As reported by The Boston Globe, last month the Massachusetts House of Representatives unanimously passed a bill (H. 4178) to increase MassHealth funding of nursing homes, improve staff training, and increase both oversight and penalties for substandard care. It follows the 2020 release of a report by a legislatively-created Nursing Facility Task Force.
MassHealth by the Numbers
That report has been superseded by the events of the Covid-19 pandemic that proved lethal to many nursing home residents, and its statistics date back to 2018 and 2019, but many of them are quite striking and informative about the nature of long-term care and spending in the Commonwealth. Here are a few of them:
- In 2018, MassHealth spent almost $5 billion on long-term care services and support for Massachusetts residents of all ages.
- Of this, $1.3 billion was spent on nursing homes and $1.9 billion on various types of home and community-based care.
- 39,000 MassHealth beneficiaries were in nursing homes and 267,000 received home and community-based care.
- The number of MassHealth-covered nursing home residents declined 3% from 2016 while the number of home and community-based beneficiaries increased 12%. Both are long-term trends.
- 18 out of the 366 nursing homes in Massachusetts were rated as chronically low quality. They also had consistently low occupancy rates.
The task force released a number of recommendations to “right size” the nursing home industry in the state, establish a higher and less complicated MassHealth rate structure, promote higher quality care, and support the nursing home workforce through higher wages and benefits and increased training.
Bill Provisions and Possible Shortcomings
The House bill incorporates many of these suggestions, including the creation of a Long-Term Care Workforce and Capital Fund to be financed in part through civil penalties paid by nursing facilities for abuse and neglect, which would be increased. It would create a task force to study the fraught status of hospital discharges, including possible changes to the MassHealth eligibility process.
One criticism of the bill by former State Senator Richard Moore on The Globe’s Opinion page is that it does not do enough to address the Department of Public Health’s shortage of experienced inspectors to enforce its quality of care provisions. Further, he says, the bill does not do enough to address staff shortages in nursing homes:
A major deficiency in oversight is the failure to penalize homes that don’t meet the state’s regulation for staffing at a weak ratio of 3.58 hours of care per resident per day. The ratio should be no less than 4.1 hours. All penalties are simply viewed by the industry as the “cost of doing business,” and fail to achieve corrective action. Care staff need a livable wage and should not be responsible for too many residents. That situation makes it hard to hire, and even harder to, retain good caregivers. Understaffing is hard on nursing home residents when there isn’t anyone to help them get to the bathroom in time, to deliver a hot meal that should be hot, to help residents out of bed so they get exercise and avoid bed sores (pressure ulcers).
https://www.bostonglobe.com/2023/11/18/opinion/nursing-home-bill/
The Massachusetts senate needs to improve and then pass this bill. As we’ve discussed before, we have about 10 years to get our elder care act in order to before we are overwhelmed by number of Baby Boomers needing care.