Massachusetts
Improving Long-Term Care for Seniors in Massachusetts – Center for Retirement Research
In recent years, Massachusetts has taken significant steps to improve care for seniors, most notably the Act to Improve Quality and Oversight of Long-Term Care. In a recent Risking Old Age in America podcast, Rep. Thomas M. Stanley, Co-chair of the Elder Affairs Committee, describes this initiative as well as further steps in the works. These include creating a family caregiver commission, licensing home health agencies, and working towards universal long-term care insurance.
Here are some excerpts from our conversation:
Senior Living Facilities
Risking Old Age in America (ROA): You have been working [to make improvements] across the whole continuum of care from nursing homes [to] assisted living facilities to home healthcare. Please talk about the legislature’s initiatives in these areas.
Rep. Thomas M. Stanley: In 2024, the governor signed the long-term care reform bill into law. This was the first major legislative update of nursing homes and assisted living residences in over 25 years.
It increases transparency and oversight of nursing homes through new suitability standards for owners and operators. It requires a review of the civil and criminal litigation history of owners and operators; and we put in place tools for the Department of Public Health to monitor and take punitive action against facilities, including increased fines and creating the ability to appoint a temporary manager to oversee a struggling facility.
It expands the suitability reviews of management companies including any [firm] with at least a 5-percent stake in a nursing facility. The law also establishes the long-term care workforce and capital fund to help address the workforce crisis in nursing homes. Money from the fund can be used for Certified Nursing Assistant training grants, career ladder grants for Licensed Practical Nurses, and also leadership training.
The law gives assisted living facilities the ability to offer basic health services, like wound care, eye drops, and medication distribution to their residents.
ROA: The Dignity Alliance [a senior advocacy group]…[has said] state supervision and enforcement of nursing facilities is…not tough enough, that there might be fines and other penalties on the books, but nobody’s applying them to nursing homes that don’t meet their obligations. It sounds like the ability to put them into receivership under the new legislation may be the remedy that’s needed.
Stanley: That’s correct. Under the old rules you would end up in the situation of really punishing or fining a nursing home and end up having it going to foreclosure. In that case, where are the residents going to go? The new law allows the Department of Public Health (DPH) to get in earlier and work with them so that they understand what the DPH is looking for in terms of quality of care and so forth. They can take care of the facility and all the residents so they don’t go astray.
ROA: So the DPH might have felt that it was between a rock and a hard place because if they enforced the regulations, they might lose the nursing home.
Stanley: [Yes]…and the nursing homes, by and large, were not letting them know that they were having certain problems. So this allows the DPH to get in earlier, understand what’s going on and help them make adjustments so that they can right the ship.
Long-Term Care Insurance
Stanley: The state of Washington is really in the forefront of looking down the road to provide for some type of revenue stream…for folks to be able to afford their home care or [other] long-term care needs. So we’re modeling our program after theirs and we’re learning from their mistakes and successes.
ROA: That’s the Washington Cares Fund?
Stanley: Yes, exactly. Last session Senator Jehlen and I worked together to get $500,000 in the state budget for the Executive Office of Health and Human Services to hire an independent firm to conduct the actuary study of various public, private and public-private long-term support service financing options. They hired Milliman to conduct the study. [The full study is available here.]
How it would work in a nutshell is that a public…insurance program would be funded via a payroll tax. After individuals pay into the program for a certain number of years, a vesting period, they would become eligible. And as they age and require long-term support services, they can apply for benefits under the program. There are countless ways to design the program, increasing or decreasing the benefit amount or…the vesting period, determining what the benefit can be used for – home care, assisted living or even paying family caregivers. We have filed legislation to establish a commission to discuss the results of the actuary study and the feasibility of a public long-term care financing program in Massachusetts and potentially recommending a model that works.
ROA: It sounds like this would help a lot, but one question I have about it is that if there’s a vesting period where you have to pay in for a number of years before you can become eligible for the benefit, would it only be available for people who are continuing to work during that time?
Stanley: That’s definitely something that has to be discussed by the commission, but everyone has to contribute and the 10-year vesting period is necessary to get enough money into the program to make it sustainable.
Listen to our entire conversation here.
For more from Harry Margolis, check out his Risking Old Age in America blog and podcast. He also answers consumer estate planning questions at AskHarry.info. To stay current on the Squared Away blog, join our free email list.