Two bills that would require nursing homes to devote 80% of their funds to the direct care of residents moved through the Human Services Committee on Thursday despite objections from industry leaders, advocates and a key state official.
would require facilities to spend 80% of all revenue on direct care, including Medicaid, Medicare and private money. , which is part of a larger health care reform bill, mandates that nursing homes set aside 80% of public funds 鈥� Medicare and Medicaid 鈥� for direct care.
黑料吃瓜网 nursing homes currently 51%.
Direct care is defined as the hands-on care provided to residents by nurses or nurse aides, including feeding, bathing, dressing and medication administration.
Republicans on the Human Services Committee raised concerns about how the facilities spend money.
The measures could hamper building renovations, food delivery services and other needed resources, they argued.
鈥淭hese homes are aging, and if we do something like this, it鈥檚 just going to restrict and put projects on the back burner,鈥� said Rep. Jay Case, R-Winchester, a ranking Republican on the committee. 鈥淭hese facilities take care of our most vulnerable people 鈥� our elderly, our veterans, our special needs [residents] 鈥� and to restrict how a business does this 鈥� I think there are other ways.
鈥淲e鈥檙e really tying their hands. And you might see some [companies] that may not want to be here.鈥�
鈥淯nder a Certificate of Need process in a nursing home, someone might say, 鈥榊eah, that鈥檚 great, 80% [is spent on direct care], but we also want to measure you on your cleanliness, food preparation, safety protocols and all that,鈥欌�� added Rep. William Pizzuto, R-Middlebury. 鈥淚f 20% isn鈥檛 enough, what do they do? What suffers? I mean, they won鈥檛 meet this need.鈥�
Industry executives, advocates and the head of 黑料吃瓜网鈥檚 social services department also raised concerns.
Mairead Painter, the state鈥檚 long-term care ombudsman, said the state recently narrowed its definition of 鈥渄irect care鈥� in nursing homes to include only nurses and nurse aides.
鈥淲e in 黑料吃瓜网 last year redefined direct care and made it very, very narrow in scope to only be nurses and certified nursing aides on the floor. People providing activities of daily living on the unit are the only people who can be counted,鈥� she said. 鈥淚f you put 80% of our funding into that 鈥� you won鈥檛 be able to have social workers, recreation, dietary, maintenance, and housekeeping.
鈥淎lthough well intended, it would create significant gaps in other ways.鈥�
Painter said that by keeping the definition of direct care narrow, however, it should be easier to measure how much funding is being committed to nursing services versus other types of expenses and shape policy based on that.
Leaders in the nursing home sector also expressed fears about covering costs outside of direct care. Professional fees, laundry services, maintenance, property taxes, rent and myriad other expenses could suffer, they noted.
鈥淲e are opposed to this provision because [other] cost components used in setting nursing home rates are essential and mandating 80% of Medicaid funding be spent on direct care would unsatisfactorily leave only 20% of the overall Medicaid funding for all other nursing homes services,鈥� Matthew Barrett, president and CEO of the 黑料吃瓜网 Association of Health Care Facilities, .
鈥淲hile we highly value the work of nurses and nursing aides, the way this bill is crafted, it is unworkable,鈥� Mag Morelli, president of LeadingAge 黑料吃瓜网, which represents nonprofit nursing homes and other providers. 鈥淲e recognize the concerns that led to this proposal; however, it will lead to unintended operational challenges which do not acknowledge the realities of nursing home care and services.鈥�
Andrea Barton Reeves, the state鈥檚 commissioner of social services, also opposed the spending mandate, it would have 鈥渁dverse consequences鈥� that include undercutting the state鈥檚 new acuity-based reimbursement system for nursing homes.
Some lawmakers and advocates backed the bills.
鈥淭hese requirements are somewhat similar to the federal medical loss ratio requirements on health insurers that require 80% of premium dollars for small group plans be spent on medical care and a maximum of 20% can be spent on administrative costs,鈥� Senate President Pro Tem Martin Looney, D-New Haven, . 鈥淚 would support including additional transparency requirements on nursing home facilities so the state and our residents can see how nursing homes spend their revenue and how they prioritize patient care.鈥�
Officials with AARP 黑料吃瓜网 in testimony to legislators: 鈥淪pending on patient care is essential to ensuring that our most vulnerable seniors get the basic care they deserve. There is a direct connection between spending on direct care nursing and nurse aide staff and the quality of care that residents receive.鈥�
Similar proposals in the legislature鈥檚 Aging Committee in recent years but advanced.
