Rosemary Fahey, left, a resident at Arbors of Hop Brook, talks to the previous owner Paul Liistro. "I will miss Paul," Fahey said. Yehyun Kim /

Editor’s Note: This brief is included in the first story in a four-part series about Connecticut’s aging population and the challenges in finding ways to care for people. Read the full story, titled “CT’s aging population is growing. There are not enough people and facilities to take care of them.” here.

This week: The country’s aging population is expected to more than double. Connecticut’s network of supports is struggling.

Next week: Nursing homes face a reckoning as they deal with fewer residents, a change in pay and plans to ‘right size’ the industry.

Upcoming: As more people choose home and community options over institutional care, will access to services be equal for all?

Upcoming: More people are aging in place. But the state’s home care industry operates with little oversight.

For decades, the bulk of Connecticut’s long-term care spending went toward institutional settings like nursing homes. But just before the pandemic began, that trend shifted considerably.

In 2018, for the first time ever, the state spent more Medicaid funds on home and community-based services than on institutional care, 53% to 47%, state data show. By 2022, it had spent 58% of its Medicaid long-term care money on home services, versus 42% for nursing homes and other facilities.

Although the spread of COVID accelerated that swing, a migration from institutionalized care to home services had been underway for years. In 2009, 65% of the state’s long-term care Medicaid expenditures went to nursing homes. By 2017, that number had dropped to 50%.

Nursing home occupancy fell steeply during the early months of the pandemic. Hovering around 88% statewide before the first reported case of COVID, it plunged to 71% by July 2020.

As of February 2023, it had climbed to 83% but still hadn’t reached pre-pandemic levels.

Facility operators have sought $193 million more from the state to sustain struggling buildings. State officials balked at the request, and lawmakers raised questions about how several infusions of money during the pandemic were spent.

“We’re concerned about quality,” said Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities. “As we move to the other side of the pandemic, especially as it relates to high Medicaid facilities and serving low-income communities, there is evidence that they continue to be under-resourced, and without proper focus and attention, we’ll continue to see slippage.”

Nursing home owners say they are having extraordinary difficulty recruiting and retaining workers, and many facilities are understaffed. From February 2020 to December 2022, the nursing home industry lost 210,000 jobs nationally, and staffing tumbled to levels not seen since 1994, officials with the American Health Care Association and National Center for Assisted Living said.

And in recent years, complaints about care in nursing homes have increased. In 2017, the Office of the State’s Long-Term Care Ombudsman logged 3,090 grievances from nursing home residents and their loved ones. Last year, it received 4,278.

Complaints range from lack of access to care, typically from understaffing, to meals arriving late and cold, problems with heating and air conditioning, trash piling up and residents missing daily activities.

During the last quarter, the health department issued four “immediate jeopardy” findings in Connecticut. In general, there has been an increase in those orders, at least partially due to staffing issues in nursing homes, Barbara Cass, chief of the department’s health care quality and safety branch, said at a public meeting recently.

The findings indicate that violations in a nursing home caused or were likely to cause serious harm or death to a resident.

The problems have stirred debate at the Capitol.

“People send me pictures and videos of their loved ones in nursing homes with their bed sores and whatnot. It’s horrific,” said Rep. Jane Garibay, a Democrat from Windsor who is co-chair of the Aging Committee. “Here we are discussing if we can afford to put in air conditioning for seniors when the majority of our animal shelters have air conditioning. We have to change the way we think.

“When someone says, ‘I went to see my father. He got up in the morning, and they didn’t answer his bell so they could assist him to the bathroom. After three hours, he went in his bed and they served him lunch in that state without cleaning him,’ people will say, ‘Oh, that’s awful.’ But there’s just not the outrage. I get outraged.”

Lawmakers have introduced bills during the 2023 legislative session to raise the mandatory minimum staffing hours in nursing homes, to require more transparency in how facility operators spend state money, to mandate that owners provide air conditioning in resident rooms, and to prompt broader disclosures about private equity investment in long-term care, among other proposals.

State officials are also trying to “right size” the nursing home industry by scaling back the number of beds — and, eventually, facilities — to align with current demand. Lawmakers are weighing a measure that would slash funding for buildings whose occupancy drops below 90% over a 12-month period.

“Essentially, we no longer want to pay for excess beds,” Andrea Barton-Reeves, the state’s social services commissioner, said at a public hearing in February.

Read the full story: CT’s aging population is growing. There are not enough people and facilities to take care of them.

Finding answers to big questions in Connecticut. CT Mirror Explains is an ongoing effort to distill our wide-ranging reporting on Connecticut topics into a "what you need to know" format.