the power of the nursing home industry.

A bill (House 4780) to improve quality care and oversight in nursing homes, was crafted in, and favorably reported by, the Legislature’s own Committee on Elder Affairs – a group of thoughtful lawmakers who know a lot about the long-term care needs of older adults and people with disabilities. Sen. Pat Jehlen and Rep. Tom Stanley deserve great credit for developing this bill. The bill also was favorably reported by the Committee on Health Care Financing, which I once chaired.

Among many needed reforms for nursing homes, House 4780 would have:

• Improved the safety and quality of nursing home care, treating residents with dignity
• Strengthened the licensure of nursing homes to ensure reputable owners
• Expanded workforce training to achieve consistent quality of care
• Implemented annual audits to ensure nursing home funds are being utilized in the best interests of residents
• Required customized outbreak response plans, including at least a part-time infection preventionist, to protect nursing home residents from ever again experiencing the devastation they suffered from the COVID-19 pandemic

Dignity Alliance Massachusetts, a statewide coalition of advocates, supports the bill, and believes that this measure, with a few targeted changes, could have resulted in transformational change in long-term care. It might also have justified the hundreds of millions of tax dollars provided in recent years to nursing homes, the vast majority of which are for-profit, investor-owned, out-of-state companies with a dismal track record for providing residents with dignity and quality care. Some of these companies have even had the temerity to sue the state to prevent enforcement of a regulation that limits nursing homes to no more than two residents per room, This, despite the likelihood that higher occupancy served to spread COVID to more elders and staff.

For more than two decades various media reports have detailed that tragedy of nursing home care both before and during the pandemic. Despite such effective reporting and editorials, advocacy by families of residents and advocate groups like Dignity Alliance and AARP, national publicity about the number of deaths in nursing homes, and the fact that 31 percent of all Massachusetts COVID deaths were nursing homes residents, it is shocking that Massachusetts nursing homes have not been reformed, and that staff remain overworked and underpaid.

As a recent survey by AARP makes clear, the problems of COVID in nursing homes have not gone away and, in fact, continue to cry out for action. The survey found “The rate of resident cases increased by 27 percent in the four weeks ending June 19 compared to the previous four weeks, with about 1 out of every 35 nursing home residents testing positive for COVID-19. The rate of staff cases increased by 42 percent, with around 1 staff member for every 28 residents testing positive. More than one-third of nursing homes nationwide reported a confirmed resident case during the four weeks, while two-thirds reported a confirmed staff case.

In an apparent slight to the thousands of older adults who were sickened or died from COVID in Massachusetts during the pandemic, the Legislature even failed to pass House Bill 4672 establishing a COVID-19 Remembrance Day! How soon we’ve forgotten this tragic event should prove the need for such a day. However, in this case, there still may be time to enact the bill during informal sessions before the end of the year.

Can there be any evidence-based excuse for such a catastrophic failure from lack of care and accountability by nursing homes or the dereliction of policy makers to require action? How much longer will nursing home residents and front-line caregivers suffer and die from poor quality care and lack of accountability, while state and federal governments line the pockets of the nursing home industry, and those empowered to change the law campaign for the votes of older adults pledging to improve their lives.

Richard T. Moore is a former state senator who served as co-chair of Committee on Health Care Financing. He is a co-founder of Dignity Alliance, Inc, but the views expressed here are not necessarily those of the coalition or its participants.