2023-05-15 00:00:00 - Joint Committee on Elder Affairs

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REP DOHERTY - HB 623 - Thank you so much for taking the time to hear this very important piece of legislation to both you, senator Jehlen and two representative Stanley. This is H.623 and act to improve quality and safety in nursing homes. I present this legislation as sponsor, of course, and on behalf of the Dignity Alliance of Massachusetts. H.623 aims to improve conditions for those living and working in nursing homes across the Commonwealth, and I have seen firsthand the challenges facing the facilities, as have you no doubt, the provisions of this bill speak to those challenges. First, adequate staffing levels.

According to research, staffing and nursing homes, numbers of staff, skills,187 mix, and training are critical indicators of quality care and positive resident outcomes. Without sufficient staffing residents may not receive the care197 and attention they need which lead to serious health problems, and even death. Section one of the bill seeks to address this problem by setting safe staffing ratios for direct208 care staff and based on current research and federal quality standards, H.623 will ensure that residents receive the level of care essential to their well-being. Another challenge facing nursing homes is the overreliance on institutional settings. A stay in a nursing home need not be forever.

We know in our own experiences again and research supports the idea that the elderly thrive and live longer in their own homes and communities.237 Many are better served by receiving care at home with support from home and community based services. Section two of the bill prioritizes community placement for residents by making a reasonable effort to ensure that they will receive the care they need in the least restrictive setting possible. There are also concerns about the quality of facilities themselves, which the bill addresses. Section three of the bill limits the263 number of persons per room in order that residents be provided with adequate space and privacy.

Any new construction, renovation, or a transfer of ownership requires new owners to commit276 to providing rooms for no more than two residents. Having that privacy ensures a safer and more dignified stay. And finally, the spill takes an important step toward protecting the right of nursing home residents. Section four establishes a human rights committee in every nursing home. And Section five, gives them the authority to investigate complaints affecting the rights of residents much the same as every other client under the care of DMA and DDS. I urge you to support H 623 and help us ensure that our most vulnerable residents receive the care and attention of essential to a317 quality of life. Thank you very much for your consideration.

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REP KANE - Thank you. Rep Doherty This is rep Cain. I just had one question. Under the Section one which changes the staffing ratios, do you know what it's going from, the basis is now?

DOHERTY - Well, it so looking at the law that we have provided the department is instructed to promulgate nursing home staffing ratios of not less than 0.75 registered nursing hours per resident, 0.55 for licensed LPNs and 2.8 for CNA's. So I'm not quite sure about what the current staffing ratio is, but I know as we talk about staffing ratios and healthcare facilities universally, it is it is not sufficient to address the needs of patients whether we're in a hospital or in a nursing home. So we're looking at about 4.1 hours of nursing attention from those three categories of direct staff. Attention to the residents a day.

KANE - Yes, thank you. I was looking for what the basis is now, but I'll follow-up and look at it. Thank you.

DOHERTY - Yeah. Thank you.

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REP KERANS - HB 633 - Thank you, senator Jaylen. Thank you, chair Stanley and Chair Jalian, members of the committee. I apologize for my tardiness. I appreciate you're taking me out of turn this morning. To testify in support of house 633 and act relative to transparency and accountability in nursing homes which I have filed in partnership with Senator Jehlen and the Dignity Alliance of Massachusetts. Very proud to have joined with both. I want to acknowledge and thank the committee as well for focusing on nursing home, quality and care, and giving a timely hearing to the several bills before you today.

To advance patient safety, standards of care, and oversight of these facilities. House 633 calls for more comprehensive financial reporting from nursing homes and related party companies so that we might know the answer to the question that any family member who's of someone in a nursing home asks all the time after every visit. Is it that they can't hire more staff or that they won't hire more staff and pay them a livable wage? Each year, nursing homes direct millions and millions of dollars through related party companies. Companies they own with little to no oversight and this is according to the national consumer voice for quality long term care.

Their report describes how nursing homes complex financial practices can obscure the actual. And full amount of revenue they take in and can create the illusion that their facilities are not profitable. The common refrain from the nursing home industry is that they are struggling to meet demand, they are in dire need of more financial assistance or reimbursement, and this is certainly true for a subset of long term care facilities. But the recent589 national consumer voice for quality long term care report indicates that funding meant to support jobs with fair pay for staff who are well trained and well supported.

Can too often be funneled off to a complex system of transactions by looking more closely at the company confirm excuse me. At the compensation remittance that nursing homes pay to their own ancillary businesses such as real estate insurance, etcetera. That are on cost reports which affect each facility's net income but funnels cash to investors, we can then see a complete picture of a nursing home's financial position. Just as a final note, madam chair and Chair Stanley, as a family member who made the difficult decision to place first my father and a few years later, my uncle, in nursing homes. I know very well how difficult it is to really know the full story of these operations.

Nicely decorated lobbies and amenities such as a hair salon can create the appearance of quality and care. But over time we become more familiar with the staff and staffing patterns and I know I didn't have time to both work, care for my father and my uncle, make sure I stopped in frequently enough and674 determine whether the facility really couldn't hire or wouldn't hire more staff. And what their profitability was. I will forever be indebted to the very kind workers who cared for my loved ones. It's not687 until you see a stranger cradling the689 head of your elderly loved one691 as they get sick that you fully appreciate693 them.

But I also can't forget the short-tempered worker who shouldn't have been doing this work and maybe if the pay had been better, and the person703 more trained and supported it would have worked out better. Only with greater transparency and accountability, can we be confident that nursing home operators and owners are putting these residents, our state's aging and sometimes our most vulnerable residents before profits and be certain that any state support is benefiting its intended recipients. I thank you for your time and consideration and for this committee's efforts to create meaningful nursing home reform.737 Thank you.

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SANDRA HARRIS - AARP MASSACHUSETTS - HB 615 - HB 648 - SB 379 - Good afternoon, Chair, Jehlen Chair Stanley and members of the committee. I am Sandra Harris, and I am the state president of AARP Massachusetts. AARP Massachusetts would also like to thank the joint committee on elder affairs for holding this important hearing and urge you to favorably pass House Bill number 615 an act to ensure the quality of care in nursing homes in addition to more comprehensive bills, such as house bill number 648 and senate bill number 379, an act to improve quality and over site and long term care. AARP is a national nonpartisan membership organization for people 50 and over. We have nearly 38 million members nationwide.

And 760000 members right here in the Commonwealth. We continue to fight to make sure nursing home residents receive safe high quality care. According to the Center from Medicare and Medicaid services, since the pandemic hit nationwide, COVID 19 has killed884 more than 168000 residents and staff of long term care, which includes nursing homes and assisted living facilities and other residential settings. We have heard directly from thousands of families about what happened to their loved ones in nursing homes, and the accounts are gut904 wrenching. AARP urges the commonwealth to take action now to protect seniors in nursing homes.

And other long term care facilities by continuing and improving just common sense policies such as increasing the minimum number of staffing nurse staffing ratios, addressing and creating the social isolation prevention policies and creating a pathway to single occupancy rooms in all facilities. We urge the committee to fairly pass house bill number 615 an act to ensure the quality of care in nursing homes taken together with house bill number 648, and senate bill number 379, an act to improve quality and oversight and long term care this spill buckle a long way to addressing the known shortfalls in the system. Thank you very much.

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LISA KRINSKY - LGBTQIA+ AGING PROJECT - HB 637 - SB 381 - So good afternoon to1108 the chairs and the members of the Committee, I will say it's a personal pleasure to be back in this building for the first time in three years and not be on Zoom with you all. So nice to be here. The LGBTQIA+ Aging Project would like to go on record in support of H.637 and S.381 an An Act establishing an LGBTQI long-term care facility bill of rights and urges you to report this bill favorably. I'm Lisa Krinsky. I1136 am the director of the LGBTQIA+ Aging Project a program of the Fenway Institute at Fenway Health. That works towards equity inclusion and community for lesbian gay bisexual transgender, queer questioning, intersex.

And asexual, older adults to ensure that they can age with the dignity and respect they deserve. The aging project supports the passing of this bill as an urgently needed safeguard to ensure that both long term care providers and long term care residents and advocates understand the expectations for the highest standards of care and quality of life for LGBTI, older adults residing in long term care communities. This bill is also a legislative priority for the Massachusetts committee on commission on LGBTQ aging of which I am a member and you chair. LGBTQIA+ older adults are significantly more likely to1184 age alone without a spouse or partner, children or grandchildren.

Who are frequently the informal and vocal advocates for long term care residents. Many LGBTQ older adults anticipate discrimination in treatment in long term care and fear that they will be most vulnerable when they are least able to advocate for themselves. Some discrimination and mistreatment may be intentional and some may not be, but the impact remains the same and harmful. To residents' physical and mental health. The residents bill of right, part of the 1987 Nursing Home Reform Act outlines a broad range of rights for long term care residents. Including the right to be treated with consideration, respect, and dignity.

While these are significant core values for all residents and all people in general. The concern is that many long term care providers may not be aware of behaving in ways that provide respect and dignity based on sexual orientation and gender identity and expression. The LGBTQI long term care bill of rights articulate specific actions that support respect and dignity. Such as including sexual orientation, gender identity, and expression, intersex, or HIV status, and discrimination, and harassment policies. And these would apply to residents, their families, and staff behavior. Also access to transgender related medical care, use of named pronouns.

And room assignment based on resident's gender identity, enabling spousal partner visitation consistent with non LGBTQI spouse and partners, and delivery of LGBTQI community programming. The LGBTQI long term care bill of rights will affirm the policies and offices of long term care providers who already meet these criteria and will offer guidance to those who wish to be more LGBTQI inclusive. Those long term care providers who fail to meet these criteria may face civil penalties or other administrative actions for violations of these rights. The LGBTQI plus aging project recognizes that when the LGBTQI long term care bill of rights passes.

Training and technical assistance with implementation of both policies and practices may reduce the regulatory sense of burden for long term care communities and result in their successful delivery of better quality of care for LGBTQI older adults. We believe that this legislation will create a welcoming long term care environment for LGBTQI residents, their families and friends, and long term care staff. Through setting standards for respectful, inclusive care. So we ask that you please support and favorably report out on an active establishing LGBTQI long term care facility bill of rights, and I thank you for your time today.

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ALEJANDRO MERCEL - CONCERNED CITIZEN - HB 637 - SB 381 - My name is Alejandro Mercel - I'm a transgender man. I I've been working in the field of public health department of public health. I've worked a lot with people do that don't have access to care, you know, nursing. The way it works out in discrimination is it could be little things, like, you get your meal, like, or they don't change help change it. I believe you're on the bathroom for an hour, toiling. I am the first transgender person for this facility that I live in. And they've done hey. They treated me really well. They still treat you well and very supportive. And we're excited to have here on the residential president with the hope that the whole nursing room, so they can't be involved.

But, primarily, discrimination, herpes happens behind the curtain. It's their issue here is that you can provide training, which is an important thing. But accountability is really the issue. I noticed when a DPH is coming in and tell that this attack running around to get everything ready. But they don't they don't continue to take care of us when DPH is there's just a lot of forms, like, discrimination, like,1484 new ones. They may take the transgender representative and put the let's say, in address, but that is not allowing them identify themselves. So that is Many dramatically, like, discrimination that would face you know, it goes down to the simplest. I'm not going to call you. She, I'm going to call you

You know, telling staff who I have proved to tell them about my translator. But we do need support, and my issue is accountability. I'm the only transfer I know into the nursing home in South Dennis. So I'm starting super late. Again, we're all and strain elder services, and other another a nursing throughout April. We really need this bill. We have no weigh a recourse to reporters, particularly transgender issues, there's really no agency or place that can report what's going on. Anyway, that's suggestive. There is discrimination. There's a lack of education and motive. We get We get nurses in here that are traveling places and they don't know. About this because they're using traveling agencies. So anyway, that's it.

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REP STANLEY - Thank you very much, madam Chair. The bill outlines like nine examples And to we to we know what do we know about any recording of when these instances have happened?

MERCEL - We don't have a clear stream to identify and cord instances of discrimination. I think in many cases, individuals and residents don't feel safe enough. To bring it up to someone. And so one of the problems is that we're not hearing from people. There's not residents aren't empowered to know a weight I have rights and these are not being attended to properly. So what we hear is mostly anecdotal.

STANLEY - Okay and then as far as a transgender day of remembrance event, and treating it equal to other holidays and cultural celebrations. Any suggestions on how that might happen? Or

MERCEL - So I think it you know, there are a variety of ways there can be a film and a discussion or a speaker about transgender issues for residents of a long term care facility. There can be connecting people to events that are happening locally in their community outside of their physical building. And with the ability to zoom into anywhere, people can also be participating remotely in larger events that take place.

STANLEY - Yeah. Thank you. Finally, part of the bill states that long term care facility staff, I think it says much but I think it's supposed box must. Right. Must receive by annual training. Is there any cost associated with that right now that we know of or How much the training would cost?

MERCEL - I think we would be looking at how to create something that would be cost effective and would reach as many of the staff and employees of the the variety of facilities across the state.

1798 STANLEY - Right. Thank you both very much. I've been1800 it's been great work with you as a chair of the committee and also a member of the statewide board that we serve on.

MERCEL - Thank you.

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KANE - Thank you so much for your test some money to you both. And for raising this issue, I think it's a it's a really important 1. So I just wanted to get a sense particularly on your because you're a provider. Is that correct? Because you said you referenced Fenway Health.

MERCEL - Yeah. Or yes. Okay. We're provided as an education.

KANE - Oh, I mean, okay, yeah, I wanted to get a sense of what you've seen be the most impactful. Blood care facility, right, to go from being, you know, having issues with discrimination and issues with not being gender affirming, like, because it is challenging. And then what has helped them shift or if you have experience of that, what are some of the best practices? Because, yeah, I wanted1855 to kind of connect together, you know, the issues of the that you're raising, and1859 then how do we solve them.

MERCEL - So, yeah, that's a that's a great question and excuse me. one of the things that we've done at the aging project is we have done a lot of training and technical assistance in other areas of elder care, so in community based councils and aging senior centers, ASAP, and such. So I think it is a combination of pieces. It is about helping folks understand what the obligations are. And then looking at how to do that implementation, looking at your policies and procedures, looking at your staff training, looking at your programming, how you convey messaging to your residents, their families, your community so there's a sort of AAA number of steps of best practices so that it's not just oh gosh you have another list we have to1906 check off, and we don't know how to do this.

KANE - Yeah. Yeah. No. That was kind of what I was trying to get to because I think that, unfortunately, sometimes what happens with either LGBTQI issues or, you know, race and ethnicity and things like that, that it gets sort of turns into a checkbox rather than how do we transform an institution and the best practices within that.

MERCEL - Yeah. That's what that's what we've been doing at at the aging and we would certainly want to look at ways that we could continue to be a resource and provide that support to long term care facilities so that They are best supported and best able to implement this and it's not onerous and it's simply here are the ways that you can comply with this obligation.

KANE - Incredible. Yeah. And then I was curious what are the main barriers that you're facing to kind of get to that place? Right? Is it the lack of capacity for, I imagine, the project, you know, like kind of what are the big barriers?

MERCEL - As the past three years, it has been you know, the priority of the immediacy of the pandemic and healthcare. Yeah. And I think there have been a number of places that have stepped forward and have said this is an important value and this is a priority for us. But as in the training requirement that we have for community based services in the state. I would hope that, you know, where Alejandro lives and where anyone else lives, that wherever you live in the state, that you can feel confident that a long term care community that you1994 are joining will have the capacity and it's not just, oh, this place didn't train or the place that I heard is great. Doesn't2002 have a bed for me. We want there to be equal access for everybody throughout the city.

KANE - Okay. Thank you so much.

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MIKE FESTA - AARP MASSACHUSETTS - HB 655 - HB 626 - SB 375 - SB 115 - Well, first and foremost, let me thank you, madam chair. And co-chair, Tom Stanley, as well as my state rep Rep Garabedian. For your continued leadership on a lot of the issues that you're hearing today and a2074 number of others. You heard from Sandra earlier on one of those issues. I wanted to just speak briefly to what I guess we could call the annual rite of spring. When the budgets come out and we talk about and worry about and wonder about why do we have to keep going through a budget process to be certain that things like raising the personal need allowance, having a bed hold, protection.

Why don't we just have that as part of our law rather than worrying that it may or may not get through the budget process? I know madam chair that you are painfully and obviously quite familiar with this. I just2121 want to show you that at AARP, we consider this a serious priority and one that whatever can be done to finally get it to a place of certainty. We want to work with you. We want to work with the committee to ensure that it happens. So the bills that, you know, that I'm speaking on, I can I can assure you as we often do? We'll provide written testimony with all of the detail but I just wanted to sort of give you the2149 message.

We respect what you're2151 doing. We think these two concepts are important to get through and hopefully, this will be the year. There's been a lot of exciting developments in long term care and protections for those in nursing2165 homes generally again led by you and Tom Stanley2169 and we really2171 sit here very appreciative. Of your2175 leadership and support. So hopefully, you'll get it out quickly and more importantly, perhaps it'll land on the respective, you know, chambers floor for final vote. So that's why I'm here today, and I want to thank you for your time. And all the best. Any questions or comments? I'm obviously happy to respond.

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SANDY NOVACK - CONCERNED CITIZEN - HB 655 - HB 626 - SB 375 - SB 115 - Okay. My name is Sandy Novack, and I am test defying in favor of H.655, H.626, S.375 and S.115. I am a Massachusetts licensed independent clinical social worker, with a specialty in aging and disabilities, I am also an active volunteer with Dignity Alliance, Massachusetts. I spent over the last six decades of my life visiting relatives, friends.

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NOVACK - I am a Massachusetts licensed independent clinical social worker with a specialty in aging and disabilities. I am also an active volunteer with Dignity Alliance, Massachusetts. I spent over the last six decades of my life visiting relatives friends and clients in long term care facilities and hospitals. In the last four so years of his life, a friend picked up2295 the conditions of his nursing home and2297 roommates, including flu which led to sepsis, and pneumonia, and then how to go to hospitals for treatment. I once asked a nursing home to move him to a single room his very ill roommate but I was told no he was fine where he was.

He was not fine, And one of the first things my friend would say on my arriving was, could I open the window for him? He needs air? Of course,2326 he needed there to breathe. His nursing home had windows that2330 did not open and had HVAC systems that were old. one of the poorest nursing homes he was sent to, not only left him exposed to the severe illness of his roommate, but they do not have air conditioning for residents in his unit. In the heat of summer, his windows didn't open. He also had no privacy to discuss his confidential health or other matters with me. We need private rooms and nursing homes to end infections from roommates and for privacy in conversations.

And we also need nursing homes to update their old and outdated HVAC systems to truly be a place of hearing and safety. In the nursing home I referred to, the administrative office is sure had air conditioning, so there is no excuse for the residents to be left in suffocating heat during heat waves. And as we were all school during the pandemic, good ventilation can protect from illness too. For human dignity, privacy, and for safety, please vote for H. 655. Meanwhile, if you are living in a nursing home, the personal needs allowance is shamefully low. In seventh grade, I made lifelong friends with a girl named Pam. Years ago, she entered the nursing home.

She used her mobility device once a week to travel a couple of blocks to2421 a retail center where she would buy herself a candy or other minor item, and she felt beside you, this outing and grit and treat how to manage her quality of life in the nursing home? If tomorrow your own life circumstances change and it is just you and your measly $72.80 a month you get in order to pay for a phone so you are not isolated. Buy and mail a birthday card for a relative. Buy a soap that doesn't itch you like maybe the one your nursing home uses. Get a haircut to look presentable and you need new shoes. Well, good luck to you because things are a lot more expensive these days. Than when the $72.80 PNA was set.

And some of you may well outlive your relatives and friends so no one is going to buy you anything. There have been plenty of cost increases for products over the decades. The stake aid legislators raises over the years, and it is long, long overdue that you give now to nursing home residents what they inherently should have in life too, the dignity that has been denied them with the decades old PNA allowance. I ask for $200 per month PNA. If Alaska can give that amount to their nursing home residents, the very least we can do is match it. Elders and younger people with disabilities in nursing homes deserve their dignity and our respect. They2517 voted for you and they depend on you to do this for them. Thank you.

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TOBY UNGER - ATTORNEY GENERAL OFFICE - HB 616 - SB 384 - Yes Chairwoman Jehlen , Chairman Stanley, and members of the joint committee on elder affairs. My name is Toby Unger, and I'm the chief of the Medicaid fraud division in the attorney general's office, and I'm here with Kevin Lownds, who is the deputy chief, of the Medicaid fraud division. I'm here today in support of House Bill 616 and senate Bill 384, an act strengthening the attorney general's tools to protect nursing home residents and other patients from abuse and neglect filed by Representative.

And disabled patients. And number two, it seeks to extend the statute of limitations the time within which we can bring these actions. In April, AG Campbell appeared before this committee to express her commitment to using the full resources of the attorney general's office to promote the safety and security of older residents, and to applaud this committee for prioritizing reforms2643 to systems of care2645 that are so important to our elders and other vulnerable populations.2649 I'm here today to reiterate that commitment and support. Every senior has the right to quality care and every family deserves peace of mind knowing their loved one is safe. The maximum civil penalties for mistreatment, abuse or neglect leading to injury or death in Massachusetts should be increased for three reasons.

Number 1, so that they reflect the severity of the offenses committed. Number two, so the AG's office can hold bad actors accountable. And, number three, so we can send a clear and resounding message to the industry that this conduct won't be tolerated. Look, these cases2691 take a while to put together. Our team has to review patient records,2695 medical staffing and administrative records, sometimes cost reports and financial records. We need to interview, you know, CNAs, nurses, supervisors, managers, family members and medical experts. And sometimes, we even need to review thousands of corporate emails2712 to truly understand the systemic causes of that abuse and neglect.

This is why we propose extending the statute of limitations from two to four years, which would be consistent with our Consumer Protection Act. Look, there are hundreds of nursing homes across Massachusetts, and the staff and leadership of many, and many of these offer quality care and peace of mind to their families. However, systemic issues continue to lead to death and injury of nursing home residents here. In December, we reached the largest settlement with a nursing home chain finding that it admitted residents with histories of substance use disorder, even though it did not have enough trained staff to treat those residents, resulting in many unreported overdoses. Other examples include a patient.

Who died after falling, not once, not twice, but 20 times. The facility did not implement interventions to prevent those falls and did not seek timely medical assistance. Finally, a facility decided at the highest levels, it was just simply too expensive to replace bed rails, which were no longer compliant with federal law, resulting in at least one case of strangulation by bed rail. These cases highlight the types of serious issues that we have found at long term care facilities in the commonwealth. And why we need to make these changes to the law now. I thank Representative Balser and senator Lewis, for their partnership. By enacting these common sense reforms, we can send a clear message about the quality of care we expect for our most vulnerable citizens.

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AYERS - Yeah. Thank you very much for your testimony today, and2844 I would agree that we need to change the statute limitation from two years. That's simply not enough. So in the Commonwealth, I haven't been practicing a contract for a while, but I think the statute limitation might still be six years on a contract. So it's great to move it to four years. Why not 6? I mean, if you and I have a contract together and I'm healthy and capable and something you breach it, then I've got six years. Someone in a nursing home very often most often, they're relying on a family member, a guardian, conservative to look after them. So I would I would be I applaud this this this bill and they would Actually like to see the committee think of raising it to four years instead of six year for six years instead of a four years statue limitation.

UNGER - I mean, the most comparable statutes that we looked at, you know, to

AYERS - In other states.

UNGER - The reason neglect is sort of consumer protection and tort, which are four years. However, I mean, six we would absolutely support extending it to a six year statutory case.

AYERS - This is a cohort of people that that are, you know, that really most of them are disabled. Most of all of them are disabled, and some of them a lot of them have mental disabilities. So yeah. I mean, a lot of states have changed the statute limitation substantially for child sex abuse understanding the problems involved. And so I would urge the committee to consider changing it to six years. Thank you. You're testimony.

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STANLEY - Thank you very much. Nice to nice to see you in the hallway before the before the meeting. How long have you been working on these issues in the attorney general's office?

UNGER - In the attorney general's office, I was here for 10 years. As a line agent in the Medicaid fraud division, and I've been the chief of the division for seven years.

STANLEY - Yeah. So you had a lot to do with a legislation when it was filed under the former attorney general

UNGER - Yes.

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REP CICCOLO - Thank you for your testimony and for your ongoing efforts. I suspect will get the reassurance, but I would like to ask for it. Does extending the time mean that the attorney general's office will then take its sweet time in acting on these things? Or will you continue to be aggressive in dealing with these issues as quickly as possible? Because of course, If they hang out there for longer and longer, that's delayed correction of a problem that might cause harm to more people in the future. So I'd like a little reassurance that just because you get four or six years doesn't mean you're going to wait until the day before that deadline to take action if you're able to move more quickly?

UNGER - Absolutely not. We feel, again, we get we get over 630 referrals in this area every single year, and it weighs on us very heavily to understand that that abuse and neglect has happened and could possibly happen again or maybe continuing to happen. So rest assured that any additional statute of limitations here is not in any way going to delay our attempt to get justice.

CICCOLO - Thank you.

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STANLEY - So I don't 630 sounds like a lot to me. How many of those are you able to look into? All of them are a certain percentage? This is really referrals.

UNGER - How many of them do we investigate?

STANLEY - Yeah.

UNGER - Make 20 to 25 a year. That's it. We have a very thorough and sort of very expert Triage group, and3115 we've been doing this for a long time. But, no, unfortunately, those are the resources we have, and we are able to do, which is 20 to 25, which is much more than most other states are able to.

STANLEY - So if you had greater resources, you you could pursue more of them?

UNGER - Yes.

STANLEY - Okay. Thank you.

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MICHAEL TURPIN - CHARLTON MANOR REST HOME - HB 653 - SB 395 - Good afternoons. Michael Turpin. I'm the owner of the3182 child in a restaurant. It's a 32 bed facility of the child3186 assets. It's over lunch. 30 acres of land. Originally it was a poor farm. Poor farms existed in the Commonwealth before we had wealthy. So it's a very historic, beautiful piece of property. It's a very unique facility in the sense that we take residents in. And they are able to remain with us all the way3207 to the end of life. So they do not have to be transferred to a nursing home. And a former nursing home administrator.

I gave that up a number of years ago to pursue the dream of owning my own business, and I have invested greatly over the last 12 years. In that facility. It is imperative to get proper reimbursement that we need for the residents. We need to actually be reimbursed for what we spend and our actual3235 costs. We take care of the most vulnerable people. I have a number of residents if they were not residing at the child in manner, they would be homeless, whether it be in a shelter, or to be3245 on the street. The amount of people who struggle with mental illness, is extraordinary.

The referrals are received weekly from people quite younger than the average age is alarming. But there's only so many folks you can care for. The rest home industry has been under an awful lot of strain these last three years, as many of you are aware. I'm happy to report most restrooms did very3271 well going through COVID. Myself, we only lost one resident to COVID, which is highly unusual given the fact of an outstanding staff. I believe, holdheartedly, that we have got to pay people appropriately. And by doing so, we need proper reimbursement.3286

The rest home industry Street is a great asset here in the Commonwealth. The fact is if you send a loved one to a rest home, you're gonna save an awful lot of money. Versus a nursing home. Nursing homes are extremely expensive to run with 24 hour staff, 24 hour nursing, the infrastructure, the size, etcetera. Rest homes are home like environments and provide a great deal of dignity, love, compassion, and respect. I would just ask you to strongly support this bill. And if you have any questions, I'd be happy to answer them. And I'd like a shout out to my own state rep miss Ken from Shrewsbury. Thank you.

RONALD PAWELSKI - MASSACHUSETTS ASSOCIATION OF RESIDENTIAL CARE HOMES - HB 653 - SB 395 - Good afternoon. Chair Jim, Jehlen, chair Stanley and members of the joint committee on elder affairs. It's a pleasure to be here today in person to present my public testimony in support of S.395 H.653 an act relative to rest home rate adjustments by senator Moore and representative of Ultrino, respectively. My name is Ronald Joseph Pawelski. President of the Massachusetts association of residential care homes, MARCH. MARCH is the trade association for rest homes in the commonwealth representing for profit not for profit, private, religious order, and multilevel nursing facilities with rest on beds.

Rest homes play an important role on the Massachusetts's healthcare continuum by providing medical management, medication management, psychosocial support and human board to engage it, inform an indigent population. Many of whom were previously homeless. However, since 1998, over 60 % of all rest times in Massachusetts have closed, primarily due to financial reasons, 4000 long term residents have lost their homes and were subjected to the trauma associated with involuntary transfer. Rest homes continue to be financially challenged in caring for predominantly and predominantly indigent population. The reimbursement rates for rest homes have been historically inadequate.

For decades, the allowable costs and formulas established by UHHS and CHIA have not accounted for actual costs and have created massive financial struggles for3436 the industry. Current reimbursement rates based on 2020 costs, do not account for the new operating expenses staffing or new mandates brought on by COVID 19. S 395 H 653 legislation is designed to provide immediate adjustments to current rates to address two key issues. The first, aging in place, and coded impact. As residents age and their acuity levels and care needs increase. Rest homes have hired additional licensed staff, so these residents can remain in their homes. Based on the reimbursement formulas, homes would need to wait over two years to be compensated for these incremental costs.

In battling the pandemic, rest homes faced and are still facing incremental costs relating to staff recruitment, staff retainment, infectious disease control, and PPE that have dramatically impacted their cash flow. Again, rest homes under current regulations would need to wait two plus years to receive adequate compensation. In regard to federal and state mandated compliance as a result of federal and state compliance requirements, including licensure surveys. Rest sums are required to implement plans of correction that span capital expenditures to staffing requirements that can significantly impact operating expenses and cash flow. Again, there is no immediate reimbursement for these expenditures pushing homes closer to the financial edge of viability.

The proposed legislation will provide much needed financial relief addressing these compliance requirements. In summary, the passage of S. 395 H. 653 will result in the following benefits3564 to the rest home industry and the population we serve. Provide for quicker rate adjustments in supporting quality of care and compliance. Enables hiring a more qualified staff as care needs increase for those residents aging in place. And will ease financial burden for homes subject to mandated Department of Public Health Plans of Corrections. On behalf of all rest home owners, executive directors, staff, and the residents that we collectively serve, I act that you support the passage of S. 395, H.653, and thank you for your consideration.

JEHLEN - And thank you all. The question is good. I'm a bridge of the committee. I would just like to ask, could the temper or the influx of funds that you got recent sort of recently last year, last year was helpful, but it isn't the reason you're asking is you want a more consistent pattern of reimbursement based on actual

PAWELSKI - That is absolutely correct. An adequate predictable reimbursement because we are continuing to be based on reimbursing being reimbursed on 2020 costs, we're always two years behind. You know? And the other thing to make mention of, at this particular point, we are still waiting for reimbursement based on the ARPA funding. That has not been3674 distributed as of yet.

JEHLEN - That was that was promised but not distributed.

PAWELSKI - We're we're waiting for ANF and EOHHS to effectively decide the monies that will be distributed. That was the initial $15 million of the $30 million that was approved by the legislature based3700 on the ARPA funding. So at this point, we have not received that.

JEHLEN - And how long is3704 that then?

PAWELSKI - It's been a significant Initially, it was promised for March, and we're still we don't know when at this point. Again, we're very thankful for the support that we have received historically, and it has allowed us to effectively significantly reduce the number of rest homes that have closed in the commonwealth. And effectively, what our one of our mandates is to effectively work with later in the executive branch to ensure no home in the Commonwealth. No additional home in the Commonwealth. Closes purely based on financial reasons.

JEHLEN - And I would just like to add that we lost our for our last rest home in my district, and now we have a new one, so that's good. I mean, that's bad and then good.

PAWELSKI - Yes. You know, and it's also interesting to know

JEHLEN - It's a little sister.

PAWELSKI - Now It’s Now it's VNA And it's also been very interesting to note that a number of the members on the joint committee of elder affairs have rest homes in their respective districts.

So

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KATHY SEAMAN - MOUNT PLEASANT HOME - HB 653 - SB 395 - Good afternoon. Chair Jehlen, Chair Stanley and Members of the Joint Committee on Elder Affairs. My name is Kathy Seaman, and I'm the Executive Director of Mount Pleasant Home, which is a nonprofit rest home in the Jamaica Plains Section of Boston. And on behalf of my 60 residents, 33 staff members and nine-person volunteer board of trustees. I am grateful to present my public testimony in support of S.395, H.653. Mount Pleasant Home was founded in 1901. In our 122-year history, we have housed and cared for over 1000 elderly residents.

Our mission is always to care for the neediest of Boston elders. Rest homes offer an affordable and supportive care environment for elders and those with disabilities who cannot live independently. But do not yet need costly nursing home care nor can they afford the care at assisted living facilities. Rest homes are an absolute gem that must be preserved, but can only survive as long as state funding is made possible to keep up with our actual costs. Our industry has fought for decades now, year after year for the funds to successfully run our homes. I have3890 been employed here for 16 years, and I still have the testimony my predecessor gave back in the nineties and the early two thousands for rate relief.3898

It is absolutely unconscionable that rest homes are allowed to close due to inadequate funding. Decades later still, Holmes like mine who have been in business over 100 years, demonstrating the obvious that this level of care is very much needed and fills the niche between skilled nursing and assisted living. My residents deserve dignity and a safe home with caring and engaged staff. As you all know, COVID has decimated the long term care industry. Staff left the field in droves due to fear, long hours, and stress. Long term care homes were left with hardly enough staff to run our homes. Recruitment and retention are extremely challenging in this area.

We have never had to offer hiring bonuses before, but we must now stay competitive, and we've had to increase the hourly rates for our staff in order to retain them. New COVID mandates3953 have also added to my staff's daily3955 tasks. We have paid countless hours of overtime in infection control and additional staffing in our personal care department in order to keep up with these changes. Current DPH regulations state that we must have a nurse for at least four hours a month. The state must realize that this is3974 an antiquated regulation and no home can run without a full time nurse on premises anymore. Even prior to COVID, our field had changed with the availability of home based support services.

People can stay in their homes longer, which is great. However, when they do come to us a little later in life than decades ago, they come with increased medical issues, complex medication regimes, and needing more oversight, which all adds increased costs. Not only do I employ one nurse full time, but we are finding it necessary to hire an additional nurse to manage these increased complexities of our residents. In closing, we cannot wait two years. Which is how it stands now to be compensated for these changes in our industry. I ask that you support the passage of S.395, H.653, and thank you for your consideration.

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KATHY PAUL - MASS SENIOR ACTION COUNCIL - HB 652 - Good afternoon. My name is Kathleen Paul. I will be 76 years old this year, and I live in Lynn, Massachusetts. I would like to thank you for the opportunity testified. On house bill 652. I speak today as the president of the Massachusetts with senior action counsel. We have a grassroots senior led membership organization with 1000 members statewide. Together, we are well informed and vocal on the issues that impact our lives and communities we are committed to fighting for social justice and a commonwealth.

In which everyone can age with dignity and respect. Chair Stanley, we would like to thank you for filing this bill and bringing the critical need of long term care financing forward. Chair Woman Jehlen we would like to recognize your decade decades of ongoing leadership on this very issue. We live in a state of denial when it comes to long term care. It is very difficult. For most people to accept that there may be a time in our lives that we cannot care for ourselves. Independently, a time that we may need to rely on someone else to assist with our daily activities and needs.

I'm one of them. Before my arthritis really hit me from the back of my head on down, I was jumping around like a happy person. Now I rely on everybody, but I still keep going. Do I add that onto here? Unfortunately, DEN does not change the reality that roughly 70 % of people4277 over the age of 65 will need some type of long term care during their lifetime. Our lifetime. Our denial that we may make here has also caused us to4294 deny that we may need to pay for care. Unfortunately, once again, denial does not change the reality that very few can afford to pay for ongoing long term services and support.

While we may not be ready to accept that we may be among those who will need care. We must accept that we need to build a system to pay for it. Denial is causing unnecessary strain on families often wipes out a lifetime of hard work and deepens existing inequity. We urge action conduct a long term care, actual study so that we end the state of denial. We thank you for your leadership, and we urge your colleagues to join you4356 so that we can fully understand what it would take to build a comprehensive long term care financing system that places equity at the center.

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KAREN LYNCH - MASS SENIOR ACTION COUNCIL - HB 652 - Good afternoon. My name is Karen Lynch, and thank you for having us. I'm also in support of Bill 652. As the population of elders grows, we need to establish a long term solution for now and for the future. We're grateful for the longevity. All of us at senior action, but it also brings the the fact that we have require a lot of assistance as we age, not only to care for the elderly, but also who and where will care for the elderly. What we must consider all that it will4414 take, I think, with the legislature4416 in groups like my senior4419 action to work together to get the funding that will be needed. Thank you.

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ELISSA SHERMAN - LEADINGAGE MASSACHUSETTS - HB 652 - Good afternoon. Chairwoman, Jaylen, Chairman Stanley members of the committee. My name is Elissa Sherman. I'm president of leading age, Massachusetts. We are the only association representing the full continuum of mission driven, not for profit providers of housing and services for older adults in the commonwealth of Massachusetts. Our members serve about 30000 older adults in various contexts and settings, every single day, and we have a vision that all older adults should be able to receive the services that they need when they need them in the place that they call home.

So you heard very eloquently from the panel before us about what some of these the issues are, we know we have a growing aging population with as you heard about 70 % of those turning 65, who will need some form of activities, support with activities of daily living, at some point in their life, and about over 52 % will need significant support with that. And at the same time, a growing number of this population are in what we call the so called middle, middle income middle market. That is that they don't have they have too many resources too much to qualify for Medicaid or subsidized care, but4528 they don't have enough to really pay privately for, for long term services and4534 support needs.

So, they rely on families and family caregivers, many of whom are now, we're seeing a growing number of younger caregivers, millennials, those who are taking4546 care of their own family's children and are stepping outside of the workforce, so4550 it's impacting their own ability to save their future, so not only is this an issue where we're seeing the impact on the current older adult population, but the ability for the next generation of older adults to also save adequately for their future. And over the next decade, at the same time, studied by the University of Illinois showed that many older adults are going to have to be more reliant on paid caregiving.

Since the majority of the unmarried will be unmarried in 2033, and many don't have children living nearby. So, ultimately, many older adults spend down their assets. They in order to qualify for Medicaid, they impoverished themselves, and this is also putting real increasing pressure on the state Medicaid program. So let me just stop, because I realize I didn't even thank Chairman Stanley for filing this important piece of legislation. Which is really important to address, address this topicand4606 also, thank you to chairwoman Jehlen, who has been a leader on this topic Because close to 15 years ago, there was a task force, long term care financing that I know that you championed. We were also on that task force at the time, and

The task force met for 18 months and looked at financing options and actually came out with a very extensive report with recommendations including at looking at state based solutions for social insurance to meet the needs. But unfortunately,4637 that was never acted upon. And now, 13 years later, we just know that the problem has gotten only, only bigger. So, we are, we are really happy about that this legislation is filed, and I'm really pleased to be here with Marc Cohen, who's the co-director of the LTSS Center at UMass Boston, who's going to talk about Why is it important for Massachusetts to begin the work on coming up with a state based solution for long term LTSS financing reform?

MARC COHEN - UMASS BOSTON - HB 652 - Thanks so much for listening. Thank you. Senator Jay Ellen and Representative Stanley for the opportunity to be here. I'm Mark Cohen. I'm a professor at U. Mass Boston. I co lead a research center called the leading LTSS center at UMass Boston. And I'm also the research director at community catalyst, which is a national healthcare advocacy organization. I'm going to move away from my remarks for a second as I listen to in fact, yes, I participated in that task force. I've been in this field for 304698 years. I had founded a risk management company in the private sector and worked with long term care insurance companies and managed care companies for 30 years doing research and services on this.

And sometimes you start to feel like you're Don Kejodis swinging at windmills, but I'm delighted that you have filed the bill and the amendment to try and move us forward. This is an issue that really needs to be resolved, and insurance is actually the best way to do for a lot of reasons, which were brought forward by the previous panel, meaning that a small number of people will have potentially catastrophic expense, many people more than half will have a4742 significant long term service and supports need, and 70 % will have some. So whenever you have this very unequal distribution of risk, insurance is the best solution. This is a risk that's very difficult to plan for and to save for. There's about 15 % of people will end up spending or needing care that will cost more than a quarter million dollars. Okay?

So it's very hard to say for that. And many of us had hoped that the private insurance sector, which has been operating for more than 30 years, would move the needle on this issue. But few but private insurance is now out of the reach of most middle income Americans, in the commonwealth, less than 10 % of individuals over age 50 have policies. So the idea is that we have to find a way to move the system away from a welfare basis meaning Medicaid financed and out of pocket expenses toward an insurance basis. And a social insurance program is precisely what is needed to get that done. And a number of states are actually exploring this right now. Some are further along than others. And the reasons that are motivating these states, and here I'm talking about.

For example, Washington State, California, Minnesota, Illinois, and others is because they're seeing rapid growth and unsustainable growth in their Medicaid budgets. And there's a fear that this growth will crowd out or compete for other priorities in4848 the state, like health care, education, infrastructure, and so4852 on. And, of4854 course, as Alyssa said, middle income elders are having to spend their income and assets, and then making claims on the social safety net. Washington state is the furthest along. They have social insurance program that will be implemented in another year where premiums will be collected, and people will be able to access if they have a long term services and supports needs up to 30 dollars to 6500 dollars in benefits to spend in alternative in alternative settings.

4886 Home4886 care,4886 community based care, and nursing home care. Now Massachusetts has a history of expanding4893 health insurance, and it's logical that we would be leading an healthy assess reform just like we did4899 in health reform. So I want to thank you, Chairman Stanley, for your leadership in filing this legislation to establish the commission. I'll close by pointing out that the bill includes a provision calling for an actuarial study. And this is really important. Because doing such a study by a third party independent contractor or firm provides a factual basis for discussing and evaluating alternative program considerations. All other states that are moving forward on this began with an actuarial study. So I thank you senator Jehlen for filing this amendment.

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JEHLEN - I want to just add that the initial presentation on the denial of aging and then denial of future is critical to the work of this committee is to keep people from imagining that they will never get old and never need help. So thank you for sharing that concern, and a4981 potential solution. Thank you.

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WAYNE SALTSMAN - THE GREATER NEW ENGLAND SOCIETY FOR POST-ACUTE AND LONG-TERM CARE - HB 628 - Good afternoon, co chairs, vice chair, and committee members. My name is doctor Wayne Saltsman and it's a privilege5023 to provide testimony in favor of5025 house bill 628 on certified medical directorship. Please allow me to extend my appreciation to my representative, Kenneth Gordon, for presenting this bill. I have spent the majority of my career as a jury attrition in the post-acute and long term care setting. I currently serve in the boards of the national and greater New England societies for post-acute and long term care medicine.

Both societies and door my testimony today. I am a5050 certified medical director or CMD. Certification Medical Directors sell beyond our state's medical director regulations in establishing clinical leadership and expert care to those5061 who are cared for in skilled nursing facilities. In 1991, the American Board of Postacute and long term care medicine established the certified medical directorship The CMB training program promotes competencies in nursing facility systems integration, regulations, and compliance quality assessment and process improvement, education, communication, and leadership.

There are currently 3500 CMDs in the United States with only 75 in Massachusetts. However, the majority of the 15000 nursing facilities in the United States with 363 in Massachusetts do not have a certified medical director. Clinical leadership, quality oversight, education and advocacy were lacking in nursing homes during COVID 19 pandemic, and people died. In our state, 55 % of the more than 24000 deaths due to COVID 19 have been within nursing homes. Growing evidence shows that a certified medical director presence can be a mitigating factor to these outcomes in fact.

During the height of the pandemic, those Massachusetts nursing facility medical directors most notable5128 for aiding the DPH and or creating innovative measures to improve care quality that no doubt saved lives were certified medical directors. In 2020, as the pandemic unfolded, the California Association for long term care medicine recognized the value of the CMD. Collaborated with its state assembly to present bill AB749, requiring all California nursing facilities over the course of five years. To be clinically led by certified medical directors. In 2021, AB749 passed unanimously and became law House bill 628 is mirrored after AB749.

Committee members, our commonwealth deserves to have the highest caliber of quality care regardless5174 of age, demographic, or5176 social determinants. The nursing home setting requires clinical leadership and expertise in not only managing older adults. But those with physical abilities,5184 complex behavioral health issues for substance use disorders. It is these populations for which a CMD is trained to serve. Learning from the tragedies of the COVID 19 pandemic, it's time for common sense solution based on evidence and experience certified medical directors make a difference in nursing5203 home care. Please support House5205 Bill 628, and thank you.

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JEHLEN - I would like to ask what do the other almost three no, more than 300 nursing facilities have if they don't have a certified medical director.

SALTSMAN - Thank you, Senator, Joan. They have just medical directors, which means that any physician in any specialty according to the state regulations to comply clinical oversight, policy oversight can spend four hours a month. In5260 a nursing facility overseeing clinical here. So the whole idea is just like any other specialty in medicine, go to a cardiologist, you expect to have expert care for your heart. If you go to a nursing facility, you should be provided expert care in the clinical oversight in management and leadership. And so the certified medical directorship and the training program, which is a continuing medical education program, helps to ensure that you have5290 the top people overseeing the clinical care in every nursing facility.

JEHLEN - So let me understand if there are only 75 in Massachusetts, they wouldn't have to be full time. They might be working. You said, four hours a month is what's required?

SALTSMAN - So the state requirement, 105 CMR 150 sub Section five requires that each skilled nursing facility have a medical director, and that medical director needs to spend at least four hours providing clinical oversight as far as a month, providing clinical oversight, review of policies, etcetera. So certified medical directors from5333 training and commitment to skilled nursing facilities spend much, much, much more time than that. So while there are only 75 certified medical directors in the state of Massachusetts. We're saying that for every one of the 363 skilled nursing facilities, each one of them needs not just to have a medical director, but a certified medical director.

JEHLEN - So in your experience, with these 75 How long would it take for enough people to be trained to be I mean, this is a problem across every Position, how long would it take.

SALTSMAN - So that’s why the California AB749 allowed medical directors and facilities currently to have five years to obtain their certified medical director directorship. The certified medical director ship not only counts for time spent as a medical director in the sir in the skilled nursing setting, but also the additional training that is provided by the American board of post acute and long term care medicine, to make sure that to advance medical directors to a certified medical director status. It gives that five years. So the medical directors the folks who are just medical directors in our Massachusetts facilities now would continue on that with the plan that within five years, they become certified directors.

JEHLEN - And how long does it take to become a how much how many hours or months?

SALTSMAN - So Honestly, between the cut the online competency modules and a an in person training, It takes about two years overall. And those are continuing medical education satisfying requirements that that physicians have to do anyway. So it's not like we're ask we're asking people to do extra things. We're asking people to satisfy their continuing medical education requirements and become more competent in this skilled nursing setting.

JEHLEN - Thank you.

AYERS - Oh, thank you, madam chair. I I just listening.5462 I I just reflect on the fact that we have We have a a5468 paucity of gerontologists, gerontology physicians, and I remember was a while ago, one of the one of them stated that what we should probably do is is have all the gerontologists teaching all the PCPs because it's just hope it's hopeless. I mean, we have so few gerontologists.

SALTSMAN - In the country so when I was in training 25 years ago, the thank you, representative, for your comments and your spot on. The I the thought was that by the year 2030, we would need 11500 geriatricians in this country to at least begin to approach the care of the aging population, which as we know, 10000 elder adults a day are reaching age 65. And so 20 % of the population would be older adult by the year 20 0. We'd need 11500 geriatricians just to start. We may have somewhere between 6000 and 6200. So you're preaching to the preacher. It's absolutely true. And this way, with a certified medical director ship, even if someone is not a geriatrician, which is fine to be a medical director, they would still have the increased education so that they would be able to provide for those individuals who are older adults in the skilled nursing setting.

AYERS - Thank you.

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