The text below is an official joint press release of the House and Senate. I was very pleased we could together enact long-term care reform today.
(BOSTON—8/29/2024) Today, the Massachusetts Legislature passed sweeping reforms to the long-term care and assisted living sectors, taking a powerful step towards delivering high quality and safe care for older residents across the Commonwealth.
An Act to improve quality and oversight of long-term care strengthens the Commonwealth’s oversight of nursing homes, provides critical anti-discrimination protections for LGBTQ+ nursing home residents, and permanently allows assisted living residences to offer basic health services.
“I’m proud of this comprehensive legislation, which reflects Massachusetts’ values when it comes to protecting our vulnerable residents, upholding their civil rights, and putting our knowledge and expertise as a health care leader to use to keep our loved ones and neighbors safe,” said Senate President Karen E. Spilka (D-Ashland).“Those who make the decision to put their loved ones in a nursing home or long-term care facility deserve to know that those loved ones will be protected. Once law, this bill will give the Commonwealth the resources and tools to ensure their safety, weed out bad actors in the field, and enforce oversight and accountability. I would like to thank Senator Jehlen for her leadership on this issue, Chair Rodrigues for his hard work, our partners in the House and all the conferees for seeing this bill through this session. It will make a positive difference in so many lives.”
“The nursing home sector has long faced workforce and financial challenges that were only exacerbated by the pandemic. Addressing persistent challenges within this important sector will not only improve the quality of care that residents receive, it will increase capacity and help acute care hospitals more efficiently discharge patients to the appropriate post-acute care settings,” said House Speaker Ronald J. Mariano (D-Quincy). “Building off of key investments in the industry in recent budgets, this comprehensive legislation takes the necessary steps to ensure that the Commonwealth’s nursing homes, and the patients that they care for, are supported. I want to thank Chairman Stanley and my colleagues in the House, along with our partners in the Senate, for working diligently to send this critical legislation to the Governor’s desk for her signature.”
“Long-term care reform was a long-standing priority for the Legislature this session, and I’m pleased the conference committee was able to come to a consensus agreement,” said Senator Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. “This comprehensive package passed by the House and Senate today addresses many of the inequities that are prevalent in the long-term care sector. With this legislation, we will now have a much stronger licensure process and stricter oversight on non-performing entities. We also make permanent basic health services at assisted living facilities. This reform bill will bring much needed stability into long term care and assisted living facilities across the Commonwealth.”
“This legislation couldn’t have come at a more critical time when more oversight and accountability are needed in long-term care,” said Representative Thomas M. Stanley (D-Waltham), House Chairman of the Joint Committee on Elder Affairs. “I’m grateful to Speaker Mariano for prioritizing long-term care at the beginning of session and to my fellow conferees for their tireless work over the last few weeks to produce such a comprehensive bill, one that marks the first major legislative reform to our long-term care and assisted living industries in over a quarter of a century. This legislation enhances both access to and quality of care in long-term care settings, tightens suitability standards for operators, strengthens supports for the long-term care workforce, and permanently allows assisted living residences to offer basic health services to their residents.”
“This landmark legislation is the culmination of years of advocacy and collaboration among so many people committed to improving life for our family, friends, and neighbors residing or working in long-term care, assisted living, and the community,” said Senator Patricia D. Jehlen (D-Somerville), Senate Chair of the Joint Committee on Elder Affairs. “There is always more work to do but we have agreed on policy that will surely have a positive impact on quality of care, transparency and oversight, and planning for the future. I am grateful for the work of the Senate President, the Chair of Senate Ways and Means, my House co-chair of Elder Affairs, and their staffs.”
“I want to thank Speaker Mariano, Chair Stanley, and my fellow conferees,” said Assistant Majority Leader Alice Peisch (D-Wellesley). “This legislation ensures the protection and care of our most vulnerable residents. The bill strengthens the long-term care industry by increasing standards and access to care and makes permanent basic health services at assisted living facilities.”
“I am very optimistic for the opportunities and reforms that this legislation will introduce to some of the most vulnerable members of our community. Not only is it our duty to ensure that our aging residents have access to the care that they deserve, but also their safety as they enter the years of their lives where they need extra assistance. Ensuring that long-term care facilities will not have to make certain sacrifices due to financial uncertainty will be crucial for the long-term health goals of our Commonwealth,” said Senator Patrick M. O’Connor (R-Weymouth), a Senate conferee. “The education and accountability measures that this bill offers are tremendous, and the improvements upon specialized care have proven to be of the utmost importance to us in the Legislature. I’d like to thank my fellow conferees for their dedication to this as we take the next step towards serving and regulating elder care.”
“This bill is an important step toward ensuring older adults receive the care they need to be safe and healthy,” said Representative Hannah Kane (R-Shrewsbury). “Strengthening oversight of long-term care facilities, requiring infectious disease outbreak plans, improving licensing requirements, and other reforms included in the conference committee report will protect vulnerable patients and provide the Commonwealth with the tools needed to enforce the standards for long-term care facilities. I thank the Speaker and my fellow conferees for their dedication to long-term care reform.”
The bill includes provisions related to basic health services administered in assisted living facilities and oversight of long-term care facilities, including the following:
Inclusion for LGBTQ+ Residents. The legislation requires each long-term care facility to provide staff training on the rights and care of LGBTQ+ older adults and older adults living with HIV. It also forbids any long-term care facility and long-term care facility staff from discriminating based in whole or in part on a person’s sexual orientation, gender identity, gender expression, intersex status or HIV status, whether through the denial of admission, medical or non-medical care, access to restrooms, or through room assignments.
Building the Long-Term Care Workforce. The Long-Term Care Workforce and Capital Fund established in the bill supports several new initiatives to recruit and retain a dedicated long-term care workforce, including grants to develop new Certified Nursing Assistants (CNAs), career ladder grants for direct care workers to train to become Licensed Practical Nurses (LPNs), along with leadership and supervisory training for nursing home leaders. The fund also establishes a no interest or forgivable capital loan program to off-set certain capital costs, including the development of specialized care units, and to fund other capital improvements. Civil penalties secured by the Attorney General against nursing home facilities for abuse or neglect will be deposited into the fund to support these initiatives.
Estate Recovery. The legislation limits MassHealth estate recovery to only federally mandated recovery and removes estate recovery for residents receiving assistance under CommonHealth.
Medication Aides. It requires the Department of Public Health, in consultation with the Board of Registration in Nursing, to create a program for the certification, training, and oversight of certified medication aides who shall be authorized to administer medications to residents of long-term care facilities.
Expanding Access to Basic Health Services. The bill makes it easier for residents of assisted living residences (ALRs) to offer basic health services such as helping a resident administer drops, manage their oxygen, or take a home diagnostic test. The legislation requires ALRs create service plans that demonstrate the residence has the necessary procedures in place, such as staff training and policies, to ensure safe and effective delivery of basic health services.
Enhancing State Oversight and Compliance to Ensure Quality Care. The legislation enhances oversight and compliance of ALRs by lowering the threshold for ownership interest disclosure from 25 per cent to five per cent. Under the new law, applicants are required to demonstrate that any prior multifamily housing, ALR, or health care facilities in which they had an interest met all the licensure or certification criteria. If any of these facilities were subject to enforcement action, the applicant must provide evidence that they corrected these deficiencies without revocation of licensure or certification.
This bill also gives the Executive Office of Elder Affairs (EOEA) new powers to penalize non-compliance by allowing them to fine ALRs up to $500 per day. This is in addition to existing EOEA powers to modify, suspend, or revoke a certification, or deny a recertification. Finally, it adds whistleblower protections for staff and residents who report anything happening at an ALR that they reasonably believe is a threat to the health or safety of staff or residents.
Further, it authorizes the Attorney General to file a civil action against a person who: commits abuse, mistreatment or neglect of a patient or resident; misappropriates patient or resident property; recklessly permits or causes another to commit abuse, mistreatment or neglect of a patient or resident or misappropriate patient or resident property.
Long Term Care Facilities. The bill requires the Department of Public Health (DPH) to inspect each long-term care facility annually to assess quality of services and compliance. It also requires DPH to review the civil litigation history, in addition to the criminal history, of the long-term care facility applicants, including any litigation related to quality of care, patient safety, labor issues, or deceptive business practices.
The bill requires DPH to review the financial capacity of an applicant and its history in providing long term care in Massachusetts and other states. It requires applicants to notify DPH if it is undergoing financial distress, such as filing for bankruptcy, defaulting on a lending agreement, or undergoing receivership.
It allows DPH to limit, restrict, or revoke a long-term care facility license for cause, such as substantial or sustained failure to provide adequate care, substantial or sustained failure to comply with laws or regulations, or lack of financial capacity to operate a facility. It also gives DPH the power to appoint a temporary manager if a long-term care facility owner fails to maintain substantial or sustained compliance with laws and regulations. This manager would be brought on for at least three months, at the facility owner’s expense, to bring the facility into compliance.
Small House Nursing Homes. Small House nursing homes have emerged over the last two decades as an alternative to traditional long-term care facilities with a growing body of evidence demonstrating superior clinical outcomes in addition to higher resident and staff satisfaction levels. The bill would streamline the process for small house nursing homes to be licensed in the Commonwealth.
Outbreak Response Planning, Enhanced Training, and Financial Performance. The bill requires long-term care facilities to develop individualized outbreak response plans to contain the spread of disease and ensure consistent communication with DPH, residents, families, and staff. These plans must include written policies to meet staffing, training, and facility demands during an infectious disease outbreak and requires plans to be reviewed and resubmitted to DPH annually.
The bill also directs DPH to establish and implement training and education programs on topics such as infection prevention and control, resident care plans, and staff safety programs. DPH would also be required to promulgate regulations necessary to enable residents of a facility to engage in in-person, face-to-face, or verbal/auditory-based contact, communications, and religious and recreational activities.
This legislation also directs DPH, in coordination with other agencies and departments, to examine cost trends and financial performance across the nursing industry that will help regulators and policymakers untangle the complicated ownership structure of nursing homes.
Uniform Prior Authorization Forms. The bill requires the Division of Insurance (DOI) to develop and implement uniform prior authorization forms for admissions from acute care hospitals to post-acute care facilities.
Two-Year Prior Authorization Pilot. This legislation requires that all payers, including MassHealth, to approve or deny a request for prior authorization for admissions from acute care hospitals to post-acute care facilities or home health agencies for post-acute care services, by the next business day or to waive prior authorization altogether when a patient can be admitted over the weekend. In the case of prior authorization for non-emergency transportation between health care facilities, once authorization has been granted, that authorization must remain valid for at least seven days.
Hospital Throughput Task Force. The bill establishes a task force to study and propose recommendations to address acute care hospital throughput challenges and the impact of persistent delays in discharging patients from acute to post-acute care settings. The task force will examine hospital discharge planning and case management practices; administrative legal and regulatory barriers to discharge; efforts to increase public awareness of health care proxies; post-acute care capacity constraints; the effectiveness of interagency coordination; and other items.
MassHealth Long-Term Care Eligibility. The bill requires MassHealth to study the cost and feasibility of changes to it eligibility requirements for with the goal of reducing the time applicants spend at acute-care hospitals awaiting long-term care eligibility determinations. The study will consider improvements to the eligibility determination process; establishing a rebuttable presumption of eligibility; guaranteeing payment for long-term care services for up to one year; and expanding the undue hardship waiver criteria.
HPC Study of Medicare ACOs. This legislation requires the Health Policy Commission (HPC) to conduct an analysis and issue a report on the impact of Medicare accountable care organizationson the financial viability of long-term care facilities and continued access to services for Medicare patients.
The compromise legislation now having passed the Legislature, the bill now goes to the Governor’s desk for her signature.
Congratulations on getting this bill passed. It’s good to know that new protections are in place as well as steps to build the workforce, ensure speedier transitions from hospitals and acute care, provide more health services, and to hold facilities accountable for standards of care .
This is a step in the right direction. During the height of Covid, there were many recommendations regarding the number of residents in a room, the requirement of an infection control supervisor, the availability of personal protective equipment, and many many more recommendations for resident protection e
during infectious disease outbreaks. I don’t see any of those issues addressed in this bill except that each facility has to come up with its own plan. And there doesn’t seem to be more funding for more DPH inspectors.
Hi Barbara, Thanks for the question.
Appropriately for legislation, as opposed to regulation, the bill does not detail outbreak response practices, but does require facilities to have an outbreak plan approved by the Department of Public Health.
Correct that there is no funding. This bill is not a funding bill. Adequate funding for DPH is indeed essential and always a priority in budgeting process.
Senator, this bill as you have summarized it, looks great.
Related question: A few years back you and I had a brief conversation about looking after elders at home. I’m wondering if there’s been any more progress along those lines.
((I don’t expect you to remember our conversation, at the Saltanstall Farmer’s Market. You immediately asked a member of your staff to send me what was available in MA at that time. I’d told you what was available in Illinois and you’d been surprised that they were so much ahead of us.)
HI Amit, this bill speaks to care in facilities as opposed to home care. Home care is always a priority to keep people out of institutions. Mostly the issue these days is finding the people to provide it. I often speak to people who have been authorized for state funded home care services, but cannot find anyone to provide the services. It is an ongoing priority to strengthen the home care work force. Feel free to ping me by email if you want to go deeper on home care.
There are a lot of wiggle words around the phrase “basic health care.” Is access being increased, permitted, made permanent, mandated, or what? This article was not clear, but considering that it could affect a lot of residents every day, clarification is important. I note absence of the word “funded.” How will facilities afford these basic health services?
Hi Laura, thank you for this question. The bill does define the term as follows:
The intention is to make basic health services more available by flexibly allowing a wider range of staff to provide these services in accordance with a plan approved by the Department of Elder Affairs. The plan should define by whom and how the services will be delivered.
This issue was first brought to my attention to during COVID by the daughter of a person in assisted living who could not get basic services because staff were prohibited from providing them.
Same issues caused by Stuart healthcare. How about banning private equity firms (root cause) from buying/holding/running all types of healthcare facilities.
This is an important emerging concern. We do have legislation still in negotiation that would significantly regulate private equity’s role in hospitals.
How about the state putting deed restrictions on the hospital properties stipulating that the property can only be used for healthcare establishments. aka St. Elizabeth’s , whatever the state’s plans, can be only used as a hospital. Can’t be used for something else like high end condos, hotel, warehouse. shopping mall etc. It is fast and pre-emptive,
Thanks for this update and your support. THis legislation is long overdue.
Before y’all get too busy patting yourselves on the back, whatever
happened to the “death with dignity”
legislation? One of those things for which there just wasn’t enough time? or do you not support?
Addressing the presence of private equity in healthcare is a good idea. Just not enough time for that either, right?
Thanks Bill, for your support for Death with Dignity. I passionately support Death with Dignity (“Compassionate Choices”). It is something that my late father championed and it is personal for me. I have worked hard over the past few years to build consensus on it. Unfortunately, there is not consensus on this. We do not have all the votes we need to pass this. It is not about running out of time.
I think we do have the votes on private equity and I expect that bill to come together in this session.
Dear Senator Will,
I need to start off with a big THANK YOU (and ALL the others involved) so much for your efforts to improve the quality of life for Seniors. It’s my belief that we are ALL SACRED SOLES, LGBTQ+ and Seniors included.
I spent several years visiting assisted living and “memory care” facilities, and experienced some good and some very poor treatment of patients in at least one memory care unit. I applaud inspections, and more overseeing of memory care facilities to help make sure the seniors and staff are treated with love. Not long ago I talked with someone who is helping reform Canadian senior care, with compassion being a key ingredient. I think they had some great ideas as well.
Because I was so saddened by what I witnessed in the memory care unit at “The Residence at Perl Street”, I started a page https://allone.org/life/memory_care/ which may become a location for more reviews or info in the future. I first sent a “suggestion page” (https://allone.org/life/memory_care/perl_street/perl_street_win/) on how to improve the memory care unit by adding flowers and animals for the seniors. After no reply , I created a page second video on the page https://allone.org/life/memory_care/perl_street/perl_street_ongoing/ with this video: https://www.youtube.com/watch?v=ocNPNnbbsBo . It talks about some of the poor treatment that I witnessed while I was there. When I looked the other day, I got the following response on my youtube channel from a former staff member:
“@KingJackson11355
4 months ago
I worked in this exact memory care unit for 15 months and was recently fired unexpectedly without any warning for not putting soap away. I will not name any names but I saw many of the other aides not be so nice to the residents which was heartbreaking to see. I very much miss not being able to see the residents I became close with while working there. Due to the managers and other workers I would not recommend putting anyone in this memory care either. I also saw exactly what you saw.”
So I would not recommend the memory care unit a The Residence at Perl Street”, and as I mention in one of my pages, it’s not the only place that needs LOVE.
Dear Will, and all involved and all who read this, THANKS on behalf of the people in the memory care units that often DON’T have a voice of their own, and sometimes get treated very poorly. If I can help, or if you have suggestions, reach out at care@AllOne.org.
Thanks!
David Morgan
Thank you for sharing your observations for others to see.
Thanks for posting this, and best wishes to you!
I had a relative back mid-1980s in a nursing home in Brighton. She stopped taking her medications I was told. When I went to see my relative, I didn’t realize she was suffering a stroke. I knew something was wrong. Some administrator or nurse don’t know, snapped at me saying they weren’t responsible because my relative had signed papers at entry to the nursing home to the effect holding them harmless, call it. There may not be an answer to this because maybe my aunt did want to die, but I certainly didn’t like the attitude of the nursing home person. Maybe this is a liability question but does this bill address a situation like this in any part? Probably complicated because you can’t force someone to take their meds maybe but at the same time the nursing home should have some responsibility for the care of the patient. Maybe they could have alerted my parents back then my aunt wasn’t taking her meds. Anyway, people shouldn’t have to sign their rights away. Maybe you can’t comment on specific cases but it’s was back in 1985 anyway.
Thank you, Anne. Yes. individual cases are hard to evaluate, especially in the distance of the past. But this bill is all about improving care.
It’s regreatble that a person can not set forth instrctions regarding their end of life decisions. unfortunately we all will
die after all we experience birth ( never to repeat it) and death can be harsh especialy due to debiliating illness and
suffering after all why prolong more pain and suffering. it doesn’t make sense. There are some people who are near hysteria when this is mentioned. Yet everyone should have their affairs in order with provisions for this to take place avoiding more pain and suffering. None of us are eternal as we die but once. Adam Burke
Thanks Senator Brownsberger – Outstanding that attention in such detail is being given to support the patients and staff in nursing homes by the legislature. I would also add support for the emotional ,spiritual and social life of patients and staff and training for staff on what’s involved in creating a caring community. Both my sisters spent their final years in facilities in Natick and in North Andover – and while staff did their best – they needed a lot of support too. And the facilities could have used more space and a much more cheerful environment – this was the last stop for both my sisters too – and nothing has been said about welcoming and supporting the spiritual life of patients – so while the details are there for review and inspections – a little more needs to be added about the space and the emotional, social and spiritual life for patients as they move toward the end of their life. Nursing homes do not need to look dismal and sad – they should be joyful and cheerful – and offer a friendly environment to those who enter the facility. And staff especially need to get all the help they need to be there for the patients in a patient, caring manner.
Congratulations to everyone who is working on this effort. It is so needed.
The next business for the legislature is the Hospital system. – Steward is painful and sickening to all of us – that should never happen again here in Massachusetts. We can do better. Ann
Thank you for this update. My question relates to the section on medication aides. I know someone who is an insulin-dependent Type 1 diabetic who was subsequently diagnosed with dementia. His family was told that, under MA law, the nursing home could not inject someone with dementia, even if it was insulin for diabetes. They were told he would need to seek care in NH or RI. Would this bill address that medical conflict?
I’m not sure about any special regulations on that. Will Check.
Providers at nursing homes are able to administer medications to patients. This sounds like an issue at a an assisted living residence, which this law does address.
Prior to the onset of the COVID-19 pandemic, assisted living facilities could not provide basic health services, including administering medications. People living in assisted living facilities who needed medication administered would have to hire their own private nurse to have medication administered, including insulin. There was a temporary rule put in place during the COVID-19 pandemic that allowed assisted living residences to offer basic health services, including medications. This temporary rule is set to expire in March 2025. Sections 2-11 of this law make this rule permanent.
The law requires the Executive Office of Elder Affairs to adopt regulations to allow the assisted living facility to provide these services. I want to note that the law does not require that assisted living facilities provide these services, but rather an assisted living facility will be able to choose whether to become certified in providing basic health services. If an assisted living facility chooses to become certified to provide basic health services, nurses at the facility would be able to administer medication, including insulin, to residents living at the facility.
Please feel free to reach out to me directly at alicia.brisson@masenate.gov if you would like to connect in further detail about this!