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CT lawmakers may pass on key elder care reforms this session

Connecticut State Capitol
Wikimedia Commons

Nursing homes, struggling with staffing levels and a recent increase in major violations, became a focal point for reform at the state Capitol this year.

But several ambitious proposals — that would raise the mandated hours for resident care, provide air conditioning in every resident room and boost the number of positions in the long-term care ombudsman’s office — have hit a wall, hampered by the sizable financial commitments needed and stunted by a lack of political will.

The problems come as the state’s population of older adults is set to balloon in the coming years. By 2040, the nation’s 85-and-older population is expected to more than double. Connecticut ranks 4th-highest nationally for its share of people in that age group.

“I hate it, because we’re competing against funding schools, we’re competing against higher education, we’re competing against school lunches,” said Rep. Anne Hughes, D-Easton, a member of the Aging and Human Services committees and a key backer of the elder care bills. “The aging folks in the nursing homes seem to be back of the line all the time. We’re competing against all these other spending issues.”

“These are people’s lives — how they are being treated and taken care of. These problems should not be addressed a year from now. It should be a bigger priority,” said Paola Lopez, whose father is a resident at the Newtown Rehabilitation & Health Care Center, which was cited in January for failing to provide adequate staffing levels to ensure patients receive timely care.

Weeks into the legislative session, lawmakers heard from a stream of residents and their families who complained of subpar staffing levels, neglect, cold food and poor living conditions. Some facility workers said they were stretched so thin they struggled with patient loads and burnout.

Legislators responded by promoting bills aimed at reform and calling for more funding to expand staff in the ombudsman’s office, which advocates for nursing home residents and investigates complaints.

One bill that passed out of the Aging Committee would increase the mandatory minimum hours of direct care per resident per day in nursing homes to 4.1, up from three. The higher mandated hours would be phased in gradually over more than two years, reaching the new threshold in January 2026.

But the substantial funding required and a lack of broad support mean the bill is unlikely to move forward, proponents said recently. A working group will be appointed to study the issue instead.

If the measure were adopted in its current form, the state would have to pay as much as $26.6 million in increased Medicaid reimbursement rates during the 2025 fiscal year; an additional $15.5 million the year after; and an additional $15.4 million in 2027, according to the state’s nonpartisan Office of Fiscal Analysis.

Several key legislators acknowledged the proposal would have a hard time succeeding with such a large financial commitment needed.

“It’s going to be a challenge,” said Sen. John Fonfara, a Hartford Democrat who is co-chair of the Finance, Revenue and Bonding Committee. “I would say there’s probably going to be a remote chance of seeing progress on that in this budget.”

“We don’t have the money for that,” added Sen. Cathy Osten, D-Sprague, co-chair of the Appropriations Committee.

Along with the competing requests for aid, legislative leaders have to be mindful of the state spending cap, which follows a formula to keep overall growth in line with increases in household income or inflation — whichever is larger. The Office of Policy and Management estimates the cap system, which permitted $906 million in growth this fiscal year, would allow $998 million in 2023-24.

Another big issue is difficulty recruiting and retaining workers to staff the nursing homes. Even if funding were available, lawmakers said, there aren’t enough candidates to fill the jobs.

But the shortage of nursing home employees is not new. For years, industry leaders have highlighted the challenges they face in attracting and retaining staff. A similar bill in 2021 raising the mandatory hours to 4.1 was watered down due to cost and ability to recruit workers.

Legislators say the problem must be addressed before increasing staffing mandates, though no proposals this year attempt to specifically tackle the issue of recruiting nursing home workers.

“We have to work on getting more people into the state, because we can’t require an industry to do something they have no capacity to be able to do,” Osten said.

The absence of air conditioning in several nursing homes also became a flashpoint this session.

Legislators heard from advocates about high temperatures in resident rooms — a burden especially for those who are not mobile.

“It is unacceptable to see residents who are ill and unable to get out of bed to get a drink go without air conditioning in the summer,” Mairead Painter, the state’s long-term care ombudsman, said in February. “Then when we go in to respond to the calls for help and investigate these types of issues, we often find management staff in air-conditioned offices while the residents suffer.

“This is not the long-term care system that residents deserve or that we as taxpayers have paid for.”

A bill that would require nursing homes to provide air conditioning in every resident room by Jan. 1, 2026 passed out of the Human Services Committee but has not progressed beyond the Judiciary Committee with just four weeks left in the session. And although it contains a mandate that nursing homes install air conditioning in all resident rooms, there is no financial penalty in the bill for those that fail to do so.

“We could come back in future years and amend that,” Rep. Jillian Gilchrest, a co-chair of the committee, said when the measure was voted on in March. “But at this point, it’s just a requirement that they have it by 2026.”

When the Appropriations Committee released its budget proposal in April, it included just $2 million for air conditioning in nursing homes. Lawmakers acknowledged that the amount set aside wouldn’t go very far in creating a grant program for facilities that want to install air conditioning, but they said negotiations are continuing.

“I don’t know that we’re there on what we’re going to do,” Osten said. “We’ll be in negotiations with the administration.

“I think it’s … [determining] if we’re going to be able to put more money in there. … We have too many requests for me to say what’s going to happen with that.”

Sen. Matthew Lesser, D-Middletown, co-chair of the Human Services Committee, said the $2 million was always intended as a placeholder amount. “I think our expectation is the funding will be substantially in excess of that,” he said.

But legislative leaders so far have been noncommittal. Some suggested the state could pursue bonding to create a larger fund to purchase air conditioning units.

“The air conditioning for nursing homes would be less than what the schools cost,” Osten said, referring to funding recently given to dozens of Connecticut schools for HVAC upgrades. “And then we could say, let’s pay a portion thereof. That’s what we’re looking at now.”

Financial support for the long-term care ombudsman’s office is also up in the air.

This year, Painterasked for enough money to staff 12 positions that will serve Connecticut’s growing home care population. Although her office has hired one person to assess the needs of those residents, there is currently no one fielding complaints or advocating for that population. And so far, Gov. Ned Lamont’s proposed budget only includes enough funding for one more worker.

While several legislators have called for more money to be directed to that office, support for additional positions is murky.

Rep. Michelle Cook, a member of the Human Services Committee, recommended that lawmakers take the $2 million earmarked for air conditioning and instead give it to the ombudsman’s office.

“I’m a huge proponent that nursing home owners should pay for the air conditioning themselves and that the state should not be funding improvements to their buildings,” said Cook, D-Torrington. “They are making so much money, I’d like to see them take some of those profits and spend it on improving residents’ lives.”

Department of Public Health officials say immediate jeopardy orders in nursing homes — findings that indicate violations in a facility caused or were likely to cause harm or death — are on the rise. Five have been issued in the last three months alone.

Part of the ombudsman’s role is investigating complaints that may be referred to the health department.

“If we know we’re still having problems inside nursing homes and we have some bad actors out there, then we need to give the ombudsman more staff to investigate them,” Cook said. “To have an ombudsman’s office with only six or seven staffers and expect them to investigate more than 200 nursing homes makes no sense.”

At least one nursing home proposal appears to be having success this session, however.

A measure that requires greater transparency on nursing home finances cleared the House with overwhelming support and awaits a vote in the Senate. Under the bill, facility managers would have to submit narrative summaries of expenses along with their annual cost reports to the state. They would also have to provide information on any private equity fund that owns part of the homes, including the most recent quarterly statement given to the fund’s investors.

“We know that our seniors are in crisis. We know that our nursing homes, the home care [sector] — every venue is having difficulties,” Rep. Jane Garibay, D-Windsor, a co-chair of the Aging Committee, said during the House vote. “What this [bill] will do is help us understand what is really happening. … Seventy percent of the money that nursing homes receive comes from the state. So we have to make sure we are getting the facts.”

A second, smaller proposal requiring nursing home administrators to notify the ombudsman’s office of a resident’s involuntary transfer or discharge passed the Senate but still must be voted on in the House.

With a month to go in the session, advocates are urging legislators to take action on some of the more substantial bills that would bring systemic change.

“It’s discouraging. If you talk to almost anybody who’s in a nursing home or who has family in a nursing home, you see that staffing is a great problem,” said Jean Mills Aranha, a retired attorney who worked in the elder law unit at Connecticut Legal Services. “There’s a lot of talk about how committed we are to taking care of the most vulnerable people. And yet, when we get these proposals that would actually do something like that, they don’t go anywhere.”

CT Mirror staff writer Keith M. Phaneuf contributed to this story.

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