Public Health Committee
JOINT FAVORABLE REPORT
Bill No.: SB-1030
Title: AN ACT CONCERNING LONG-TERM CARE FACILITIES.
Vote Date: 3/26/2021
Vote Action: Joint Favorable Substitute
PH Date: 3/17/2021
File No.: 457
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
Public Health Committee
REASONS FOR BILL:
This bill makes various changes related to long-term care facilities and the delivery of long-
term care services. Principally, it:
requires long-term care facilities to employ a full-time infection and prevention control
specialist ( 1);
requires a facilitys administrative head to participate in developing the local
emergency operations plan of the municipality where the facility is located, which plan
is required under the Intrastate Mutual Aid Compact ( 2);
requires, within six months after the governor terminates a declared public health
emergency, (a) DPH to maintain at least a three-month supply of personal protective
equipment (PPE) for long-term care facilities and (b) facilities administrative heads to
ensure they acquire the supply from DPH and maintain it for their staff ( 3);
requires a facilitys administrative head to ensure that there is at least one staff
member during each shift who is licensed and certified to start an intravenous line (
4);
generally requires a facilitys infection prevention and control committee to meet at
least monthly, and during an infectious disease outbreak, daily ( 5);
requires every facilitys administrator and supervisor, by January 1, 2022, to complete
the Nursing Home Infection Preventionist Training Course produced by the CDC, in
collaboration with the Centers for Medicare and Medicaid Services ( 6);
requires facilities to test staff and residents for an infectious disease during an
outbreak at an appropriate frequency determined by DPH ( 7);
 requires a facilitys administrative head, by January 1, 2022, to facilitate the
establishment of a family council to encourage and support open communication
between the facility and residents families and friends ( 8);
requires facilities, by January 1, 2022, to take certain actions to ensure residents have
regular opportunities for in-person and virtual visitation with family members and
friends and that their social and emotional needs are met ( 9);
requires DPH, by January 1, 2022, to establish an essential caregiver program for
long term care facilities to implement ( 10);
requires the states Public Health Preparedness Advisory Committee, by October 1,
2021, to amend the plan for emergency responses to public health emergencies to
include responses in relation to long-term care facilities and providers of community-
based services to facility residents ( 11);
starting July 1, 2021, requires facilities to allow residents to use communication
devices in their rooms (e.g., phones and tablets) to remain connected with family and
friends and facilitate the participation of their family caregivers in their care team (
12);
requires DPH, by January 1, 2022, to modify minimum nursing home daily staffing
levels to require at least 4.10 hours of direct care per resident, including 3.75 hours of
care by a registered nurse, 0.54 hours of care by a licensed practical nurse, and 2.81
hours of care by a certified nurses assistant ( 13);
allows a non-verbal nursing home resident, or his or her resident representative, to
install an electronic monitoring device in the residents room or private living unit
under certain conditions ( 14).
Under the bill, a long-term care facility includes a nursing home, assisted living facility,
residential care home, home health agency, chronic disease hospital, hospice, and
intermediate care facility for individuals with intellectual disability, except those operated by a
DDS program subject to background checks under existing law.
RESPONSE FROM ADMINISTRATION/AGENCY:
The Connecticut Department of Public Health:
The Department of Public Health (DPH) offers information regarding this bill. The DPH served
on the Nursing Home and Assisted Living Oversight Working Group, which was jointly led by
members of the General Assembly and representatives of the Department of Public Health,
the Department of Social Services, and the Office of Policy and Management.
As stated in the testimony, Section 1 defines a long-term care facility as a nursing home
(NH), residential care home (RCH), home health agency (HHA), assisted living services
agency (ALSA), intermediate care facility for individuals with intellectual disabilities (ICF/IID),
chronic disease hospital, or hospice agency for the purposes of Sections 2-12 of the bill."
Since ICF/IID facilities are licensed by the Department of Developmental Services (DDS),
DPH would defer to DDS for comments regarding such facilities. Section 2 requires the
administrative head of each long-term care facility to participate in the development of the
emergency plan of operations of the Intrastate Mutual Aid Compact pursuant to C.G.S.
Section 28-22a. The Department stated its support of the concept outlined in this section and
"requests further discussion with the proponents of the bill and the Department of Emergency
Page 2 of 8 SB-1030
Services and Public Protection to determine the best approach for long-term care facilities to
be involved in emergency response planning." Additionally, in the testimony, DPH provides
recommendations to Section 3, specifically regarding personal protective equipment (PPE): "
The Department agrees that a comprehensive strategy needs to be in place during
extraordinary circumstances such as the COVID-19 pandemic. However, the Department
does not think that legislation is needed; often such a statute may diminish our ability to be
flexible in responding to an emergency that is ever evolving." DPH supports Sections 4-5.
The Department recommends language for Section 6, "that would require a nursing home
administrator to have a minimum of four contact hours of continuing education on infection
control and the prevention of infections associated with antimicrobial use, including
antimicrobial resistant infections within subsection (b) of C.G.S. Section 19a-515. These
CEUs would allow the administrator to continually train on the best practices for infection
prevention and control.
For Section 7, DPH recommends not moving forward with this section of the bill because the
Department already provides guidance to long-term care facilities that reflects the
recommendations supported by the CDC. DPH supports Sections 8-11. The Department
respectfully requests that, within Section 12, the timeline to develop policies regarding the
use of communication devices be extended until December 2021.
Lastly, regarding Section 13, the DPH recommends "all facilities have adequate staffing with
the appropriate competencies and skill sets to provide nursing and related services, based on
a facility assessment, to assure resident safety and attain or maintain the highest practicable
level of physical, mental, and psychosocial well-being of each resident."
NATURE AND SOURCES OF SUPPORT:
AARP Connecticut:
AARP Connecticut offers strong support for this bill. AARP is a nonpartisan, social mission
organization that advocates for individuals age 50 and older. The organization has a
membership of 38 million nationwide and nearly 600,000 in Connecticut. As stated in the
testimony, "S.B. 1030 addresses several key issues related to nursing homes that emerged
or were exposed during the pandemic, including: deficiencies in infection control, a lack of
adequate emergency planning, social isolation and restricted visitation, and staffing levels."
AARP Connecticut also includes recommendations to the bill.
Sharia Ann Ashmeade, CNA:
Sharia Ann Ashmeade, CNA at Regal Care of New Haven, offers support for this bill. Ms.
Ashmeade has worked as a healthcare worker at Regal Care for seven years. She believes it
is important to pass this legislation as it will bring much needed improvements to the Nursing
Home industry so that residents can receive proper care. As stated in her testimony, "[e]ven
though I love my job, what frustrates me is that we work in an environment where risking our
lives to do something we love is often unappreciated With proper staffing we will be able to
spend more time caring for each resident according to their need. It will help to offer our
resident with better quality of life." Ms. Ashmeade offers two recommendations to the
proposed legislation. As stated in the testimony, twelve-hour shifts will not solve staffing
problems. She recommends not changing the shifts to twelve hours as it "will demoralize the
Page 3 of 8 SB-1030
workforce even more." Additionally, she recommends changing penalties for not giving
access to PPEs to workers. She writes, "[w]e need strong penalties so that when
management withholds employee access there are repercussions."
Rob Baril, President, SEIU District 1199NE:
Rob Baril, President of SEIU District 1199NE, offers support to the proposed bill with
recommendations.
The recommendations are as follows:
Section 1: Add language requiring the Infection Prevention and Control Specialist to
file Infection Control reports monthly to the Department of Public Health.
Section (b)(1): Add language to say, and other languages where there is a significant
population of workers who speak that language.
Section 3:
o The length of time that should be covered should be changed to six months
o Add worker access language as well as language that would establish penalties
for administrators that withhold access to PPE from workers.
Section 4: Add a subsection requiring that the Nursing Home must pay for the worker
to get certified in this, and that it must be an allowable cost under Medicaid.
Section 5:
o Define who makes up the Committee and make sure that there is direct care
worker, non-direct care worker, management, non-management and Union
input (at the homes that are Union) on the Committee.
o Add language that would require Committee notes to be kept for a specific
amount of time at the home or filed with the State and made a part of the survey
notes.
Section 7: Add Once a month, or more frequently as determined by DPH. to line 84.
Section 8: Add Family Council reports that are either kept for a specific period of time
on the premises at the Home or filed with the Ombudsmans Office.
Section 9:
o Add a subsection making this training an allowable cost under Medicaid
Section 11: Include the Union on this Committee
Section 13:
o Change staffing levels to equal 4.1. RNs should be .54, LPNs should be .75,
CNAs stay at 2.81
o Change lower to raise in line 168
o 1 Social Worker for 75 residents
o 1 Recreational Aide for 25 residents
Section 13(C): District 1199 opposes this language in its entirety.
Connecticut Legal Rights Project, Inc.:
The Connecticut Legal Rights Project (CLRP), a statewide non-profit agency that provides
legal services to low income adults with serious mental health conditions, offers support for
this bill with a recommendation. CLRP believes this legislation is necessary because the
pandemic has had a devasting impact on the residents of long-term care facilities in
Connecticut. CLRP recommends adding that the state should ensure all LTC residents
receive counseling on their options to receive services in the community and support those
who want to return to the community.
Page 4 of 8 SB-1030
Tracy Nicolo, CNA:
Tracy Nicolo, CAN at Foxhill Center, offers support for the proposed bill with
recommendations. Ms. Nicolo states, "[w]hile I do love my job, it can be very frustrating
dealing with low staffing, a lack of PPE, and poor training. Ms. Nicolo expresses that there is
a direct connection between staffing levels and the quality of care residents receive.
Additionally, another stressor is the inadequate supply of PPE. As mentioned, My
coworkers and I were told to reuse PPE that was intended for single use, we had PPE hidden
from us, or locked away. All the while we were told we must risk our lives and our families
lives by coming to work during a pandemic. There has also not been enough training on
infection control, especially training provide in a language other than English. Ms. Nicolo
respectfully request the bill is passed with these issues in mind.
National Association of Social Workers, Connecticut Chapter (NASW/CT):
The Association of Social Workers, Connecticut chapter, representing over 2,300 members,
supports S.B. 1030. As stated in the testimony, Section 13 (b) (2) is of particular importance
as it requires the Commissioner of Public Health to determine a bed to social worker ratio that
is less than the current ratio of 120 beds to 1 full-time social worker. This ratio, which has
been in existence for over 30 years, has no resemblance to a reasonable ratio. Outlined in
the testimony, social workers have a sole professional role in the home responsible for the
psycho-social needs of residents.
The Association recognizes and thanks the Long-Term Care Oversight Group for their
recommendation to reduce the current bed to worker ratio. NASW/CT looks forward to
working with the Commissioner of Public Health in determining a social worker to beds ratio
that is based on best practices. NASW/CT also offers support for Section 8 of this bill that
requires each facility to have a family council. This will greatly assist families in
organizationally addressing concerns regarding care and policies and will offer mutual
support to families. Lastly, NASW/CT supports Section 9 that addresses making sure the
resident care plan meets the social and emotional needs of individual residents.
NATURE AND SOURCES OF OPPOSITION:
Rhonda Boisvert, President, Connecticut Association of Residential Care Homes:
Rhonda Boisvert, the President of the Connecticut Association of Residential Care Homes,
offers concerns to the passage of this legislation. Connecticut Association of Residential Care
Homes is the trade organization for the approximately 100 residential care homes in the
state. As stated in the testimony, Senate Bill 1030 tries to take a one size fits all approach to
long-term care. By doing so, the requirements to residential care homes would frankly
change the current residential care home model. We are also concerned that such sweeping
legislation would be proposed coming from the Nursing Home and Assisted Living Workgroup
without our inclusion as an Association or individual homes.
The concerns of the Association per Section are as follow:
Section 3 requires at least a three-month supply of personal protective equipment for
its staff. This would be cost prohibitive for homes unless the Department of Public
Health was supplying such PPE at no cost to the homes.
Section 4 requires a certified or licensed staff member to start an intravenous line.
Most of the Associations homes have no such licensed staff and hiring any staff is a
problem.
Page 5 of 8 SB-1030
 Section 5 goes on to require a full-time infection prevention and control committee.
The Association believes that requiring a non-medical model with non-licensed staff to
run a fulltime infection prevention committee without training would be inappropriate.
Section 6 requires Nursing Home Infection Preventionist Training. The CDC describes
that as a course [which] is designed for individuals responsible for infection prevention
and control (IPC) programs in nursing homes. As the Association has noted,
residential care homes are a very different model serving different types of residents
than nursing homes.
Section 7 requires mass testing available during a Public Health Emergency at each
long-term care facility. The Association required outside agencies to come test staff so
any such requirement on homes will require outside resources to be able to effectively
and appropriately test residents and staff.
Section 8 requires the establishment of family councils inside each residential care
home. The Association opposes any such blanket requirement especially as
participation of residents families or conservators can be a challenge and vary
depending on the resident and home.
Section 9 presumes that every resident in a residential care home has a resident care
plan. This is not always the case. Many of our residents have been living in their
home for over a decade plus and are highly independent. Putting additional
requirements on staff that average wages between $13-$15 is problematic. The
Association continues to advocate for a raise for employees who worked on the front
lines of the pandemic.
Section 10 requires each long-term care facility, including residential care homes, to
establish an essential caregiver program for implementation. The nature of living in a
residential care home means there is likely no caregiver and certainly not someone
critical to the daily care and well-being of the resident.
Section 12 is less of a concern for the industry as residents in residential care homes
are free to have their own cell-phones and other devices. The Association would,
however, caution that not every residential care home has access to Wi