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Bill addresses staffing, cameras, infection control in nursing homes

A bill before the legislature would make wide-ranging changes to laws around long-term care facilities, such as increasing minimum staffing levels, implementing an essential caregiver program and allowing residents to install cameras in their rooms.

The Public Health Committee on Wednesday heard testimony on S.B. 1030 An Act Concerning Long-Term Care Facilities. It implements some of the recommendations from the Nursing Home and Assisted Living Oversight Work Group, formed last fall to address issues brought to the forefront by the COVID-19 pandemic.

"All of these issues have come to your attention now but are the result of years of paring back in our long-term care communities," State Long-Term Care Ombudsman Mairead Painter said.

The bill would require the state Department of Public Health to establish daily minimum staffing level requirements in nursing homes of at least 4.1 hours of direct care per resident, including 2.81 by a certified nurse's assistant, 0.75 by a registered nurse and 0.54 by a licensed practical nurse. Painter said Connecticut has one of the country's lowest requirements for daily care, at 1.9 hours.

Stephen Wanczyk-Karp, executive director of the state's chapter of the National Association of Social Workers, is particularly interested in the part of the bill that would lower the ratio of beds to social workers.

It's currently 120 to 1, which he said "bears no resemblance to the needs and the care of the residents, and it really leaves the social workers with far too little time to accomplish their work."

Wanczyk-Karp also supports the section requiring the administrator of each long-term care facility to ensure each resident's care plan addresses their potential for isolation and ability to interact with family members and friends, how social and emotional needs will be met, and opportunities for in-person and virtual visitation, and to disclose changes to visitation protocols.

With a translator reading her statement, certified nursing assistant Maribel Sanchez said staffing has always been problematic but it became worse during the pandemic, and it's "very hard to give quality care when we are short-staffed."

Sanchez and certified nursing assistant Gladis Castro — two of many people signed up to testify from the SEIU 1199 union — also noted that infection control training wasn't offered in their language. The bill would require facilities to employ a full-time infection control specialist, and part of their responsibility will be providing written materials in English and Spanish.

Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities/Connecticut Center for Assisted Living, said he is "100% in support of increased staffing" but objected to what he called the "cookie-cutter demarcation" of setting requirements for specific positions.

"We think we need the flexibility" to direct staff in a way that is "directly related to the needs of that facility," he said.

Barrett and DPH acting Commissioner Deidre Gifford both objected to the proposed requirement that there be at least one staff member on shift who is certified to start an intravenous line, with Gifford saying this "may be onerous" and noting that most facilities contract out this service.

But Gifford supports other parts of the bill, such as the requirement of a full-time infection prevention and control specialist in each facility. She said in written testimony that over the past year, DPH has "often found that the individual in charge of infection prevention was handling multiple positions or working part time and was unable to provide the support needed during the COVID-19 pandemic."

Gifford also said DPH is working with the state long-term care ombudsman on developing an essential caregiver program. The bill defines "essential caregiver" as a "person deemed critical, as determined by a long-term care facility, to the daily care and emotional well-being of a resident of the facility."

Public Health Committee member Rep. Kathleen McCarty, R-Waterford, said she is a particularly strong advocate for this provision, as it would provide residents social interaction with families even during shutdowns.

The section of the bill allowing residents to install an electronic monitoring device in their room only pertains to nonverbal residents, and multiple people expressed that they'd like to see it applied to all residents.

While some aspects of the bill pertain solely to nursing homes, others impact a broader definition of long-term care facilities that also include residential care homes, home health agencies, assisted living services agencies and more.

Representatives of the Connecticut Association of Residential Care Homes and the Connecticut Assisted Living Association would like to see their facilities excluded from the bill.

e.moser@theday.com

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