Home care and nursing home industry leaders expressed cautious support Tuesday for a sweeping bill that would overhaul aspects of the state’s elder care sector, including more oversight of home care workers and swifter access to Medicaid, though a section transferring investigations of nursing homes from the public health department to the social services department became a flashpoint.
The measure, introduced by House Speaker Matthew Ritter and leaders of the Aging Committee, would make several changes to Connecticut’s sprawling home care industry, including creating an online registry of employees, requiring companies to send clients photo identification of workers, launching a presumptive eligibility program for people who need to access Medicaid quickly and want care at home, and expanding the long-term care ombudsman’s office.
There is also a controversial provision to move nursing home oversight and investigations from the state’s health department to the social services department. Licensure of facilities would remain with the health department.
Commissioners from both offices opposed the change.
“This proposal would create more problems and more delays rather than solve the ones we have,” said Dr. Manisha Juthani, the state’s public health commissioner.
“You cannot extricate complaint investigations from the body of work [at the health department], especially when you have a staff that require six months of training. That training is done by experienced staff within DPH who are already doing this type of survey work and complaint work, which is intertwined.
The social services department “does not have the management expertise and staff to supervise and oversee this group of people that has been specially trained to do this type of work.”
Juthani said the state receives about $10 million from the federal government that could be in jeopardy if investigative responsibilities are removed from DPH.
Andrea Barton Reeves, commissioner of social services, also spoke out against the shift.
“We support keeping the complaints and oversight at the Department of Public Health and leaving DSS to the work that we do well,” she said. The social services department handles Medicaid payments to nursing homes, which covers more than 70% of nursing home care in Connecticut.
Aging Committee members questioned Juthani about a backlog in inspections related to nursing home complaints. The commissioner acknowledged her department had a backlog of about 2,000 complaint inspections but said serious complaints, such as abuse and neglect, continue to be prioritized.
The department is still recovering from the pandemic, when survey inspections were delayed, and from employee turnover that at one point caused surveyor staff to drop by 40%, she said. The department has been “aggressively recruiting” people, she said, and the vacancy rate recently fell to 14%.
But the number of complaints has also increased in recent years.
“Every day we go and do more [complaint investigations], but we also get 75 complaints every month. So, we get ahead, but then we also get more,” Juthani said.
Sen. Lisa Seminara, R-Avon, expressed alarm at the volume of nursing home complaints each month.
“It is concerning to me that we are still receiving 75 complaints, on average, per month,” she said. “Not only do we have a backlog that we have to address, but obviously things are not working correctly. Otherwise, your department would not be getting 75 complaints a month.”
Juthani said the high number of complaints points to the need for reform in the sector, including the changes proposed in Ritter’s bill and another wide-ranging proposal introduced by Gov. Ned Lamont that takes aim primarily at nursing home operations.
Home care agency leaders expressed support for the bill Tuesday, though some raised concerns about unintended consequences.
Marlene Chickerella, chairwoman of the Home Care Association of America Connecticut chapter, said she is in favor of home care workers wearing photo identification but called a requirement to send clients an employee’s picture 24 hours before an appointment “onerous” and “impractical.”
“Our members make every effort to be transparent and try to prevent identity theft while protecting the safety of caregivers and clients,” she said. “However, the one-day notice requirement to send a photo to the client is unreasonable … given the nature of the home care industry, particularly if a caregiver needs to be placed immediately in the home. Clients typically call home care agencies to add visits on the same day or next day.”
Chickerella said she does not oppose the registry of home care workers for clients in Medicaid programs, but she questioned who would pay for it and how it would be maintained.
“The current Medicaid program registry of home care workers is often out of date,” she noted.
Clients have reported receiving paper binders with workers’ names that are not updated. The state has proposed an online registry that would be managed through the social services department.
Tracy Wodatch, president and CEO of the Connecticut Association for Health Care at Home, said she favors sections of the bill that deal with presumptive eligibility for Medicaid and expansion of fingerprinting locations for workers undergoing background checks.
But she shared concerns about the worker registry only being available to people receiving Medicaid, when “many [services] are paid by other insurances as well as privately.”
“Once again, we caution the legislature that our agencies have been providing these home-based services with flat Medicaid rates year after year,” she said.
Wodatch also worried about how agencies would comply with the requirement to send clients photo identification of workers in advance.
“Many agencies will need to invest in technology solutions to sufficiently comply, so additional funding will be needed,” she said. “Furthermore, there are logistical concerns about compliance. Notifying a client of a change in scheduled staff already occurs, but sending a photo for said change at least 24 hours prior to a scheduled visit would be an administrative nightmare. I could cite many examples of last-minute changes that would not be able to meet this suggested mandate.”
The bill would also provide greater transparency of nursing home care and operations by requiring the state to contract with a firm specializing in data analysis and reviewing data “to determine if skilled nursing facilities are staffing to the acuity needs” of residents. The health and social services departments would have to post prominently on their websites tools for comparing the quality of nursing homes.
Mag Morelli, president of LeadingAge Connecticut, which represents 35 nonprofit nursing homes, said she backs the effort for increased transparency.
“While there is a plethora of nursing home information available to the public, it is not always easy to access,” she said. “Consumers are often faced with the challenge of choosing a nursing home under sudden and difficult circumstances. This effort to make the process easier is worthy of support.”
Morelli expressed similar concerns about home care agencies sending workers’ pictures in advance.
“While understanding the desire to let the consumer know in advance who will provide care in their home, we suggest more thought be given to situations in which the client is unable to receive the prior identification in a timely manner due to unforeseen circumstances,” she said.
Several advocates and nursing home residents praised the bill.
John Balisciano, president of the resident council at Apple Rehab Hewitt in Shelton, said the measure is vital for improving quality of care and giving people in nursing facilities a stronger voice — especially the plan to expand the ombudsman’s office.
“With enough staff, the program can continue to assist us not only individually but also in a collective effort to influence systemic changes,” he said. “This expansion ensures that every resident has support they need to raise their voice and that we all can continue to benefit from the advocacy and guidance the ombudsman program provides.”
The measure would authorize four additional positions for the long-term care ombudsman’s office — two for facility settings like nursing homes and two for the community ombudsman program that would serve the home care population. It would set aside $20,000 for a new data system to support the community program.
Mairead Painter, the state’s long-term care ombudsman, said the measure “introduces critical reforms” to improve quality of life in nursing homes and home care services.
“This legislation represents a significant step forward in ensuring that our most vulnerable citizens receive the care and respect they deserve,” she said.
Sen. Kevin Kelly, R-Stratford, an elder law attorney, said he would work with his colleagues in the legislature to ensure the bill’s advancement.
“Aging is not a Republican or a Democratic issue, it’s a human issue,” he said. “Overwhelmingly, people want to age in place at home and not go into a nursing home, and this bill would not only help people do that but also expands the oversight into home health care.”
