Acknowledging Connecticut’s substantial and increasing older adult population, the House of Representatives on Monday passed sweeping legislation overhauling the state’s elder care system, including requiring more oversight of home care workers, creating a speedier process for accessing Medicaid, and launching a registry to make it easier for consumers to find caregivers.
The legislation follows reporting by The Connecticut Mirror that exposed gaps in Connecticut’s elder care system — both in nursing homes and home care — and shined a light on worsening conditions in many nursing homes. The CT Mirror’s reporting highlighted the lack of oversight across the home care industry, showed how the absence of a presumptive eligibility program limits options for people who need care quickly but can’t afford to pay out of pocket, and revealed the lack of an updated home care worker registry. People on the state’s Medicaid program seeking care at home receive a binder with printed pages that in many cases contained outdated employee information.
The CT Mirror also reviewed more than 75 complaints against homemaker companion agencies alleging theft, neglect and deceptive advertising. While many cases resulted in fines or an employee being fired, the state acknowledged it had never denied an agency a registration or revoked a registration following an investigation.
The bill that passed the House by a vote of 143 to 3 Monday makes several changes to Connecticut’s sprawling home care industry, including creating an online registry of employees, requiring home care workers to wear badges with their name and picture, and creating a presumptive eligibility program for people who need to access Medicaid quickly and want care at home.
“What this is going to do is change the entire dynamic of how people age,” said Rep. Mitch Bolinsky, R-Newtown, a ranking Republican on the Aging Committee. “We’ve been talking about aging in place for as long as I’ve been here; now we’re actually going to be able to not just talk the talk, but walk the walk. It’s a significant game changer for an awful lot of people.”
“We’re saying our elderly are important,” added Rep. Jane Garibay, D-Windsor, co-chair of the Aging Committee. “It seems like everybody has jumped on the idea that we have to help our elderly live with dignity. We are not asking for the Taj Mahal or private servants. It’s changing the dialogue in big part with this bill, saying this is important.”
Beginning Jan. 1, 2025, the state Department of Social Services must develop and maintain an online home care provider registry to help consumers find workers who have the correct language proficiency and skills. Employees who were subject to domestic violence or sexual assault, or who have a restraining order out against someone, would be allowed to seek an exemption.
The registry would support recruitment and retention of home care workers by helping them stay enrolled as home and community-based Medicaid service providers, attracting new candidates through job advertisements and fairs, and connecting providers with training and opportunities for professional development.
Rep. Gale Mastrofrancesco, R-Wolcott, expressed trepidation during the debate Monday about employees’ private information, including name and training they have completed, being featured in the registry of home care workers.
“I’m concerned that very private information about a person such as who they work for and how long will be on a public website,” she said. “There are some good parts to this bill, but I have a lot of concern about putting private employees’ information on a state website.”
Mastrofrancesco voted against the bill, as did Rep. Doug Dubitsky, R-Chaplin, and Rep. Anne Dauphinais, R-Danielson.
Proponents of the measure say the registry will also bolster state oversight of home care providers by facilitating background checks, verifying provider qualifications, identifying special skills, and increasing communication in the event of an emergency, the bill’s authors have noted. It mandates that workers at home health, home aide and hospice care agencies wear a badge with their name and photograph during each client visit.
It also requires the state to study how it can expand worker fingerprinting locations across Connecticut to provide better access for people who require background checks prior to getting hired or obtaining a license. Lawmakers said there currently are 12 fingerprinting locations, with several “deserts” in which the nearest location is far away.
The proposal would also help people get quicker access to Medicaid so they can receive care at home. Legislators recommended creating a presumptive eligibility program, in which case managers and social workers use screening tools and financial information to swiftly determine if a person qualifies for Medicaid and to offer services.
Bolinsky praised the move toward presumptive eligibility, saying he knew multiple people who were pushed toward a nursing home while they awaited Medicaid enrollment authorization.
“In the past, we haven’t had the choice. Families, when they’re faced with a loved one who has a setback, that setback can become permanent if the discharge is handled to a nursing home,” he said. “We’re enabling the 75% of people who want to age in place in the state of Connecticut to actually age in place as a first choice rather than having to default to an institution. That, ladies and gentlemen, is the reason this is a bipartisan issue. This is a societally important stake in the ground.”
But there is risk involved. If a person ultimately is found ineligible for Medicaid, the financial burden of the services falls on the state or is shared with home care providers. Connecticut would use one-time funds through the American Rescue Plan Act to set up the program. The bill allows the state to discontinue it after two years if the effort is found to not be cost effective.
Some provisions that were outlined in a separate elder care bill, proposed by Gov. Ned Lamont, were moved Monday into the legislation voted on by the House. They include a plan 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.
And under the 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.
Garibay noted that some of the bill’s sections, including a provision that would fund several additional positions in the long-term care ombudsman’s office, were removed due to fiscal constraints. But she expects those issue to be revived next year.
The bill now heads to the Senate for a vote.