Under a wide-ranging reform bill, assisted living communities in Massachusetts would offer basic health services and face additional oversight, which one senior living provider said will ensure high quality care.
HB 5033, which touches virtually every part of the long-term care continuum, passed the Massachusetts legislature last week and is awaiting the governor’s signature.
It would would strengthen regulations and oversight of the long-term care industry in the state, require facilities to have infection outbreak response plans, and create a program to address staffing issues, according to its supporters.
“This bill expands the opportunity for the commonwealth’s citizens to select assisted living, due to the ability to provide basic health services to residents,” Brian Doherty, of the Massachusetts Assisted Living Association told McKnight’s Senior Living. “It continues to advance the goals of regulators, advocacy groups and providers to ensure high-quality assisted living care in Massachusetts.”
LeadingAge Massachusetts said the legislation includes a number of “critical” provisions it has long advocated for to strengthen the long-term care sector.
Under the bill, assisted living communities would be able to offer basic health services, including injections; the application or replacement of simple, nonsterile dressings; oxygen management; diagnostic home testing; and the application of ointments or drops. Residents who receive those basic health services would be required to undergo a quarterly service plan review, and the state would be required to biennially review all assisted living residences.
After extending COVID-era waivers to allow assisted living residences to provide certain healthcare services prohibited by statute, the legislature took the step to allow these services on a permanent basis, LeadingAge Massachusetts President Elissa Sherman told McKnight’s Senior Living. But there are concerns that the final language requires assisted living residences choosing to offer those services to offer “all” of the defined services, in contrast to current policy under the waiver that allows providers to choose which services they are comfortable offering.
“The question remains what level of staffing will be required by providers that choose to offer basic health services, and whether they will be able to recruit and retain needed numbers of nurses to meet the requirements,” Sherman said.
The bill also would create an assisted living residences commission to recommend policies to ensure that communities are meeting the health and safety needs of residents. The commission would be tasked with studying the statutory and regulatory oversight of assisted living, best practices in other states, the effects of licensing or certifying residences, advertising practices, transparency, safety standards, consumer protections and trends in incident reports made to the state and whether those incidents were resolved.
And a new provision on ownership disclosure applicable to assisted living residences would require owners and management companies with at least 5% controlling interest in a community — rather than the current 25% — to disclose information including their criminal and civil litigation history and financial history.
A legislative commission also would be established to study oversight of continuing care retirement communities, and a task force would be created to review the viability and sustainability of long-term care facilities in the commonwealth.
A compromise agreement
Rep. Hannah Kane (R-Shrewsbury) said the bill represents a compromise agreement reached by a conference committee that worked to resolve differences between earlier bill versions.
HB 5033 would strengthen the licensing oversight and review process of senior living communities and other long-term care residential settings by requiring applicants to disclose civil litigation history and demonstrate the financial capacity to establish or maintain and operate a long-term care facility, Kane said. Employees also would be protected from retaliation for filing complaints or providing information to the state Department of Public Health on violations or potential risks to public health.
Other requirements for long-term care facilities included in the bill that do not apply to assisted living residences involve filing outbreak response plans with the state Department of Public Health and adopting an LGBTQI Bill of Rights to prohibit discrimination against individuals based on their gender identity or HIV status. The involvement of private equity and real estate investment trusts in long-term care facilities also would come under increased scrutiny.
Additionally, a new Long-Term Care Workforce and Capital Fund would be established to help recruit workers to long-term care, including grants to develop new certified nursing assistants and to train direct care workers to become licensed practical nurses. Providers also could tap into the fund, which will be supported by expanded abuse and neglect penalties collected, to invest in facility improvements.
The bill was sent to Gov. Maura Healey (D) on Aug. 29 for her signature. That same day, AARP Massachusetts sent a letter to Healey urging her to sign the bill as soon as possible.
“Massachusetts’ most vulnerable residents who live in nursing homes and other long-term care facilities deserve better than subpar conditions,” AARP Massachusetts State Director Jennifer Benson and State President Sandra Harris wrote. “It is time to hold nursing homes and other long-term care facilities accountable for providing safe environments and high quality care for residents.”
