Outline of the state of Connecticut

A bill before the Connecticut Legislature overreaches the licensing scope of assisted living communities by extending regulatory requirements aimed at healthcare settings, according to state senior living associations.

Senate Bill 1030: An Act Concerning Long-Term Care Facilities was drafted in part based on recommendations from the state’s Nursing Home and Assisted Living Oversight Working Group. The work group was formed to address lessons learned from the pandemic in long-term care and was based on findings in a report from Princeton, NJ-based Mathematica Policy Research

The proposed bill would require assisted living communities, residential care homes, intermediate care facilities and nursing homes to adopt “unreasonable and costly” measures that go beyond the scope of an assisted living service agency’s license, according to Chris Carter, president of the Connecticut Assisted Living Association, an Argentum state affiliate.

The legislation would require assisted living communities and other applicable settings to establish essential caregiver programs and hire full-time staff members to address infection prevention and control measures. The bill also would require communities to employ a staff member during every shift who is trained on how to start an intravenous line, and it would impose statutory requirements for quarterly N95 mask-fittings and require the establishment of an infection prevention committee.

“The proposed bill overreaches by extending regulatory requirements aimed at healthcare settings, such as a full-time infection preventionist and RN training requirements,” Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities / Connecticut Center for Assisted Living, told McKnight’s Senior Living. The association is a state partner of the American Health Care Association / National Center for Assisted Living.

The bill also would require each assisted living community and other covered setting to establish a family council with the goal of improving communication between residents, families and staff members, and it would require devices designed to make it easier for residents to communicate with their loved ones. 

In testimony Wednesday before the Connecticut Public Health Committee, Carter said that CALA supports many of the concepts, adding that the nature, structure and model of how care and services are provided in assisted living settings “have contributed significantly to much lower incidence of resident and staff infection and death stemming from the COVID-19 virus.”

But assisted living communities, which are prohibited from providing skilled nursing care, differ from nursing homes, he cautioned in the hearing. As nonmedical settings, Carter said, infection prevention requirements are not required in assisted living, which he argues should not fall under the definition of a long-term care facility in the bill.

As a result of those differences, Carter testified that many of the bill’s mandates not only are “unreasonable and costly” but they also go beyond the scope of an assisted living service agency’s license.

“Connecticut’s assisted living model is structured as a residential platform, governed by landlord-tenant law,” Carter testified. “While assisted living is licensed to provide assistance with activities of daily living, the licensing strictly prohibits the provision of skilled nursing care.”

The requirement for a full-time infection preventionist, Barrett added, should provide flexibility for smaller nursing homes. But assisted living communities and residential care homes should be removed altogether from the proposal, he added.

Carter said that the state’s assisted living model allows for the provision of assisted living services in a wide range of settings, including state-funded congregate housing, Department of Housing and Urban Development-financed low- and moderate-income senior housing, state pilot and demonstration program sites, market-rate assisted living, memory care-specific settings, and continuing care retirement / life plan communities. 

Rhonda Boisvert, president of the Connecticut Association of Residential Care Homes, testified that Senate Bill 1030 “tries to take a one-size-fits-all approach to long-term care” and would change the current residential care home model. She shared many of the same concerns raised by Carter about the requirements going beyond the scope of licensure and that they would exacerbate already difficult staffing challenges.

“It is very challenging to hire anyone when we can’t compete with other long-term care providers, or even, frankly, big-box stores or the fast food industry,” Boisvert said regarding staffing requirements for infection prevention and control and intravenous line insertion. 

The bill also would require the state Department of Public Health to maintain a three-month stockpile of personal protective equipment and would require every administrator and supervisor of a long-term care facility to complete the Nursing Home Infection Preventionist Training course from the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services.

The bill contains additional language regarding placement of electronic monitoring devices in the rooms of nonverbal residents of nursing homes.