Not long after John Interlandi began visiting his brother Joe, known as “Bubba,” in a Connecticut nursing home, he noticed that care was lacking.
“I visited Bubba on three occasions within the first week,” he wrote to legislators. “On each occasion, I found his pants and/or bed linen soiled in urine and the temperature on his floor was well over 80 degrees.
“On week three, Joseph lost his prescription glasses, they were never located and it took the staff over a month before an eye appointment was confirmed. This was just to set up the appointment. Personally, I have worn eyeglasses since the age of 12, and I would feel anxious if I was without for almost 2 months!”
Interlandi, who is Joe’s conservator, said he was not informed about his brother’s medication changes, and a dispute between Joe and a roommate prompted a police response.
“Based on my personal experiences, I am very concerned about the care that folks like Joe receive within the nursing home setting,” he said. “There is a clear lack of process (i.e. intake), communication, suitable staff, commitment to action and providing folks with a safe and respectful environment.”
Interlandi was among dozens, including nursing home residents, staff and administrators, who showed up at the state’s Legislative Office Building on Thursday or sent letters to lawmakers testifying on a sweeping bill that would boost mandatory minimum staffing hours — the time that a nurse or certified nursing assistant spends directly with a resident — from 3 to 4.1 hours per person each day.
Facilities that fail to comply with staffing level mandates must pay the civil penalties imposed within seven days of the violation and must use funds from management fees or money assigned for administrative or general costs.
The measure also would require nursing home operators to provide greater transparency in their annual spending. Beginning this year, administrators would have to submit narrative summaries of expenditures along with the cost reports they already must file.
By January 2024, the state’s social services commissioner would have to post links to yearly cost reports and the plain-language explanations prominently on the department’s website and include comparisons between nursing homes’ spending and summaries of the average reported expenditures by facility. The operators must also provide a glossary and explanation of the terms they use.
Nursing homes that fail to do so may be fined as much as $10,000 for each violation.
In addition, if a private equity firm owns any portion of a nursing home, operators would be required to disclose the name of the firm’s investment advisor and a copy of the most recent quarterly statement to investors, including any fees and expenses and the performance of the firm.
The bill also requires chronic and convalescent nursing homes and rest homes to provide air conditioning in all resident rooms. A revolving loan fund would be created to cover the expense.
The hearing lasted hours, as legislators heard stories from nursing home residents as well as testimony from nursing home providers and administrators from across the state.
Jeannette Sullivan-Mitchell, a resident of Pendeleton Nursing Home in Mystic, took lawmakers through a typical day for a nursing home resident.
“You wake up and you ring your bell because you need to use the bedpan or go to the bathroom, and you wait on an average of at least 15 minutes,” Sullivan-Mitchell said. “Think about that. Waking up and then having to hold your bladder. Otherwise you start your day off with a loss of your own dignity, humiliated and embarrassed, and this is just the first 15 minutes of your day.”
She implored legislators to do better for the state’s elderly population.
“There are veterans that have served our country, teachers, doctors, nurses, everyday citizens that deserve respect, and most of all good personal care that comes with good and efficient, abundant staff,” Sullivan-Mitchell said. “Please don’t look away. Help us with our everyday residents. We are counting on you.”
Several legislators said that as COVID wanes, the time has come to address systematic concerns in the nursing home industry.
“We have a moral and ethical obligation to protect our elderly residents, and we have failed, and it pains me to say that,” State Rep. Michelle Cook said.
Owners, operators oppose staffing increase requirement
Nursing home owners and operators pushed back against the proposed increase in mandated staffing hours, saying they already are having a hard time recruiting and retaining workers.
They warned that if the mandated hours per patient are increased, they may be forced to not accept new patients because they wouldn’t have the staff to meet the requirement.
From February 2020 to December 2022, the nursing home industry lost 210,000 jobs nationally, and staffing fell to levels not seen since 1994, according to the American Health Care Association and National Center for Assisted Living.
Joan Antico of Wachusett Health Care said nursing home employees are tired after three years of COVID and the constant battle to have enough staff to care for residents.
“Mandating more staff will not bring more people through our doors looking for work,” Antico said. “Do not follow through with this mandate — but if you do, then you need to help us financially, because we need your help.”
Several other providers said the struggle to find workers is the worst it’s ever been and that alternatives such as using temporary employment agencies aren’t the answer, because they are charging exorbitant rates.
“[We] have struggled over the last several years to hire staff to fill various open positions,” said Amy Bentley, executive director of Beechwood Post-Acute and Long-Term Care in New London. “Beechwood alone has over 500 vacant nursing hours or 15 full‐time equivalents, which have remained vacant in some instances [for] well over a year.
“Our industry is experiencing one of the worst staffing shortages in decades. Simply requiring facilities to staff at a higher ratio will not fix the problem. This will only force facilities to utilize more [temporary] agency staff, increasing financial burdens and providing less consistent and substandard care. We need to build the resources available to the facilities in the form of funding and individuals, which in turn will allow facilities to provide a higher more consistent level of care and services.”
Mag Morelli, president of LeadingAge Connecticut, which represents nonprofit nursing facilities, has said funding must keep up with mandates.
“It is imperative that during this time of severe workforce shortages, we prioritize workforce development and adequate Medicaid and Medicare reimbursement,” she said. “This is how we ensure that, as providers, we have the resources available to serve the growing number of older adults who are in need of aging services, support and long-term care.”
‘Short staffing has only exacerbated the problems’
Robert Willis has lived at Westside Care Center in Manchester for three years. He said Thursday that the difference in staffing at the beginning of his stay compared to now was stark.
“It’s hard, when you work with a skeleton staff, to help people. Everything is short-staffed,” Willis said, adding the employees are doing a good job under increasingly difficult circumstances.
“COVID almost took me out. If it wasn’t for the people caring for me I would have died,” he said. “There’s just not enough of them left to do the job anymore.”
John Balisciano, a resident at Apple Rehab Hewitt in Shelton, described the grisly conditions some residents are facing in nursing homes.
“People hit their bell to get assistance, and sometimes it takes hours for them to get any help,” Balisciano said. “Just imagine not being able to get help to go to the bathroom and having to sit there in your own waste for hours. It happens all of the time now.”
Marybeth Cimino, a certified nursing assistant at Arden House in Hamden, said she is supportive of the higher staffing levels.
“Every year, staffing gets worse. And residents’ acuity concerns continue to grow,” she said. “Short staffing has only exacerbated the problems that we have here in nursing homes and leaves my co-workers and I burnt out, broken and exhausted.
“While we’re trying to do the very best we can, we know they are not receiving the quality care they deserve. These people are mothers, fathers, retired mailmen, retired teachers, retired policemen, people who have been in our community. Like everyone, they deserved dignified lives, and we struggle every day to give it to them.”
Andrea Barton Reeves, the state’s social services commissioner, said although her department is supportive of the bill’s intent, funding for the changes is not included in Gov. Ned Lamont’s proposed budget.
“I’d like to say that the concerns we note are primarily budgetary,” she said. “We are, as an agency, in full support of improvements in care and quality in nursing homes. But you’ll hear me say time and again that some of these concerns — and our ability to respond to them — are constrained.”
The legislature is also considering a bill that would allow the attorney general’s office to conduct investigations and bring civil actions against nursing homes in cases of harm or risk of harm to residents. The office would be able to claw back state funds from those facilities and to impose penalties of up to $11,000 for violations.
“I am deeply concerned that over the last couple of years Connecticut long-term care facilities have failed in some instances to deliver adequate care, and as a result residents have suffered serious harm,” Attorney General Tong wrote in testimony to lawmakers. “The state pays billions of dollars annually through Medicaid and other state programs for long term care for our most vulnerable residents. Remarkably, the state does not have an adequate remedy to recover the monies it spends when the care it pays for results in harm to long term care residents.”
The Human Services Committee has until March 23 to vote on any bills it has raised.