2021-06-30 00:00:00 - Joint Committee on Elder Affairs

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SANDRA HARRIS - AARP MASSACHUSETTS - HB 727- SB 414 - Good afternoon, Chair Jehlen, Chair Stanley and requirements of the committee. I am Sandra Harris, the state president, AARP Massachusetts. AARP Massachusetts would like to thank the Joint Committee on Elder Affairs for holding this important hearing and we urge you to favorably pass House Bill number 727 and Senate bill number 414, and act to ensure the quality of care187 in nursing home. AARP is the non profit non members of the organization for people 50 people and over. We have nearly 38 million members nationwide and 775,000 members in the commonwealth. As the coronavirus spread like wildfire across the country last year, Massachusetts did not escape its perils.

With nearly 9000 deaths in the Bay State nursing homes from Covid 19, this amounted to about 60% of our deaths. AARP has heard directly from thousands of families about what happened to their loved ones in nursing homes and the counts are gut wrenching, you will hear from some of our members today. We cannot and will not allow these COVID-19 deaths to be ignored as mere statistics. These deaths represents mothers, fathers, grandparents, siblings, and spouses with families248 who love them. Last year, we came before you urging action on the need for greater transparency around measures to protect nursing home residents.

We are here again, urging action to better understand why so many residents died in Massachusetts nursing homes to make structural and systemic changes to the long term services, the court system and most importantly to learn how to prevent these tragic outcomes from ever happening again. AARP urges the commonwealth to act now to protect seniors in nursing homes and other long term care facilities by improving common sense policies, such as increasing the minimum nurse staffing ratios and hence the state preparedness and response to infectious disease outbreaks and require facilities to have plans to address them, require facilities, develop and implement a written department of public health approved isolation prevention plans and have appropriate technologies and capabilities in place to prevent residents from becoming isolated during public emergencies, to create a pathway to single occupancy room, all facility to reestablish extended for real lap staff training grant program.

In addition, we urge the committee to favorably pass House bill number 735 and Senate bill number 412, an act increasing the personal needs allowances for residences of long term care facilities and Senate bill number 422, an act relative to reserving beds in nursing homes during certain leaves of absence. For years, AARP has urged this committee to codify these provisions rather than to continue to have them part of the annual billing budget process. Medic aid eligible nursing residents are permitted to keep a personal needs allowance to cover basic expenses. AARP believes that long term services and support should emphasize the independence, dignity, autonomy and privacy of individual consumers, but personal need allowance helps them to do so at both the state and the federal level. We support adjustment annually to account for changes and account and the cost of personal needs.

Additionally, residents who reside a nursing home consider the facility their home. When residents take a temper relieve and you eliminate their bed, you eliminate their home. Simply providing them with the next available bait as408 is required by federal law is just not enough. I would also give the requirements. Please make the payments to nursing facilities, relieve of absence days permanent and ensure that residents who leave nursing facilities temporarily are guaranteed a return to the same. Thank you.

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BENETTA KUFFOUR - CONCERNED CITIZEN - Good afternoon, Chairman Jehlen, Chairman Stanley and members of the committee. My name is Benetta Kuffour, I'm here to share my story about my beloved brother and to urge you to take action and to make improvements in nursing homes. Now, my brother who we fondly called AB was a quadriplegic since 2012. He lived alone and often got urinary track infections600 during the later years of his life. Last year he was receiving home care to the VA. Due to COVID 19 restrictions and staffing shortages, his home care was stopped. Therefore he was temporarily placed in a nursing home while they looked for another agency to place him after a series of admissions and discharges to and from a variety of hospitals and nursing homes, he was replaced at a rehab nursing home in Worcester.

His expectations were that he would go home as soon as his rehab was over. So just to give you a little history, starting in November 2020, he went to a nursing home for rehab because he got pressure wounds and ultimately had one of his toes amputated. I am his only living relative here in Massachusetts. His four Children live in four different states. He has one son living in Massachusetts and one who died while he was in care. I was not able to visit my brother in the Nursing Home due to Covid 19, I spoke with him nearly almost every day, my only connection to him was when I called him on his cell phone. My brother did not die because of COVID-19, but rather sepsis.

The limited staff at the nursing home was not able to address the conditions that he was experiencing or the symptoms that he was experiencing. The nursing home was understaffed, they delayed him transferring him to the hospital because the nurse practitioner was not available. There were times when he was ignored and even I was ignored. When I wasn't able to get ahold of my708 brother for a couple of days, I contacted the nurse's station.712 It was very hard to get the staff to call me back with an update of his condition. There was not enough staff to take care of him, I believe the staff were overwhelmed and underpaid. I believe that due to COVID-19 restrictions, the staff was even more limited. I will tell you that on April 9th 2021, my brother passed away at the age of 73.

I believe had he received the treatment he needed, he would still be alive today. I always hear in the back of my head when I spoke to him that week and I called him and asked him how he was doing the Saturday before Easter and I asked him, you think you're getting a little sick? He said no, I feel okay. I didn't hear from him Easter Sunday, I didn't hear from on Monday, then I called and I finally got a hold of him. I spoke to him, I asked him how he was doing and his words to me was, this is a big one. I said, what do you mean? He said I'm seeing things, I'm very sick and I said to him, when you got off the phone to go to the nurse's station and I myself would call as well.

He says, yes, because I'm feeling really really loopy and my brother knew when he was getting UTIs and he knew when they were getting bad. He himself when he was living at home would call the ambulance and they would come and get him but while he was a nursing home, he didn't have the option to make that decision. So I called the nurse's station and I was told that there's nothing they could do about it until the nurse practitioner came in. She came in the next day and told me she apologizes for having the day off but she had some personal things to do, which to me was of no interest to me but she was treating him for medications that I was very unfamiliar with, had never heard of and she would get back to me. That was in the morning, that same, within an hour she called me back and said I want to send him to the hospital just to make sure and he never left.

He was supposed to go to hospital that morning, he didn't get there till like 5:00 PM in the evening. His heart stopped at 1:00 AM and 3:00 he was gone, he was so septic that the poison was throughout his body and there was nothing they could do at that time. We put a lot of trust into our nursing homes to provide care for our family members and there needs to be some type of improvement, there needs to be some education and training around how to treat patients like my brother, patients who are familiar with UTIs because if you let something879 go that long, it's inevitably going to be a negative reaction.

So I ask you,915 you know, consider your own family members, think about what you would want for them. Would you want the best to care? I don't know what kind of laws that you can mandate or make happen but we really need change to nursing homes as soon as possible, especially the training and that's because of the number of people who have died because of Covid in nursing homes or even staff who refused to even take the vaccine.

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SEN JEHLEN - Thank you. I want to thank you and I'm sure there are other people who will have stories like yours but your story is so clear that the shortage of staff in both home care and nursing1009 homes is life threatening to lots of people and it's just the failure after failure of the system to care for your brother. I just heard that the president recognized that the shortage in daycare work and care workers could be remedied by raising their wages. It's a kind of simple solution, it will cost money, but your story makes that point so personal and so clear and I won't say that again after other people testify but I want to thank you all.

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Yes.

CANDI HITCHCOCK - CONCERNED CITIZEN - HB 727 - SB 414 - Good afternoon, Chairwoman Jehlen, Chairman Stanley and members of the committee. My name is Candi Hitchcock. I'm here to share my story about my significant other and to urge you1093 to make improvements and take action with nursing homes now. My significant other, John Brown who slipped in the gardener rehabilitation and nursing center for 2.5 years. While this story is about John, I want you to know a few things about me. I was John's health care proxy, I spoke with him nearly every day, sometimes more than once a day and I visited him often until the pandemic made it impossible to do so. In late December of 2020, I was contacted by the Nursing Home Administration requesting verbal authorization for them to administer the COVID-19 vaccine to John.

I agreed only if it was mandatory and by the time I received the vaccine information paperwork, John had already received the shot. My next communication was to inform me that John had hit his head, I immediately asked that they sent him to the hospital for their scan and I was told the doctor wouldn't authorize it because1154 he had passed the neuro protocol. A few days later John called again, he was very confused. Despite my request for a follow up from the nursing home staff, I received none. On Saturday January 16th, I had not spoken with John in a week. As I was preparing to call him, the phone rang I looked at the caller ID, I thought it was John unfortunately the call was from the nursing home telling me he's failing fast, we're considering sending him to the hospital.

I had no idea what this nurse was talking about. She asked me, is this the first time that you have gotten a phone call since he's been sick? Sick with what I said? He's got covid. No one could tell me when this happened, so I asked a supervisor to call me. Less than an hour later, the emergency room called, apparently John had been treated in1209 the nursing home for 10 days. Within the hour, I received a phone call that no one ever wants to receive, it was the emergency room physicians assistant, it was the dreaded words. I'm sorry1223 to inform you. I am devastated that John died alone, thinking that I didn't care.

Today, you will hear a lot of statistics about what happens to residents in nursing homes and the accounts are1238 tragic. We cannot and will not allow these COVID-19 deaths to be ignored like mere numbers or simply explain them away these deaths are our loved ones. I urge you to favorably pass House Bill number 727 and Senate Bill number 414, and act to ensure the quality of care in nursing homes. I entrusted the nursing homes to take care of John. I urge you to make improvements to nursing home laws now so that no other family has to go through this experience. Thank you for your time.

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KAREN CURTIS - CONCERNED CITIZEN - HB 727 - SB 414 - Good afternoon, Chairwoman Jehlen, Chairman Stanley and members of the committee. My name is Karen Curtis and I'm here today to share my story about my father and urge you to take action in making improvements to nursing homes. Not only as a resident of Massachusetts, but also I'm a professional in the aging services field. My father died of Covid 19 in the nursing home on May 2nd 2020 early in the pandemic. He was a renowned national landscape architect who died alone with me, talking to him through a window. My father was 78 years old and struggled with frontal temporal dementia. He had been residing in a nursing home for about five years. Actually, it was his third nursing facility as we struggled to find a quality nursing home with an open Medicaid bed.

At his stage of dementia, he could no longer speak, required assistance to eat and had limited mobility, but I must say he still knew who we were. My family experienced everything that was shared publicly, lack of transparency, inability to make contact, nearly impossible to have a conversation with a physician or a more advanced clinical personnel like a nurse practitioner and no understanding of our options. Once he was diagnosed with Covid. As I noted earlier, I am a professional in the aging services field, particularly managed long term care and have worked for two of the senior care options plans, including commonwealth care alliance.

As my career has focused on aging in place, I do believe there is a role for nursing homes in our long term care delivery system. I have lots of thoughts, though today I really want to stress communication and I define communication not only the communication between the family member and the loved one. Keeping in mind that technology changes of older caregivers, my 79 year old mother doesn't even know how to use her iPad, never mind face time to be able to communicate with my father via some kind of video chat in the nursing home. But also the communication with advanced clinical practitioners, it really would have been have been nice to have talked to a physician or a nurse practitioner once he was diagnosed and I cannot underscore the importance of communication with the nursing facility management.

I really think it's important when considering any kind of outbreak plan that the state consider a few things. A state approved templates to be part of the communication protocols with families, just like with the senior care options, the state has to approve any member of communications that go out to ensure that the minimum standards are met. A specific emergency communication channel to centralize communication to the clinical staff, to triage the staff that the nurses that are manning the desk, they just don't have time to deal with acute care issues. An escalation protocols for family to contact clinical team leadership or nursing home facility management.

I do believe in the role of nursing homes and urge you to make improvements so that no other family has to feel helpless and ensure that their loved ones die with dignity and the respect that they deserve. I urge you to favorably pass House bill 727 and Senate bill 414, an act the quality of care in nursing homes. Thank you.

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SEN MOORE - DIGNITY ALLIANCE LEGISLATIVE - SB 413 - HB 733 - Thank you, Chairs and members of the committee. My name is Richard Moore and I served as chair of the dignity Alliance Legislative work group member and member of the coalition's coordinating committee. I am joined by Arlene Jermaine and Jim Lee maestro as part of this panel. Dignity alliance is grateful the1733 opportunity to present testimony today regarding the urgent need for transformative change in how the commonwealth serves our older adults and people with disabilities. We are a coalition of organizations and1750 concerned individuals who believe in that all Massachusetts residents deserve the dignity, respect independence as well as the ability to live in their homes and communities with appropriate supports and services.

Members of Dignity Alliance have strongly endorsed Senate Bill 413 and House Bill 733, an act to improve employer standards in nursing homes, which we believe would improve the quality of life among residents and staff of Massachusetts nursing homes through strengthening protocols for nursing home licensing and other transactions to prevent inappropriate owners from acquiring a nursing home, creating a workforce and it would create a workforce annual survey, worked as a stronger voice on the issues impacting their lives and the lives of nursing home residents and ensuring that the facilities finances will be used for most to provide the best quality of life.

The nursing home residents. We look forward to working with the committee to suggest that the bill should include a survey of residents as well as1818 the staff and perhaps if not them, the members of the resident family council to supplement the input from caregivers. We trust the Department of Public Health will provide a standard survey1830 instrument and require all licensed nursing homes to conduct the survey and1834 evaluate the results, as well as incorporating the results into the next annual inspection of the facility. We respectfully recommend the establishment of a meaningful medical loss ratio concept, with regard to the state reimbursement of nursing homes along the lines of that was in part of the nursing home facility nursing facility accountability and support package1858 that was provided during the Covid experience.

We believe that a minimum of which that provided, a minimum 75% of revenue to be spent on direct care staff. We would like to suggest that it should be closer to 90% much as the federal legislation requires and as the save New Jersey has done. Dignity alliance members urge this committee to favorably report Senate 413 and House 733. We urge your, your colleagues in the legislature to advance this important measure to the governor's desk. We believe it establishes critical policies that had they been in place, might have alleviated some of the problems that1905 occurred during the COVID-19 pandemic, but more importantly, will lead to better long term care for older adults In the commonwealth will be submitting more detailed testimony the next few days. We thank you for your attention and consideration.

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ARLENE GERMAINE - DIGNITY ALLIANCE - SB 414 - HB 727 - Good afternoon, Chair Jehlen, Chair Stanley and the elder affairs committee. My name is Arlene Germaine and I am a member1961 of dignity Alliance in Massachusetts coordinating committee and1964 chair their facilities, workgroup. Dignity Alliance members strongly support bills S 414 and 727 and act to ensure1972 quality of care in nursing homes. With the distinct goal of protecting Massachusetts, nursing home residents and staff not only in a pandemic but every day. Responsible staffing levels, outbreak response plans, social isolation prevention policies, a blueprint to minimize congregant living and career ladder opportunities all necessary to support nursing home residents no matter what the future holds.

We thank Senator Jehlen and Representative Balser for their leadership on these bills. We are submitting comprehensive written testimony on2013 these issues, so it's not to duplicate testimony, we've selected out a few separate issues that we would like to discuss. The bills calculation of hours per resident per day, the HPRD includes RNs LPNs and CNAs. However, Massachusetts regulations also included temporary aid position, which was created by CMS to help with staffing during the pandemic. A temporary aid does not have to complete 75 hours of training before working. Well trained staff are crucial for the safety of both residents and staff, so the omission of this temporary position from HPRD, keeps standards high.

Related to this issue is a 75 hour federal minimum training requirement. Massachusetts is one of 19 states that have not changed this basic requirement in 30 years. We recommend increasing training time to at least 120 hours, the level recommended by the2076 National Academy of Medicine and we respectfully request adding the extra training to the career ladder opportunity. Codifying the infection preventions position in Massachusetts law as part of part of the outbreak response plan is also very important. CMS was considering changing the federal mandated part time position to only sufficient time, a vague description open to interpretation.

To address the many perils of infection control, we respectfully ask you to consider increasing this position to full time as recommended by the CDC and the Association for Professionals in infection control and Epidemiology. Dignity Alliance members urge you to approve these bills to raise the bar on quality care to protect nursing home residents and their care givers. Thank you very much.

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JAMES LAMASTRO - DIGNITY ALLIANCE MASSACHUSETTS - SB 406 - Good afternoon. Thank you for the opportunity to speak about Senate Bill 406, an act relative to small house nursing homes. My name is James Lamastro and I am a member of dignity alliance of Massachusetts. This bill is a strong start towards the transformation of long term care necessary to ensure the dignity, self determination of quality life of those in need of nursing facility level care. While the majority of older adults and individuals with disabilities who currently reside in nursing facilities are unnecessarily institutionalized, they could be served in their homes communities. We recognize that there is a need for specialized congregate care. We feel strongly that to ensure the high quality and high value care sending in dignity and independence, it must be delivered through the small house care.

While the small house designed most clearly involves architectural plans, residential environments for private rooms and bathrooms, home like living and dining rooms and accessible kitchen out to a space, it is far more than simply a building. Small health model design is a radical change in delivery of care, embracing the best practices for providing community based care and avoiding the personalization and stigma associated with institutions. It requires a cultural metamorphose away from the medical institutional model care to serve the needs of the institution and orientated towards a focus on the needs and preferences of each individual residents. A more comprehensive bill is necessary to ensure that the nursing facility industry does not superficially change congregate care setting by adopting the façade of the small house model of care while neglecting the transformation of the culture and2277 delivery care.

A small house cultures, centers on the residents and surrounds them with a self managed team of care partners. The model of service2287 delivery is person senate and funding on a core values of the new power its staff in highly collaborative relationship. Ultimately, we support the spirit of this legislation if not the current version. What is needed is a comprehensive overhaul delivery of long term care, to commonwealth, older adults and individuals with disabilities. To achieve this vision, legislation must address more than just the physical plant of nursing facility to truly provide a quality of life Senate on holistic view of residents that preserves the dignity Independence legislation must adjust, must address changing the mindset and culture of institutional care and training, education, accountability and new structures. Thank you.

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FAYERUTH FISHER - SEIU 1199 - HB 733 - SB 413 - Thank you to the committee and Chairs2384 Jehlen and Stanley for the opportunity to testify in strong support of H 733 S 413, an act to improve employer standards for Massachusetts nursing homes. For the record, my name is favorite fisher and I'm the political director for 1199 in Massachusetts and we represent 75,000 healthcare workers across the commonwealth. We've submitted written testimony so we'll keep our remarks short today and I'm joined by my colleague Jamie Willmuth, our senior policy analyst, to add any additional remarks and we can both answer any questions that may arise. First, I want to thank our lead sponsors, Chair Jehlen and Leader Cronin, Chair Jehlen, thank you not only for your leadership on this bill, but for your career long commitment to both long term care and quality2429 long term care jobs.

We are excited to continue our work with you with Chair Stanley and the entire committee to positively impact policy conversations on this critical issue. As a union that represents the entire long term care spectrum, it's vital that all options remain viable and the quality skilled nursing facilities are available to those that need them. To that end, this bill implements three components learned from lived experience of nursing home workers, productive conversations that took place during the skilled nursing home task force and urgent insights from the COVID-19 pandemic. This legislation does three things; it creates stronger oversight and standards for new owners, it conducts a comprehensive audit of the entire nursing home industry and ensures that workers survey and voice is a part of quality care metrics.

Several of these components are overdue to creating a stronger industry and we thank the House and Senate for their work in advancing suitability requirements, both in the Senate last session and as recently as in the House ways and means Fy 22 budget. We also appreciate the administration continued commitment to these issues and we know that oversight over nursing home ownership and particularly strengthening suitability requirements must be implemented, especially in this very fluid environment that we saw pre pandemic. I also2506 want to take just a moment to particularly lift up the need for the workers surveys as a measure of quality. We all know that worker satisfaction is tied to care outcome.

To understand worker satisfaction gives us a much more full picture, including the potential to retain hard to recruit nursing home staff that is also already under stressed. I'm an organizer at heart, I will always be an organizer at heart and as most organizers learn that to create real and lasting change, those closest to the problems or to the work must be part of the solution by ensuring that workers have a voice on care delivering is fundamental to increase quality outcomes. So Jamie will talk about the final components of this legislation, but I do want to say that if we take one thing away from the past year and a half, listening to these stories that have been shared, we must take away the clarity of experience and integrate that into our action to allow this to accelerate policy making and continue to improve care and residents alike.

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JAMIE WILLMUTH - SEIU 1199 - Thank you, Chairman, thank you for having us. I just wanted to talk about the final component of the bill, which is a comprehensive industry audit and we see that audit as a necessary tool to continue to bring greater transparency and to inform future policy recommendations as it relates to funding other reforms and the like, we really need to get a better understanding of the environment in the state to effectively implement interventions to stabilize these really industry influx. I just wanted to say that2606 sort of the third component of the bill is directing CHIA in consultation with Mass health and the Department of other Affairs and others to conduct a full examination of the cost trends and2629 the financial performance among nursing facilities.

We want this audit to look at revenues, trends in prices and stays, affiliations with other health care providers, various categories of costs, including labor costs, building costs, capital costs, total spending on direct patient care as a percentage of their total expenses, occupancy rates and any other relevant measures of financial performance and service delivery. Again, we think these are essential, and we're pleased to say that the bill includes this important reform. As a general matter, there are a number of bills being heard today that share some2668 of these same intense to strengthen the long term care for residents of the commonwealth. Implementing mandatory infection control standards, increasing resident2674 per day care hours and other interventions are really important and are much needed.

So we respectfully urge this committee to act with urgency to debate and advance an act to improve employer standards from Massachusetts nursing homes and other reform proposals that were discussed during this hearing today. With that, I will conclude and we're open to any questions that the committee might have. Thank you.

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TARA GREGORIO - MASSACHUSETTS SENIOR CARE ASSOCIATION - SB 400 - HB 736 - Good afternoon to you and Madam, Chair and members of the Joint Committee on Elder Affairs. My name is Tara Gregorio and on behalf of the Massachusetts Senior Care Association, representing approximately 350 long term care facilities caring for2786 and employing nearly 100,000 individuals, I thank you for the2790 opportunity to present testimony this afternoon, which will be followed by written testimony on virtually every piece of legislation before the committee today so we do have extensive written comments. Mass Senior care remains committed to continuing to work with lawmakers, this committee, the Baker administration and stakeholders to advance public policy that ensures the safety and well being of our residents and their caregivers.

While we agree in concept with many, most, in fact, of the ideas contained in the proposals before the committee, some of which are already in place2839 and have been in nursing facilities across the commonwealth, we do, however, have a strong objection to and concern that combined these bills as drafted, would impose over $1 billion dollars in unfunded mandates on2855 a sector that is teetering on the verge of financial collapse. The states 377 nursing facilities provide a core state service to 31,000 frail elders and disabled individuals who can no longer be cared for safely at home as determined by the states ASAPs.

Nursing facilities are in need based service, and with very few exceptions, there are no alternatives to the care we provide. Over two thirds of nursing facility residents have their care paid for by Mass health, which under funds the cost of care by at least $25 per resident per day, resulting in an annual gap of $175 million between state funding and the cost of providing quality nursing home care. We are grateful that Mass health and the legislature are working to close the funding gap and modernize the state's reimbursement system through implementation of2918 recommendations from the legislatively established nursing facility task force, which issued its report in February of 2020.

However, we must do more to ensure the safety and well being of the commonwealth's nursing facility residents by continuing to invest in nursing facility resident care so that consistent with the nursing facility task force report, state funding better reflects the actual cost of providing quality resident care and allows for long overdue and necessary investments in expanding our workforce and paying a living wage. A2957 May 2021 voter poll again indicated broad support for investing in nursing facility care with 75% of voters supporting paying nursing facilities their actual cost of care per resident, and 77% of voters said that a lack of state government funding for nursing home care has a negative impact on the quality of care offered by nursing facilities.

This documents that voters have a strong awareness of the undeniable link between government funding and nursing facility resident outcomes and workforce investments. This link has also been verified and established repeatedly using publicly available government quality rating data and reimbursement data. Core to ensuring the safety and well being of our residents is a strong, well trained, appreciated and compensated workforce. Over 45,000 dedicated individuals, 90% of whom are women over half of whom are people of color with most yet not earning a living wage, are the backbone of our facilities as they provide the majority of hands on3039 care by assisting residents with all aspects of daily living as well as providing vital companionship.

Today, there are approximately 5500 vacant nursing positions in Massachusetts, nursing facilities, nursing facilities are simply unable to compete for job applicants, primarily due to their inability to offer competitive wages, which are tied to government funding. Since 70% of nursing facility residents rely on state Medicaid program, a facility's ability to invest in staff wages is directly tied to government funding. To meet the care needs of nursing facility residents today and in the future, we must jointly address these workforce challenges. Mass Senior3083 care top priority continues to be the establishment of a stable and skilled workforce in order to ensure the safety and well being of our residents.

This critical goal can only be achieved through a strong partnership with the Legislature, administration, nursing facilities and stakeholder partners to develop and fund a quality job that includes a competitive living wage, which an astounding 87% of voters support and we must create opportunity for career growth by enacting scholarships designated for our CNAs is to attend community colleges and universities so that CNAs have the opportunity to grow within the long term care profession to become LPS and our ends. Also, we must expand the direct care pipeline in order to meet the care needs of older adults and individuals with disabilities across the entire continuum of care through3142 partnerships with local training centers, vocational schools and other stakeholders.

Mass Senior care continues to work with nursing facilities in the office of Labor and workforce development, health and human services to increase the direct care pipeline through a series of workforce initiatives, including the development of the resident care assistant position, utilizing asynchronous hybrid CNA training to train new CNAs and working with the Governor's Health Care collaborative to address severe bottlenecks in the American red cross CNA certification process. in addition to a well funded long term care system that supports our workforce, there must correspondingly be strong data driven3182 education and training to ensure the safety and well being of our nursing facility residents and their caregivers.

Senate 400 House 736 acts relative to promoting the betterment of residents, health and safety in skilled nursing and rehabilitation would establish interactive training and education for nursing facility clinical and frontline staff. Specifically, the legislation would require the Department of Public Health in collaboration with subject matter experts to lead annual training programs on licensure and certification regulations and twice a year quality improvement training based on identified deficiency trends, skilled nursing facility. I'm happy to conclude there and just say that we believe strongly that training is core in addition to a strong workforce. So thank you, Mr. Chairman.

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ARLENE GERMAIN - MASSACHUSETTS ADVOCATES FOR NURSING HOME REFORM - I'm just going to have a brief introduction. This time I'll be representing as policy director and co founder Massachusetts, advocates for nursing home reform. We are the only statewide consumer group in Massachusetts working to improve the quality of care, dignity and quality of life of Massachusetts nursing home residents. Frank Basket and I will each be testifying on both the personal needs allowance as well as the bed hold policy, the leaves of absence policy and all bills represents issues currently in the budget and we are seeking to permanently protect them in legislation. Frank will start with the personal needs allowance.

FRANK BASKET - HB 735 - SB 412 - NATIONAL ASSOCIATION OF SOCIAL WORKERS - Thank you, Chair Senator Jehlen and Representative Tom Stanley. Thank you for having us here. Massachusetts chapter of the National Association of Social Workers in Massachusetts is the largest professional social organization in the state and we are here to support House 735 and Senate 412. We hold a long standing program, increase the base rate at a cola and place it3366 in statute. Policing the statute, something we've been advocating for for a long time. The PNA is a modest sum reserved residents owned income to cover needs not covered by Mass health. Residents do pay for some health care needs, such as some dental and podiatry care.

Those in residential care facilities or rest homes must use their PNA to cover copays for medication, integrates with the cola, ensures that many can maintain their personal autonomy and dignity while in a long term care facility. Mass Health does not provide for personal items such as clothing, reading material, barber, beauty parlor, phone and postage. A lack of personal funds prevents the resident for making phone calls, sending cards, visiting, family and friends. This isolates residents from family and community. Our experience this past year with covid reinforces the whole debilitating. The commonwealth priority is to return appropriate residents to the community.

These residents will need a source of funds to facilitate a successful transfer to the community. Advocating for older adults is a priority for any SW in Massachusetts. The PNA costs little to the Commonwealth with a 50% return from the federal government. But the older adults, it is vitally important And many of these older adults on health are eligible. Thank you for the opportunity to present this testimony on the PNA.

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GERMAIN - SB 412 - HB 735 - We are in strong support of S 412 and H 735 to permanently protect the PNA in law. The Bills raise the PNA. Monthly rate from a flat $72.80 which is the current budget level To $100 plus an annual cost of living adjustment or Cola. We are grateful again to Senator Jehlen for her leadership on an S 412 And we also thank Representative Garballey for his leadership on on his bill. The PNA pays for long term care resident expenses not included in the Mass health payment rate, nursing and rest home residents have already lost their homes and most of their belongings when they moved to a long term care facility.

Now they depend on the PNA to cover personal expenses important to their quality of life. Clothing, shoes, haircuts, the ride3533 and other necessities. We believe the PNA came into focus during the pandemic. We had conversations with several nursing home residents who wanted to buy special treats, needed to get a cell phone replaced and other items of comfort were having difficulty doing so on a PNA Budget. We submit that the PNA budget history supports an increase in the monthly rate as well as adding a cola. The $100 PNA rate proposed by this bill raises the PNA to a more equitable level but may sound like a large jump from the current 7280. However, we point out that $100 is a conservative amount since the 30 year old rate of 7280 is equivalent to over $134 today. Also since the 7280 monthly budget rate has been stagnant over the past 30 years, its value has declined to less than $40, a meager amount which does not cover current3588 day costs.

This situation supports including a cola in this legislation to ensure that going forward PNA purchasing power will be reasonable. A person's wellbeing is due to more than managing medical needs, which is why federal nursing Home law recognizes a dignified existence as the first protected resident right. The commonwealth is also charged with this responsibility, however, if the PNA remains in the budget, a Mass health residents dignity and quality of life will remain in jeopardy. We urge you to support this legislation to increase and strengthen the PNA to protect such basic needs. Thank you very much.3628

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BASKET - SB 422 - Again, on behalf of any SW Massachusetts, I am here to support an act relative to reserving beds and nursing homes during certain leaves of absence, that Senate 422. The medical leave of absence. Some residents while they were in the hospital consistency and staff and the environment increases the possibility of a successful recuperation and acute medical crisis. They're also reduces the3729 risk of further debilitation and an expensive return to the hospital and possibly worse. During this time of covid, a familiar and welcoming setting is vital for someone's health. The non medical leave of absence allows the residents to leave the facility for a short period, such as holidays, weddings, graduations, this is their quality of armed by the federal government and enables them3756 to3757 live a fuller life while receiving nursing home or rest home care.

The bed hold allows the resident to return to a familiar bed room, staff and routine research has demonstrated the change will place an elder or older adults at risk. This has been the case even after a room change. Covid makes it3776 even more imperative. Despite the fact there are empty beds in the industry, the facility without the better hold the residents and displaced3788 the3788 former resident. You may have to go elsewhere, or even to a different bed in the former facility. Initial cost of the commonwealth will be supplemented by 50% from the federal government but the value of doing so for injuries and seniors is hard to quantify. Please maintain residents sent her home and support Senate 422 by placing it in statute.

May I just add one more thing, I've been a social worker for many years, worked with older adults in nursing homes and now I have also have a different hat, as my wife is in a nursing home with Alzheimer's disease. We are fortunate that so far her care has been decent and the staff has been consistent, but I3835 know that that consistency of staff is not3838 typical in the nursing home industry today and so the care can really vary from one place to another. So I'm strongly in support of Senator's Jehlen bill to begin the transformation of the nursing home industry and3850 I support her ability to do that. Thank

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GERMAINE - SB 422 - Massachusetts advocates for nursing home reform is in strong support of bed hold provisions S 422, and we thank Senator Montigny for his leadership on this bill. S 422 ensures that a Mass health nursing home resident returns to the same bed to their home after medical or personal leaves. That holds support nursing home residents with most vulnerable following hospitalization, and they give residents of freedom for personal needs to prevent isolation from their family and community. The bill's provisions are identical3918 to the current state budget, 20 days per medical leave and 10 personal leave days per year. An observation stay in the hospital in excess of 24 hours is considered a medical leave.

If that holds remain in the budget, these protections will be in constant jeopardy telling residents that their home will never be secure. How many of us could live with this uncertainty and fear. We are also submitting written testimony that includes a comprehensive account of what's at stake if bed hold provisions are not protected in law and I just want to mention a few examples. Residents experience stress and trauma when forced to move to an unfamiliar room unit or facility. Personal connections are lost and the move feels more like an eviction. Multiple hospitalizations can be multiple evictions and adverse consequences. The staff's collective understanding and knowledge of a resident is lost when a resident is relocated.

This also jeopardizes efforts to reduce the use of anti psychotic drugs. Consistent care is necessary to successfully use non pharmacological approaches instead of medications. The commonwealth has been entrusted with providing nursing home residents with quality care, security and dignity. We urge you to permanently protect such basic needs in Massachusetts law and favorably report out these bills. Thank you.

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ELISSA SHERMAN - LEADING AGE MASSACHUSETTS - SB 406 - SB 407 - Thank you very much, Chairman Stanley, Chairwoman Jehlen and members of the committee. My name is Elissa Sherman, I'm president of Leading Age Massachusetts, which is an association representing not for profit, the entire continuum of not for profit providers of housing4056 and health care and services for older adults, including nursing facilities, rest homes, assisted living, life planned communities, also known4063 as continuing care retirement communities, subsidized senior housing and other community based service providers.

Our members are4070 all governed by volunteer boards of directors. Many of them have been around operating for over 100 years. We will be submitting detailed written testimony on a number of the bills that were heard today before the committee. I just want to provide some brief comments in support of two bills; Senate Bill 406 an act relative to small house nursing homes and Senate Bill 407 an act relative to rest homes. I first want to start by thanking chairwoman Jehlen for once again sponsoring both of these bills and for her leadership on these issues. Just briefly, I think you've already heard a prior speaker. Mr. Lamastro speak about the small house bill and I think many members of the committee are familiar with what the small house model is about and some of you have had a chance to actually visit some of the the greenhouse nursing home that is located in Chelsea Massachusetts.

Again, as Mr. Lamastro explained, there's really two concepts behind two important concepts that make up a small house nursing home and that's really in the design. So small residential, 10 to 14 individuals in private rooms, private bathrooms, but with residential dining, kitchen, residential living, it's not made to be home like, but it is home where care is provided. Just as importantly as the design and architecture is the staffing, the staffing model that relies on consistent staffing, so4155 the same staff members take care of the same residents and know the needs intimately of needs and preferences of those residents. They relies on a universal worker concept so you get away from the siloed kind of departments, but there's an additional training and the staff really do everything in that household.

There's been a lot of interest on this model, some prior research, but I think this past year there's been heightened interest and awareness of the small house model because of some new research that has emerged showing how the small house model really, or at least the greenhouse, which is a specific type of a small house fared very well during Covid. A recent study that was published in the Journal of Post acute and long term care Medicine, which examined data that was collected by the University of North Carolina or analyzed by the University of North Carolina between January 20th 2020 and July 31st found that the incidences of covid and mortality in greenhouse homes were much less4220 than in traditional nursing homes.

A lot of this is again attributed to the private rooms, the architecture, the design as well as the staffing. So, this is a model that we believe strongly we should be encouraging. There's also a lot of prior research that is in existence about positive resident and staff satisfaction, as well as other clinical indicators but we don't have that many of them. Part of the reason is because of the regulatory model that really was developed to support kind of a larger 40 bed unit nursing facility requiring a number of waivers for models that deviate from that, as well as limitations on the capital cost of capital reimbursement, so this legislation would really look to create either as both a subset of regulations specific to small house4270 as well as reimbursement, the capital reimbursement for that. So, we hope the4275 committee will consider and give a favorable report to Senate 406.

Quickly Senate 407, an act relative to rest homes. Essentially, what this bill would do would be to create also a separate subset of regulations specific to rest homes. Right now, their regulations are embedded within the long term care licensing regulations. Rest homes are very different than than nursing homes in many important ways, and often times you have to read through the regulations to say what does not apply to rest homes in order to understand what their regulations are. During Covid, we had some real examples where this was actually problematic, where rest homes were treated very similarly to nursing homes when assisted living was very different. Even just now, I can give you the example on restrictions in assisted living residences right now, residents who are fully vaccinated no longer have to wear masks in their homes, they are walking around in a common area.

Rest home residents, if there's anybody in there who's not vaccinated, even4358 the residents who are fully vaccinated still have to continue to wear masks. There were a number of these types of examples throughout covid. Basically this bill would just be able to pull out a separate set of regulations for the rest homes as well as update them because they essentially have not been substantially updated since the 1970s when they were first written. So we also hope the committee will act favorably on Senate 407. So thank you so much for your time.

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