With safety violations in nursing homes on the rise, more people choosing to age at home and an older adult population set to balloon in the coming decades, lawmakers in the House of Representatives unanimously approved a bill Tuesday night that overhauls aspects of the elder care system in Connecticut.
The legislation, HB 5781, boosts transparency in nursing home finances, increases oversight of homemaker companion agencies and adds protections for residents who are discharged from nursing facilities, among other reforms. It passed the House 150-0 and now heads to the Senate.
Legislators heard from a stream of residents and their families this year who complained of subpar staffing levels, neglect, cold food and poor living conditions. Some facility workers said they were stretched so thin they struggled with patient loads and burnout.
The push to make significant reforms to the state’s elder care system overlapped with reporting by CT Mirror that exposed the growing problems in the home care and nursing home industries. The stories detailed how private agencies and the state are struggling to recruit enough workers to care for the expanding older adult population and highlighted problems people experience navigating a convoluted home care system that operates with little oversight.
The Mirror’s stories also examined how a dearth of affordable housing and lengthy process for accessing Medicaid are undercutting efforts to care for the state’s elderly and showed that Connecticut lacks a streamlined process for hospital discharges to the community, as it has with nursing homes. At the same time, nursing home occupancy, which plunged steeply during the pandemic, has yet to fully recover, and complaints about the quality of care in some facilities are escalating, as are questions about how owners spend taxpayer money.
Lawmakers keyed in on the issue of transparency in nursing home finances during the debate on Tuesday.
As part of a push for more accountability, the bill requires facility operators to submit narrative summaries of their expenditures along with the annual cost reports they file with the state. Summaries must include profit-and-loss statements going back three years, total revenue and expenditures, assets, liabilities, short- and long-term debt, and cash flows from investing and financing.
Nursing home operators would be required to disclose if a private equity company or real estate investment trust owns any portion of the facility. Operators that violate the mandates may be fined up to $10,000 for each lapse.
The legislation also directs Connecticut’s social services commissioner to develop a guidebook with a glossary, a plain-language explanation of the cost report terms and a description of the Medicaid nursing home rate-setting process.
Rep. Jane Garibay, a Windsor Democrat who is co-chair of the Aging Committee, noted that some nursing home owners were collecting millions of dollars while the industry has struggled to staff facilities and ensure adequate care of residents.
“When we’re giving out taxpayer money, we have to do due diligence and know where that money is going, what it is doing for our residents,” she said. “We know they’re in crisis. We know there’s a problem. This will help us to understand better what is going on.
“Take care of our seniors. They are dying because [nursing home workers] forget to put the oxygen on. They’re dying because they feed them solid foods when they’re supposed to be on soft foods. They’re leaving people and serving them food in their excrement,” she added, referring to residents who are left in soiled adult diapers during meals. “There are lots of things these business owners can do to help the people we are paying them in part to take care of.”
State health officials have expressed concerns about a rise in immediate jeopardy violations across Connecticut nursing homes recently, including five in the last quarter alone. Immediate jeopardy findings occur when lapses in a facility’s care caused or were likely to cause serious harm or death to a resident.
In one case, residents at the Newtown Rehabilitation & Health Care Center were left in their beds for hours without trips to the bathroom or diaper changes and received food late and cold, while nursing aides reported having as many as 20 residents to care for during some shifts, state records show.
The bill would also require facility managers to notify the state long-term care ombudsman’s office of a resident’s involuntary discharge or transfer and would give the ombudsman access to residents’ discharge plans (with the residents’ permission or if it is necessary to investigate a complaint).
It would allow for the creation of family councils in managed residential care facilities — groups of family members or friends who advocate on behalf of a resident — and add a dementia services coordinator position to the Department of Aging and Disability Services to evaluate state-funded dementia services.
“We represent three and a half million people … and a good amount of those folks are elderly and a high amount are in care. A lot of those folks do not have loved ones to represent them or speak for them,” said Rep. Michelle Cook, D-Torrington.
“The problem that we have is we want to believe that every actor is a good actor in the industry of taking care of our elderly population. I’ve learned this time and time again over the last 15 or 16 years — that is not the case,” she said. “It is a profit-making industry, and not everybody that owns or runs a nursing home is in it for the right reasons.”
Mag Morelli, president of LeadingAge Connecticut, which represents nonprofit nursing homes in the state, said facility leaders would work with state officials to implement the changes “in a way that makes sense and is helpful to the consumer.”
“LeadingAge Connecticut wants to work with any interested legislator in ensuring quality care is delivered in our nursing homes,” she said. “We believe that the vast majority of care provided by nursing homes and those who work in them is high quality care. And we want to make sure we support those homes, as well as supporting efforts to improve the care in others.”
Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, said nursing home managers are supportive of the enhanced transparency mandates.
“We’re among the most transparent reporting systems in the nation,” he said. “Connecticut nursing homes have been reporting on third-party-related expenditures for a decade or more. While we are already highly transparent, we are not opposed at all to additional transparency provisions.”
Incidences of substandard care in some nursing homes are “not reflective of care across the entire spectrum of skilled nursing facilities,” he added.
The proposal would also transfer oversight of homemaker companion agencies from the state’s consumer protection department to the public health department. It would require the commissioner to revoke a certificate of registration if any agency violates certain provisions three times in a calendar year and mandates that the department create a guide that details how to file a complaint against a homemaker companion company.
Elder care advocates have called the industry the “wild west” because of its lack of oversight, unlike long-term care facilities, which are heavily regulated by the state.
Unlike nursing home employees and home health aides, who must be licensed by the state Department of Public Health, there is no licensing process for homemaker companion workers. Instead, the agencies must register annually with DCP.
Managers at the companies are required to conduct criminal background checks on prospective employees but aren’t required to share that information with DCP, which does not track who works at the more than 900 HCAs registered with the state.
The Mirror reviewed more than 75 complaints against homemaker companion agencies filed with the consumer protection department between 2018 and 2020 and discovered at least half a dozen cases in which HCA employees were arrested for allegedly stealing from their clients, more than a dozen findings by DCP investigators of agencies that routinely mis-advertised the services they provided, and seven complaints of clients being left alone for hours at a time.
Rep. Mitchell Bolinsky, a Newtown Republican and ranking member on the Aging Committee, said the wide-ranging elder care bill was crafted after its authors were told they must consolidate several unrelated proposals into one piece of legislation. The transparency measure, involuntary discharge notification and homemaker companion pieces had previously been in separate bills.
Lawmakers took a proposal originally intended as a study bill and amended it to include the varying elder care reforms.
Bolinsky said several legislators and their constituents have family members who have dealt with substandard, sometimes “heartbreaking” elder care.
“I will never forget the feelings of what happened because of negligent care, in some cases [care] denied to our loved ones,” he said. “We owe it to our elders to make sure that they’re looked after.”