Connecticut Latest State to Propose Higher Staffing Ratios, Transparency for SNFs – But Without Funding Support

Following states like Illinois and New York, Connecticut is the latest state to introduce a bill aimed at transforming staffing and requiring transparency changes among area nursing homes.

Proposed changes would apply to the more than 200 nursing homes across the state. One change involves boosting minimum staffing hours from 3 to 4.1 per person each day. Local nursing home advocates shared concerns over the bill’s impact given that it lacks provisions to fund the proposed staffing mandate and other requirements.

Moreover, if operators can’t meet the new mandate, they will incur civil penalties within seven days of the violation, according to the bill. Funds from management fees or money assigned for administrative or general costs must be used to pay these fines.

Connecticut legislators haven’t tied any sort of Medicaid increase to its bill, according to Matt Barrett, president and CEO of the Connecticut Association of Health Care Facilities and the Connecticut Center for Assisted Living (CAHCF/CCAL).

It’s a diversion from how other states are tackling staffing initiatives. The sector may be entering a new era, with payment and performance intertwined, Zimmet Healthcare Services CEO Marc Zimmet said during the annual eCap conference in Miami last week.

This is especially true at the state level, with the future of Medicaid tied to facility performance in multiple states already, including Illinois and Pennsylvania.

The proposed mandate in Connecticut clashes with nursing home staffing shortages felt across the country. In its State of the Nursing Home Sector report, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) found nursing homes experienced the worst job loss of any health care sector during the pandemic.

Between February 2020 and December 2022, the sector lost 210,000 jobs, with the workforce at its lowest since 1994. The association’s report comes on the heels of President Joe Biden’s State of the Union address, which again put the sector in the spotlight, one year after an initial call for reform.

“Similar to concerns being expressed by providers across the nation, an expanded staffing mandate simply will not work because the workers are just not available for hire,” Barrett told Skilled Nursing News. “The staffing shortage is even worse than it was in 2021 when Connecticut’s state legislature directed new state regulations to significantly increase staffing minimums for direct care staff to 3.0 hours per patient per day.”

Today, operators will have challenges even meeting the 3-hour requirement, let alone the 4.1 proposed change, he said, adding that the staffing change is estimated to cost Connecticut facilities an additional $200 million.

“It is imperative that during this time of severe workforce shortages, we prioritize workforce development and adequate Medicaid and Medicare reimbursement,” Mag Morelli, president of LeadingAge Connecticut said in a statement. “This is how we ensure that, as providers, we have the resources available to serve the growing number of older adults who are in need of aging services, support and long-term care.”

The bill would also require operators to be more transparent with their annual spending, submitting narrative summaries of expenditures along with cost reports they already need to send in.

Nursing homes that don’t submit these narrative summaries could be fined as much as $10,000 for each violation, according to bill’s text.

If passed, the state’s social services commissioner would be tasked with posting links to yearly cost reports and easy to understand explanations, complete with comparisons between spending and average reported expenditures by facility.

A glossary and explanation of terms is required in the narrative summaries as well.

There’s a private equity addendum too. If a PE firm owns any portion of a facility, operators must disclose the name of the firm’s investment advisor and copy of its most recent quarterly statement to investors. That includes fees, expenses and performance of the firm.

Other aspects of the bill: facilities are required to provide air conditioning in all resident rooms; notify the state ombudsman when a nursing home plans to involuntarily discharge or transfer a patient; establish a grant program for transportation of non-ambulatory nursing home residents to homes of family members; and, make changes to waiting list requirements for nursing homes.

The state will set up a revolving loan fund to cover the air conditioning expense, according to the bill.