Sen. DiDomenico supports sweeping systemic reforms to long-term care and assisted living facilities

Bill enhances oversight, requires outbreak planning and creates LGBTQ+ Bill of Rights

On July 25, 2024, the Massachusetts Senate approved sweeping reforms to the Commonwealth’s long-term care and assisted living sectors, taking a powerful step towards delivering the high quality and safe care that Massachusetts seniors deserve. Senator Sal DiDomenico supported An Act relative to long term care and assisted living, which substantially strengthens oversight and enforcement while also requiring facilities to create outbreak plans should a health issue arise. The bill also creates an LGBTQ+ Bill of Rights for aging residents to prohibit discrimination based on their LGBTQ+ identity or HIV status. After robust debate, the bill passed, 39-0. Different versions of the bill having been passed by the House and Senate, on July 29, 2024, a conference committee was appointed to reconcile the two versions before sending a bill to the Governor’s desk.

“Our state’s older residents are invaluable members of our community, and it is of the highest importance that we ensure the best quality of life for people living in assisted living facilities,” said Senator DiDomenico. “I am proud to support this legislative package that will move our state forward in helping ensure our long-term care and assisted living facilities are safe and providing quality care throughout the Commonwealth. We are all going to need some form of care when we get older, and it is our obligation in government to guarantee everyone has the right to age with dignity. I want to thank Senate President Spilka, Chair Rodrigues, and Senator Jehlen for shepherding this critical legislation through the Senate.”

The bill includes provisions related to basic health services administered in assisted living facilities and oversight of long-term care facilities, as outlined below.

Assisted living basic health services: The bill makes it easier for residents of nursing homes and long-term care facilities to get timely and efficient care by allowing Assisted Living Residences (ALRs) to offer basic health services, such as helping a resident administer drops, manage their oxygen or take a home diagnostic test. The legislation requires ALRs create service plans that demonstrate the residence has the necessary procedures in place, such as staff training and policies, to ensure safe and effective delivery of basic health services.

The legislation enhances oversight and compliance of ALRs by lowering the threshold for ownership interest disclosure from 25 percent to five percent. Under the new law, applicants are required to demonstrate that any prior multifamily housing, ALR or health care facilities in which they had an interest met all the licensure or certification criteria. If any of these facilities were subject to enforcement action, the applicant must provide evidence that they corrected these deficiencies without revocation of licensure or certification.

This bill also gives the Executive Office of Elder Affairs (EOEA) new powers to penalize noncompliance by allowing them to fine ALRs up to $500 per day. This is in addition to existing EOEA powers to modify, suspend or revoke a certification, or deny a recertification. Finally, it adds whistleblower protections for staff and residents who report anything happening at an ALR that they reasonably believe is a threat to the health or safety of staff or residents.

Long-term care facilities: The bill requires the Department of Public Health (DPH) to inspect each long-term care facility every nine to 15 months to assess quality of services and compliance. It also requires DPH to review the civil litigation history, in addition to the criminal history, of the long-term care facility applicants, including any litigation related to quality of care, patient safety, labor issues or deceptive business practices.

The bill requires DPH to review the financial capacity of an applicant and its history in providing long-term care in Massachusetts and other states. It requires applicants to notify DPH if it is undergoing financial distress, such as filing for bankruptcy, defaulting on a lending agreement or undergoing receivership.

It allows DPH to limit, restrict or revoke a long-term care facility license for cause, such as substantial or sustained failure to provide adequate care, substantial or sustained failure to comply with laws or regulations, or lack of financial capacity to operate a facility. It also gives DPH the power to appoint a temporary manager if a long-term care facility owner fails to maintain substantial or sustained compliance with laws and regulations. This manager would be brought on for at least three months, at the facility owner’s expense, to bring the facility into compliance.

The bill requires long-term care facilities to submit outbreak response plans to DPH with clear protocols for the isolation of residents, lab testing, visitor screening, preventing spread from staff, and the notification of residents, family and staff in the event of a contagious disease outbreak.

The bill prohibits long-term care facilities from discriminating against residents based on LGBTQ+ identity or HIV status, whether through the denial of admission, medical or nonmedical care, access to restrooms or through room assignments. It also requires staff training on preserving LGBTQ+ rights and care.