Human Services Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-559

Title:

AN ACT CONCERNING A PILOT PROGRAM FOR SMALL HOUSE NURSING HOMES.

Vote Date:

3/13/2008

Vote Action:

Joint Favorable Substitute Change of Reference to Appropriations

PH Date:

3/4/2008

File No.:

SPONSORS OF BILL:

Human Services Committee

REASONS FOR BILL:

To establish a pilot program to provide grants-in-aid for the development of small house nursing homes in the state.

RESPONSE FROM ADMINISTRATION/AGENCY:

Michael P. Starkowski, Commissioner of the Connecticut Department of Social Services testified: “This bill creates a pilot program for the development of up to ten small house nursing homes. As defined in the bill, a small house nursing home is a home-like facility for the care of no more than 10 residents. In this bill, the Commissioner of Social Services will provide up to 10 grants (unspecified amounts) to be financed with general obligation bonds. Grants would be awarded through a competitive process to be outlined by DSS by no later than October 1, 2008. It should be noted that our current bond fund authority does not reflect these additional capital commitments.

“Developers of small house nursing homes must be providers of long-term care and grants would be awarded with a priority for conversion of existing nursing homes and use of energy efficient technologies. Development of the pilot homes would not be subject to DSS certificate of need processes or criteria.

“Small home like facilities have the potential for providing more personalized care and enhanced quality of life for the elderly and development of such models under a pilot program will allow the state to assess care and cost effectiveness before expanding state-wide.

“My department is interested in exploring this new model of care further with the proponents, although we have concerns over the efficiencies of limiting the maximum number of residents as this does.”

Julia Evans Starr, Executive Director of the Connecticut Commission on Aging testified: “In Connecticut, there are approximately 28,000 older adults and persons with disabilities living in nursing homes. The Long-Term Care Needs Assessment demonstrates that Connecticut is institutionally biased and has a profound need to fully develop and support a home and community based infrastructure. To do so honors the wishes of the vast majority of needs assessment respondents.

“Nonetheless, with the moderately paced rebalancing goals set forth in Connecticut's Long-Term Care Plan, the need for nursing homes in Connecticut is still slated to grow by approximately 25%. (Many would suggest that CT should embrace more aggressive rebalancing goals.)

“With the knowledge that nursing homes will continue to play an important role in long-term care, these facilities, in Connecticut and across the country, are in dire need of culture change. Ground-breaking movements, such as the Green House model, seek to transform the physical structure and culture of care in nursing homes. Presently, nursing homes are designed as institutions – large hospital-like structures geared to a medical model type of provision of care. There is growing recognition that quality of life can be profoundly enhanced when nursing homes become more person-centered, with a smaller, more home-like construct valuing privacy, community, and personal rights, and infused with warmth brought on by such comforts as plants and pets and family-style dining. Additionally, and notably, staff turnover is dramatically reduced in environments that value individualized care.

“Connecticut should further embrace such culture change and provide incentives for the development of small house nursing homes. This quality initiative can help move our state forward in valuing residents, as well as providing a better working environment for staff. This bill is a good beginning toward modernizing nursing home care in our state.”

Nancy Shaffer, State Long-term Care Ombudsman testified: “I'd like to speak directly to Senate Bill 559, AN ACT CONCERNING A PILOT PROGRAM FOR SMALL HOUSE NURSING HOMES. The long-term care ombudsman program is highly supportive of the efforts of health care providers to provide resident-centered care in a home setting.

“This bill is an initial step in that direction. Some states have already created what we've already talked about this morning, the small home nursing homes. We've learned much from their experience. This greenhouse model is one model of a small nursing home. There are long-term care professionals in Connecticut who have formed the Connecticut Culture Change Coalition, and are doing a great deal of education around the concepts and philosophy of culture change.

“I would ask the Legislature to include this group in the development of grant criteria for the proposed 10 grants. Their knowledge and expertise regarding resident-centered care could be quite invaluable to this program. As I've stated at other times, I believe that there are also many opportunities for our state to provide incentives to the current nursing homes, to develop more resident-centered care.

“A small thing, such as a nightlight, rather than an over-bed lighting situation, would be a significant improvement for residents who must be awakened at night for medication or repositioning. Public address systems can be not only harsh and annoying, but also confusing and distracting. They're not conducive to a home-like setting.

The Legislature could think about incentivizing these kinds of simple changes to the environment that would improve the quality of care and become a more resident-centered, home-like environment.”

Wendy Furniss, Branch Chief, Department of Public Health submitted written testimony: “As written, this bill mandates that the small house nursing homw be in compliance with all federal and state requirements, which govern nursing homes. The state would be able to waive certain requirements of the Public Health Code; however, the Department has no waiver authority with regards to the federal Medicare/Medicaid requirements.

“Since the small house nursing homes would be situated in private homes the Department has concerns these facilities would not meet the physical plant and fire safety requirements as specified under the federal regulations. Since these are federal regulations, the Department would be unable to waive the requirements.”

NATURE AND SOURCES OF SUPPORT:

Mag Morelli, President of the Connecticut Association of Not-for-profit Providers For the Aging testified: “CANPFA supports this bill which is a laudable step towards shaping the future of nursing home care in Connecticut.

“This bill looks beyond the current nursing home moratorium to propose a pilot of new programs and buildings similar to what is commonly known as the Green House project, a system of small self-contained residences each serving as home for ten residents and providing nursing home level of care.

“The Green House project is in the forefront of the nursing home culture change movement. Culture change moves nursing homes towards a resident-centered structure of care with a goal of resembling home in every way. In small houses and other nursing homes that have adopted culture change, outcomes show that residents are more satisfied, families are more involved, and staff appear more satisfied and committed.

“This bill recognizes the fact that the nursing home infrastructure in Connecticut is dated and aging. It is time for the state to consider a process of renovation and rebuilding, and this idea of encouraging the small house model and emphasizing energy efficiency is an excellent start.

“We are concerned, though, that these ten new pilot nursing home facilities would not only be exempt from the moratorium, but they would also be exempt from any certificate of need process. Instead of a certificate of need, the bill grants the Commissioner authority to develop guidelines and criteria for the grants.

While we support this proposal, we would ask that the additional conditions be placed on the grant process to require an assessment of need and a process to consider the concerns of established nursing home providers in the service area.”

Julia Brown, Elder Law Attorney testified: “SB 559, which proposes establishing a pilot program to provide grants-in-aid for the development of small house nursing homes in the state is an important step for Connecticut to be taking. We are far behind other states in changing our mode of delivering services to our elders. This type of change in delivery of services must be embraced and pushed forward if we are not to continue to be ashamed of how we treat our frailest and most vulnerable citizens.”

Andrew H. Banoff, President & CEO of The Jewish Home for the Elderly testified: “Thank you for allowing me to testify in support of Senate Bill 559, An Act Concerning a Pilot Program for Small House Nursing Homes.

“I believe that enactment of this Bill is consistent with the State's Long-Term Care Plan, the Long-Term Care Needs Assessment, and our collective goal to improve nursing homes for our elders.

“As I am sure the Members of the Committee are aware, Connecticut's long-term care system is facing significant challenges. According to U.S. Census projections, the number of people over the age of 65 in the State of Connecticut will increase by 50% over the next 20 years. As this population becomes frail with age, there could be an overwhelming burden to the State's Medicaid system, which currently absorbs over half of all the long-term care expenses incurred in Connecticut. The bulk of these State and Federal expenditures are due to nursing home utilization, which is troublesome given that most elderly people would prefer to age in their homes or in less restrictive, less expensive settings. The upcoming baby-boomer generation of seniors is going to be significantly less willing to tolerate institutional care as they become disabled with age, and the current infrastructure for home and community-based care is simply not going to be enough to meet their needs.

“In response to the changing long-term care environment, The Jewish Home for the Elderly, a 360-bed Skilled Nursing Facility in Fairfield, CT, is planning the development of a new Senior Living Campus in Monroe, CT. The site is approximately six (6) miles from our current location in Fairfield. It is large enough to allow for the development of Independent and Assisted Living and a replacement of our current Skilled Nursing facility in Fairfield, CT in such a way as to establish a life enhancing and a quality of life environment for the elderly that would be a model of a truly integrated senior living community for the State and our region.  The new SNF facility could be one of the proposed new “Small House” models – to allow the State to move the industry forward consistent with research being done in other States and the Robert Wood Johnson Foundation “Green House” model.

“As the proposed Senior Living Campus will enhance quality and access to long-term care in the area, I am supporting immediate enactment of Senate Bill 559. I believe that these specifications will enable the State to remain in control of local bed availability, while also promoting more cost-effective forms of long-term care that will make the system as a whole more sustainable in years to come.

“Once implemented, we will work closely with the Department of Social Services to submit an application and, of course, the Department has the administrative authority to ensure implementation consistent with this rationale.”

Bunny Kasper testified: “As a dedicated Jewish Home Volunteer who is unrelenting in my quest for quality of care, as a family member until just recently, to one of its Residents, and as a former patient, I recommend immediate approval of Senate Bill 559, An Act Concerning a Pilot Program for Small House Nursing Homes. Allowing The Jewish Home for the Elderly to relocate their outdated nursing home to the same property as the Independent Living and Assisted Living components of the Senior Living Campus is crucial to the conceptual model of the Continuing Care Retirement Community, and key to the cost savings that will allow us to make this amazing facility a reality.

“And, as a resident in the State of Connecticut, I recommend the immediate approval of Senate Bill 559, An Act Concerning a Pilot Program for Small House Nursing Homes, so we can begin to pioneer a much needed culture change in Nursing Home care that will be historic in its positive effects on both residents and their families.

“Not approving this initiative will be a vote against the progress Connecticut has made over the past 10 years in decreasing the amount of long-term care that is delivered in an institutional setting and increasing choice in aging services available in the system. I look forward to working with The Jewish Home for the Elderly to do whatever I can to make this project come to fruition.”

See also: RESPONSE FROM ADMINISTRATION/AGENCY:

Michael P. Starkowski, Commissioner of the Connecticut Department of Social Services

Julia Evans Starr, Executive Director of the Connecticut Commission on Aging

Nancy Shaffer, State Long-term Care Ombudsman

Also submitting written testimony:

Christy Kovel, Senior Director of Public Policy and Communications, Alzheimer's Association

NATURE AND SOURCES OF OPPOSITION:

See: RESPONSE FROM ADMINISTRATION/AGENCY:

Wendy Furniss, Branch Chief, Department of Public Health

Reported by: Heather Dorsey, Assistant Clerk
Jeanie B. Phillips, Clerk

Date: March 17, 2008