New Massachusetts Law Seeks to Address Long-Term Care Issues

A sweeping new state law is aimed at addressing persistent challenges at long-term care facilities—including staff turnover and poor infection control.

The set of reforms, signed into law by Gov. Maura Healey (D) in September, includes creating a new fund to support career advancement for long-term care workers, requiring care facilities to submit disease outbreak response plans, and allowing qualified assisted living staff to provide basic health services.

AARP Massachusetts has pushed for such reforms for years, says Jessica Costantino, the organization’s advocacy director.

While the law is now in place, lawmakers and the governor still must fund the changes, Costantino notes. They are expected to do so as part of the annual budget process in the coming months.

“AARP urges legislators to fully fund the programs and services ... so that the safety and well-being of nursing home and other long-term care facility residents are put first,” she says.

Of the numerous reforms in the bill, the efforts to bolster the workforce will probably have the greatest impact, says Marc Cohen, professor of gerontology and co-director of the LeadingAge LTSS Center at the University of Massachusetts Boston. The research center focuses on long-term care services and supports, including workforce issues.

At nursing facilities statewide, an estimated 17 percent of nursing positions, or 4,400 slots, are unfilled, says Tara Gregorio, president of the Massachusetts Senior Care Association, a nonprofit that represents long-term care organizations. Wages have increased in recent years but not enough to keep pace with hospitals, retail and other sectors, Gregorio notes. The result is that nursing facilities periodically decline new admissions, she says.

A 2023 report by the Massachusetts Health and Hospital Association found that statewide there were often more than 1,000 hospital patients who were ready for discharge but “stuck” waiting for space to open up at a skilled nursing facility or other post-acute care setting. Staffing and capacity constraints at post-acute facilities were among the top reasons for delayed discharges reported by hospital case managers.

The law establishes a long-term care workforce and capital fund that will support career advancement, such as covering tuition and other costs, for lower-skilled long-term care workers seeking to become nurses.

It could go a long way toward retaining long-term care workers, but it will probably not help as much with recruiting new workers to the sector because it doesn’t address the issue of low pay, Cohen notes.

Crisis response

The law also seeks to improve how long-term care facilities handle infectious disease outbreaks by requiring them to submit a response plan to the state Department of Public Health and to review it every year.

Plans must include how the facility will isolate residents who are infected or at-risk, meet staffing demands, and notify residents, visitors and staff of an outbreak.

Several other reforms in the law related to care facilities include:

• Allowing qualified assisted living staff to provide basic health services, such as helping a resident take a home diagnostic test, instead of requiring residents to get outside help.
• Strengthening oversight by allowing the state to require a temporary manager for a long-term care facility that doesn’t comply with regulations.
• Streamlining the licensing process for small house nursing homes. These facilities house up to 14 individuals, and studies suggest that they may lead to good clinical outcomes.

Protection for families

The legislation also changes how MassHealth is reimbursed after recipients 55 and older die.

The joint state-federal health care program for low-income residents used to be allowed to recoup from a member’s estate the total cost of health care paid for that individual after he or she turned 55. Under the new law, the program can only seek reimbursement for the cost of long-term care and related hospital and prescription drug services.

The reform is critical to protect family members, often spouses, from losing their homes and to allow them to stay in the community, Costantino says.

Going forward, how effective many of the reforms will be depends on how much money state lawmakers allocate to them, says UMass Boston’s Cohen.

Some changes, such as the requirement for more state inspections of facilities, will be costly, says state Sen. Pat Jehlen (D-Somerville), who is co-chair of the Joint Committee on Elder Affairs and helped craft the long-term care legislation.

But Jehlen also notes opportunities to save money, such as a new requirement for insurers to decide within a day whether to authorize transitions from hospital care to less expensive long-term care or to settings with home- and community-based services.

Jehlen thinks lawmakers will make the investment.

“This is a priority,” she says. ■

Carina Storrs, a New York–based journalist, covers aging, health policy, infectious disease and other issues.

Also of Interest:

• Smart Guide to Aging in Place
• Federal Nursing Home Staffing Standards to Increase Care Hours for Residents
• How to Communicate with Frontline Staff at Your Loved-One's Long-Term Care Facility