CT lawmakers unveil bill overhauling aspects of elder care sector

As advocates and industry officials testified Thursday on Gov. Ned Lamont’s wide-ranging bill to boost transparency in nursing home operations, lawmakers unveiled another sweeping measure that would overhaul numerous key aspects of the elder care sector, including requiring more oversight of home care workers, creating a speedier process for accessing Medicaid and expanding the long-term care ombudsman’s office.

“This bill will revolutionize elder care in our state and show who we are as a people and that our elders deserve the proper care,” said Rep. Jane Garibay, D-Windsor, co-chair of the Aging Committee. “I hope we never go to sleep again on how we care for our elderly.”

“Over the years, we have lost our view of the elderly and the importance of taking care of them,” she said.

The broad proposal introduced by members of the legislature’s Aging Committee and House Speaker Matthew Ritter would make several changes to Connecticut’s sprawling home care industry, including creating an online registry of employees, requiring companies to send clients photo identification of workers and creating a presumptive eligibility program for people who need to access Medicaid quickly and want care at home.

Beginning Jan. 1, 2025, the state Department of Social Services would have to develop and maintain an online home care provider registry to help Medicaid recipients find workers who are in close proximity and have the correct language proficiency and special skills.

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 to training and opportunities for professional development.

It would also bolster state oversight of home care providers by facilitating background checks, verifying provider qualifications, identifying special skills, and increasing communication with providers in the event of an emergency, the bill’s authors wrote.

The measure promotes greater oversight of home care employees by mandating that home health, home aide and hospice care agencies send a photograph of each employee scheduled to visit a client to the client at least a day before the appointment. Employees must also wear a badge that includes their name and picture during each visit.

It also requires the state to expand worker fingerprinting locations across Connecticut to provide better access for people who require background checks prior to getting hired or obtaining a license.

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. 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.

A typically lengthy process for enrolling in Medicaid means people who need care urgently but can’t pay out of pocket may be pushed toward a nursing home, even if they prefer to stay at home. Nursing homes usually can admit a person pending Medicaid eligibility determination because they are generally able to bear the cost of providing services until they are eventually paid, or even to withstand a loss if they are never paid, officials with the AARP noted in a 2021 report. In contrast, agencies that provide home and community-based care typically cannot afford to start services without the certainty of being paid right away, the organization said.

The bill would also authorize four additional positions for the long-term care ombudsman’s office — two for facility settings like nursing homes and two for the community ombudsman program that would serve the home care population. It would set aside $20,000 for a new data system to support the community program.

And it would provide greater transparency of nursing home care and operations by requiring the state to contract with a firm specializing in data analysis and reviewing data “to determine if skilled nursing facilities are staffing to the acuity needs” of residents. The state’s Department of Public Health and social services department would have to post prominently on their websites tools for comparing the quality of nursing homes.

Oversight and investigations of nursing homes would also move from the public health department to the social services department, though health officials would continue to license facilities.

In a special report last year, The Connecticut Mirror exposed gaps in the state’s elder care system — both in nursing homes and home care — and shined a light on worsening conditions in many nursing facilities. The reporting highlighted the lack of oversight across the home care industry. The CT Mirror reviewed more than 75 complaints 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 CT Mirror also exposed how a lack of presumptive eligibility limited options for people who need care quickly but can’t afford to pay out of pocket, 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), and the absence of an ombudsman program for home care clients.

“The fact we are making this a priority will make it difficult for future legislators to forget about how we care for our elderly residents,” Ritter said. “Lasting change doesn’t come without bipartisan legislation, and I think we have all gotten those calls from someone about the care a family member got in a nursing home.”

Ritter called the measure a “game changer” for elder care in Connecticut and said lawmakers had been working on it for months.

“We’re not going to solve all of the issues in one year and this is a large, multi-pronged bill that makes sure we have better checks and balances in this entire industry. …  It is clear this is a priority,” he said. 

Mairead Painter, the state’s long-term care ombudsman, praised the proposal.

“I’m thrilled the speaker has followed through and made our elderly population a priority,” she said. “This bill will enhance the ability of our elderly residents to live with dignity, get them the support they may need and give them choices on how to live the last years of their lives.”

Painter said the bill addresses several issues with home care, including ensuring background checks are being properly done and that photos of caregivers are provided to clients 24 hours ahead of time to stop scams.

Nursing home executives said some of the bill’s provisions will pose challenges, but commended the focus on elder care.

“We are very encouraged that Speaker Ritter has put such a strong focus on nursing home quality improvement in his comprehensive aging services proposed legislation,” said Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities. “This is a common goal that nursing home providers have too. While some of the proposals do represent significant challenges for the providers, we think the speaker’s comprehensive approach creates a real opportunity for advancing meaningful quality improvement measures this session.”  

Jalmar De Dios, a spokesman for the social services department, said officials there are opposed to taking over investigations into nursing homes.

“It is important that DSS, as the payor, be seen as impartial,” he said. “Adding a regulatory role would lead to challenges and the perception of a conflict of interest in DSS’s rate-setting decisions, particularly when those rates are based on acuity.”

Public hearing on governor’s bill draws support

A public hearing Thursday on Lamont’s elder care bill drew mostly positive comments.

Under the governor’s measure, 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, including the health department, which is responsible for nursing home inspections, the state’s long-term care ombudsman and the Department of Social Services’ Protective Services for the Elderly program.

The public “dashboard” would be supported by $500,000 in American Rescue Plan Act funds and maintained by the public health department.

Lamont has also proposed banning three- and four-person nursing home rooms to help curb the spread of infection and promote privacy. The plan would bar facilities from adding residents to rooms that already have two occupants beginning July 1, 2025, and would downsize all rooms with more than two occupants by July 1, 2026. More than a dozen nursing homes still feature rooms with three or four residents.

And the governor recommended using $250,000 in ARPA funds 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, officials said.

“While this bill will not solve all of the problems that we know exist in this industry, it does a job to address three key themes that we need to consider and those themes include promoting quality of care, protecting consumer rights and choice and strengthening enforcement of state and federal laws and regulations,” said Dr. Manisha Juthani, the state’s public health commissioner.

Juthani said the nursing home dashboard would give consumers vital information to make informed choices.

“When people are looking for a home for their loved one, we need to be able to ensure they have the information at hand to make the decision about where they’re trusting the last days of a loved one’s life,” she said.

Juthani also said her department’s regulatory staff has slowly begun to return to full capacity.

“We, at one point, [were as much as] 40% down in terms of staff and our regulatory piece …. but we are down to only 14% vacancy right now,” she said. “We are getting closer and closer in terms of being fully staffed. I do think we will have more and more ability to be able to dig out of the hole we have been in through COVID.”

Andrea Barton-Reeves, Connecticut’s social services commissioner, also testified in favor of the bill, saying she supports a provision that allows her staff to do deeper forensic audits of nursing home providers if deemed necessary.

“We want to prevent or identify serious financial mismanagement at facilities that may place state funding and residential health, safety and well-being at risk and we will also have greater financial transparency with our ability to conduct forensic audits,” she said.

Legislators questioned Barton-Reeves about how often they do audits of nursing homes and whether there is a wait list for Medicaid-eligible residents to get into nursing homes.

Barton-Reeves said her department does about 60 nursing home audits per year, meaning a home’s finances are audited about once every four years. Department of Social Services officials also said there are currently about 3,000 empty nursing homes beds across the state.