Senate Makes Sweeping Systemic Reforms to Long Term Care and Assisted Living Facilities
Bill enhances oversight, requires outbreak planning, and creates an LGBTQ+ Bill of Rights
(BOSTON—7/25/2024) The Massachusetts Senate today approved sweeping reforms to the Commonwealth’s long term care and assisted living sectors, taking a powerful step towards delivering the high quality and safe care that Massachusetts seniors deserve. S.2889, An Act relative to long term care and assisted living, substantially strengthens oversight and enforcement while also requiring facilities to create outbreak plans should a health issue arise.
The bill also creates an LGBTQ+ bill of rights for aging residents to prohibit discrimination based on their LGBTQ+ identity or HIV status. After robust debate, the bill passed 39-0.
“Today the Senate took an important step forward to ensure that our aging residents have safe, equitable, and high-quality care,” said Senate President Karen E. Spilka (D-Ashland). “It is far too common—and unacceptable—for residents in assisted living facilities to receive subpar care. By boosting transparency and accountability, the Senate is continuing to create a compassionate Commonwealth where all residents can age with dignity. I am grateful to Senator Jehlen for her leadership on this legislation, Chair Rodrigues, and each of my colleagues for their support of our state’s residents.”
“Long term care reform was a long-standing priority for the Senate this session, and I’m glad we were able to get it done,” said Senator Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. “This comprehensive package passed by the Senate today addresses many of the inequities that are prevalent in the long term care sector. With this legislation, we will now have a much stronger licensure process and stricter oversight on non-performing entities. We also make permanent basic health services at assisted living facilities. This reform bill will bring much needed stability into long term care and assisted living facilities across the Commonwealth.”
“I am grateful to all those—Senate leaders, legislators, and so many advocates and industry representatives—who have worked for many years to pass this bill that will improve care and stability in nursing homes and assisted living residences,” said Senator Patricia D. Jehlen (D-Somerville), Senate Chair of the Joint Committee on Elder Affairs. “The pandemic revealed starkly the lack of nursing home preparedness for the spread of fatal diseases. Many of us knew someone or relatives of someone who passed during that disaster. Even homes with consistently high ratings lost many residents. This bill offers measures to address issues in nursing homes and assisted living facilities; issues faced by the LGBTQ+ community when looking for care; bariatric care; and pooled trusts. It also ensures facilities that are not compliant with safe standards face consequences and are held responsible. I am grateful for the work of the Senate President, the Chair of Senate Ways and Means, my staff, and the many advocates that we have worked with and heard from over the years.”
The bill includes provisions related to basic health services administered in assisted living facilities and oversight of long term care facilities, including the following.
Assisted Living Basic Health Services. The bill makes it easier for residents of nursing homes and long term care facilities to get timely and efficient care by allowing Assisted Living Residences (ALRs) to offer basic health services such as helping a resident administer drops, manage their oxygen, or take a home diagnostic test. The legislation requires ALRs create service plans that demonstrate the residence has the necessary procedures in place, such as staff training and policies, to ensure safe and effective delivery of basic health services.
The legislation enhances oversight and compliance of ALRs by lowering the threshold for ownership interest disclosure from 25 per cent to five per cent. Under the new law, applicants are required to demonstrate that any prior multifamily housing, ALR, or health care facilities in which they had an interest met all the licensure or certification criteria. If any of these facilities were subject to enforcement action, the applicant must provide evidence that they corrected these deficiencies without revocation of licensure or certification.
This bill also gives the Executive Office of Elder Affairs (EOEA) new powers to penalize non-compliance by allowing them to fine ALRs up to $500 per day. This is in addition to existing EOEA powers to modify, suspend, or revoke a certification, or deny a recertification. Finally, it adds whistleblower protections for staff and residents who report anything happening at an ALR that they reasonably believe is a threat to the health or safety of staff or residents.
Long Term Care Facilities. The bill requires the Department of Public Health (DPH) to inspect each long term care facility every nine to 15 months to assess quality of services and compliance. It also requires DPH to review the civil litigation history, in addition to the criminal history, of the long term care facility applicants, including any litigation related to quality of care, patient safety, labor issues, or deceptive business practices.
S.2889 requires DPH to review the financial capacity of an applicant and its history in providing long term care in Massachusetts and other states. It requires applicants to notify DPH if it is undergoing financial distress, such as filing for bankruptcy, defaulting on a lending agreement, or undergoing receivership.
It allows DPH to limit, restrict, or revoke a long term care facility license for cause, such as substantial or sustained failure to provide adequate care, substantial or sustained failure to comply with laws or regulations, or lack of financial capacity to operate a facility. It also gives DPH the power to appoint a temporary manager if a long term care facility owner fails to maintain substantial or sustained compliance with laws and regulations. This manager would be brought on for at least three months, at the facility owner’s expense, to bring the facility into compliance.
The bill requires long term care facilities to submit outbreak response plans to DPH with clear protocols for the isolation of residents, lab testing, visitor screening, preventing spread from staff, and the notification of residents, family, and staff in the event of a contagious disease outbreak.
The bill prohibits long term care facilities from discriminating against residents based on LGBTQ+ identity or HIV status, whether through the denial of admission, medical or non-medical care, access to restrooms, or through room assignments. It also requires staff training on preserving LGBTQ+ rights and care.
Versions of the bill having passed both chambers of the Legislature, the two branches will now reconcile their differences before sending a bill to the Governor’s desk.
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