Baker gives nursing homes $130 million – with strings

Administration also plans to release COVID-19 data by facility

GOV. CHARLIE BAKER announced Monday that the state will give nursing homes another $130 million to help them respond to the coronavirus outbreak, but will require the facilities to adhere to new standards on staffing and testing in order to get the money.

Nursing homes that repeatedly do not live up to the standards for infection control could be put into receivership or even shut down, according to the new rules.

“Nursing homes have a pressing obligation to provide the best care they can to many of the most vulnerable and fragile residents,” Baker said during his daily press conference at the State House.

Nursing homes have emerged as a hotspot in Massachusetts’ fight to contain the coronavirus. As of Monday, 10,635 residents and staff had tested positive for COVID-19 at 300 long-term care facilities. Nearly 57 percent of the state’s 3,003 COVID-19 deaths have occurred at long-term care facilities, and the establishments accounted for two-thirds of the new COVID-19 deaths in the state on Monday.

The elderly adults with underlying health conditions who tend to live in long-term care facilities are the population most vulnerable to COVID-19. Patients are living together in a way that makes social distancing difficult. Many nursing homes do not have sophisticated protocols for infection control, and the coronavirus can circulate for several days before patients begin showing systems, making it hard to contain.

Nursing homes for years have faced labor shortages, brought about, they say, by inadequate state funding that has kept pay levels low. Many care givers at nursing homes make $13 an hour or less.

The staffing issues have become pronounced during the COVID-19 pandemic. As the virus spreads, some staff members have become infected themselves and others, fearful for their health, have stayed away from work. Long-term care facilities have reported having 20 to 40 percent of staff call in sick.

Holyoke Mayor Alex Morse recently called for a state takeover of all nursing homes with COVID-19 cases, saying he does not believe local health officials and nursing home administrators can handle the pandemic.

The Baker administration previously announced a $130 million infusion of cash into nursing homes. The administration has been working with the nursing homes to create dedicated buildings and dedicated wings for infected residents. It also created a mobile testing unit run by the National Guard that travels from nursing home to nursing home testing residents and staff.

In the buildup to the COVID-19 surge, the Baker administration focused nearly all of its attention on hospital preparedness, personal protection equipment, and testing for the virus. The new $130 million in funding for nursing homes is recognition that the fight shifted over the last several weeks from hospitals to nursing homes.

The Baker administration said it intends to publicly release the numbers of COVID-19 cases and deaths in each facility and will also publicize funding levels and the results of the audits. The administration had resisted releasing facility-by-facility data previously, prompting the House to pass legislation mandating the publication of the data. The Senate has not yet acted on the legislation.

Monday’s announcement indicates that the state is putting a much heavier focus on both providing assistance to troubled nursing homes and also demanding accountability.

The state is prepared to provide up to $130 million to long-term care facilities, doled out biweekly over two months, between May 1 and June 30. The amount each home gets will be contingent on its meeting certain requirements.

Nursing homes will be required to test all residents and staff for COVID-19.

They will be audited to determine how well they measure up to a 28-point infection control checklist. The checklist will include requirements related to infection control; supply and use of personal protective equipment; staffing; clinical care; and communication. The frequency of the audits will depend on the facility’s performance.

The amount of money a facility can get – up to 50 percent of its historic reimbursement rate – will be directly dependent on the results of its audits. A facility in full compliance with the standards will get the full amount, but nursing homes that are not adhering to the requirements will receive less money. A facility that is deemed not in adherence with the infection control standards in three separate audits would not only lose the extra money, but could face sanctions, including receivership, loss of MassHealth contracts, and forced closure.

The facilities will be required to use the extra money for staffing, infection control, personal protective equipment, and direct staff support. Staff support could include things like paying higher wages, hiring temporary staff or paying for hotel stays for staff worried about infecting family members.

The state will also offer additional assistance to help facilities meet these requirements. It is establishing a team of 120 nurses and nursing assistants, who will be deployed in groups of 10 to provide emergency staffing support. Crisis management experts will be available to advise homes. The state will contract with temporary staffing agencies if a home cannot access enough staff on its own.

The National Guard can be deployed to provide logistical help.

The Massachusetts Senior Care Association, which represents nursing homes, and Hebrew SeniorLife, which runs several senior living facilities in Greater Boston,  have created a centralized center to help facilities improve their infection control measures. The center will provide training, protocols, access to suppliers of personal protective equipment, and help hiring staff and testing residents. It will also help identify which facilities need the most help and triage requests.

Tim Foley, executive vice president of 1199SEIU United Healthcare Workers, a union that represents state nursing home workers, called the new policy “a really good step forward” in getting resources to nursing homes to offer higher wages, ensure personal protective equipment is available, and control infections.

Foley said staffing has long been a problem at nursing homes, and this money should let facilities attract more staff with better wages and, equally importantly, safe working conditions. Today, he said, existing shortages are exacerbated by large numbers of staff falling ill, so that the workers who remain are “stressed, tired and fearful.”

Meet the Author

Shira Schoenberg

Reporter, CommonWealth

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

Tara Gregorio, president of the Massachusetts Senior Care Association, thanked the Baker administration and said in a statement, “Nursing facilities will use this funding to acquire PPE, implement infection control, and, most importantly, to give our dedicated staff across Massachusetts the heroes pay increases that they need and deserve.”

Separately, the state also announced a $44 million funding boost for private providers who contract with the state to provide residential services to children, people with disabilities, domestic violence survivors and others living in state-funded group homes.