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February 8, 2024

Lamont proposes broad bill to address elder care reform in CT

SHAHRZAD RASEKH / CT MIRROR Gov. Ned Lamont delivers the 2024 State of the State Address at the State Capitol on February 7, 2024.

Citing the state’s ballooning older adult population and lapses in care at several Connecticut nursing homes, Gov. Ned Lamont released a wide-ranging bill Wednesday that proposes reforms across the elder care sector, from measures designed to increase transparency in nursing home operations to consumer protections for people in assisted living centers.

The proposal by Lamont marks the first time the governor has introduced a comprehensive bill on elder care. But House Speaker Matthew Ritter, D-Hartford, said he and other legislative leaders are also preparing a broad measure targeting aging services.

The Connecticut Mirror has reported extensively on gaps in the state’s elder care system — both in nursing homes and home care — and highlighted worsening conditions in many nursing facilities. Serious violations known as immediate jeopardy orders were on the rise in 2023, a major nursing home chain faced a number of lawsuits, and the chief executive officer of that company acknowledged he was six months behind in paying health claims for employees.

“Older adults deserve dignity, and family caregivers should have peace of mind that their loved ones are receiving good care across the long-term care continuum,” Lamont said in a statement. “Our proposal provides a comprehensive strategy that moves beyond a system of minimum standards and penalties to one that rewards high quality, aligns the industry around person-centered care, and promotes transparency.

“The COVID pandemic resulted in some of the most acute care issues in nursing homes and congregate care settings, that’s why we are focusing on strengthening industry standards.”

Under the governor’s bill, the state would create a website where people could compare nursing homes’ quality ratings, track complaints and find information about recent safety violations and staffing levels. Multiple agencies could feed information to the site, including the Department of Public Health, which is responsible for nursing home inspections, the state’s long-term care ombudsman and the Department of Social Services’ Protective Services for the Elderly program.

The public “dashboard” would be supported by $500,000 in American Rescue Plan Act funds and maintained by the public health department.

“Improving the transparency of facilities’ quality of care will allow consumers to have informed choices when selecting the nursing homes that best fit their needs, as well as help Connecticut rebalance by reducing the number of lower-quality homes over time,” officials noted.

Lamont has also proposed banning three- and four-person nursing home rooms to help curb the spread of infection and promote privacy. The plan would bar facilities from adding residents to rooms that already have two occupants beginning July 1, 2025, and would downsize all rooms with more than two occupants by July 1, 2026. More than a dozen nursing homes still feature rooms with three or four residents.

The governor recommended using $250,000 in ARPA funds to develop a set of standards that would allow some nursing homes to be designated as “Centers for Excellence.” The designation would be awarded to facilities that demonstrate better care, and rankings would be developed with input from industry leaders, the long-term care ombudsman’s office and other stakeholders. The program would be voluntary and is meant to incentivize higher quality care, officials said.

Lamont’s bill would also require better disclosure of fee increases in assisted living centers and managed residential care communities. Facilities would have to reveal how frequently they increase fees and make them clear in their contracts with residents. The governor’s proposal would also allow for a partial refund of fees if a facility’s managers determine they can’t meet a resident’s needs during the person’s first 45 days living there.

The bill would also help residents of a nursing home that is closing to get priority placement in other facilities and would eliminate the requirement that candidates who want to oversee struggling nursing homes must be licensed administrators in Connecticut.

In addition, the proposal includes several accountability measures. It:

  • Allows the public health department to deny a nursing home management certificate (or decline to renew one) based on past or current disciplinary actions
  • Gives the health department power to impose disciplinary action on nursing home management companies, including revocation of a certificate or imposition of civil penalties
  • Gives the health department power to enforce plans of correction against management companies
  • Requires management companies to get state approval before taking on new facilities beyond those identified at licensure or renewal (the health department may impose conditions on the approval)
  • Permits forensic audits of nursing home finances under certain circumstances

Advocates praised the proposal.

“I’m happy the governor is seeing aging as an important issue,” said Rep. Jane Garibay, D-Windsor, a co-chair of the legislature’s Aging Committee. “We’re supportive of the public dashboard — having one place to go and really look at nursing homes so people can make a choice and it’s easier. We’re on board with that. I think the governor highlighting aging and the [House] Speaker highlighting aging means they’re taking senior issues seriously.”

“The recent initiative to provide clear and easily accessible information on which homes deliver quality care is a testament to our administration’s commitment to transparency,” said Mairead Painter, the state’s long-term care ombudsman. “This effort empowers families and individuals in need of [long-term care services] to make choices that best suit their needs and preferences, ensuring they can remain in their communities and maintain the connections that matter most to them.”

Mag Morelli, president of LeadingAge Connecticut, which represents the state’s nonprofit nursing homes, said the industry is open to the proposals.

“We are happy to talk with them about where they might see the need for additional oversight,” she said. “We would be very supportive of a Center for Excellence model, which would not only incentivize nursing homes but also recognize nursing homes that already are providing excellent models of care. On the dashboard issue, we hope they would work in collaboration with stakeholders too. We’re supportive of giving consumers the information they need.

“We’re happy to work with the state on how we address the three- and four-[person] rooms, and helping the nursing homes restructure their infrastructure if those beds are still in demand.”

Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, which represents 160 skilled nursing homes and assisted living centers, said he was ready to work with the governor and lawmakers.

“Connecticut nursing homes share and support the focus, attention and enhanced resources proposed to elevate quality as reflected in the governor’s recommended budget adjustments,” he said. “Our state has an exploding aging population on the horizon, and assuring there’s a rigorous supply of high-quality providers to be there when our older residents and their families need them most is essential.”

Ritter said legislative leaders will soon unveil their own bill addressing elder care reforms, though language has not yet been drafted.

“There’s no question that elder care will be a focus this session,” he said. “There’s a lot of interest in aging issues and improving care, so it will be a big topic, and hopefully we can combine all of the proposals and come up with a bipartisan plan.”

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