Bringing common sense to assisted living
Bill would allow nurses to provide handful of basic services
By 
PEACE OF MIND for assisted living residents and their families – that’s what a bill before the Massachusetts Legislature would deliver. What small changes could make such a big difference? A handful of non-invasive treatments that are simple yet highly consequential.
To understand the issue first requires understanding the model. Assisted living, which has been certified and regulated for 27 years in Massachusetts, is a special combination of residential and personalized support services designed to meet the needs—both scheduled and unscheduled—of those who require help with activities of daily living. Activities of daily living include tasks related to bathing, dressing, grooming, eating, and other similar personal care needs.
Different from a nursing home, assisted living is a distinctly non-medical setting. Every resident has a private living area and maintains their preferred level of independence. In addition, while every assisted living community has nurses on staff, the law prohibits them from providing any skilled care whatsoever to residents. In the cases where a resident needs care, he or she has the choice of having a family member administer it or arranging and paying separately for an outside provider.
For many years, this system worked. However, as people in Massachusetts have been living longer, assisted living communities have found four non-invasive, basic types of services coming into higher demand among residents – services like blood sugar monitoring for residents with diabetes, providing simple wound care for skin tears or other minor injuries, or assisting residents with oxygen.
Some argue these restrictions are in the spirit of assisted living’s non-medical or “social” model. These arguments can sound reasonable when they are discussed outside the context of resident and family expectations, but they ring hollow to those seeking to have basic needs met. I recently spoke with an adult child whose mother wants to stay in assisted living but needs a nurse to provide insulin injections, and to the spouse of a resident who lost a toenail and would need to pay $300 per day for changing of a Band-Aid if prohibitions against an assisted living nurse changing it are put back in place. We’ve seen nearly every other state in the country successfully embrace the option for nurses to provide basic services to residents. It’s time for Massachusetts to meet that same standard for care in assisted living, and to help residents age in community.
The Massachusetts Assisted Living Association (Mass-ALA) first introduced a bill six years ago permitting but not mandating assisted living nurses to provide a discrete set of simple, non-invasive treatments. What makes it so important that we pass this bill, An Act Authorizing Common Sense Health Services in Assisted Living, now?
The answer is that the pandemic has given us a test run of how effective and helpful these services can be. As part of the Commonwealth’s state of emergency in spring of 2020, the Baker administration began allowing assisted living nurses to provide these simple treatments as a public health measure to limit outside visitors to residences. Thus, the state of emergency essentially became a pilot project for this concept that already works so well in more than 40 states.
We commissioned Collective Insight, in partnership with the Gerontology Institute’s LeadingAge LTSS Center @UMass Boston, to independently evaluate the policy and released a report with the results. Stakeholder interviews with nurses, family caregivers, and residents demonstrate that the in-house services were easy to implement, made life easier for families, and complemented the more complex skilled services delivered by outside providers.
One family said having their parents in assisted living with in-house services “really positively impacted my quality of life and my brother’s because we feel like they are both in a place that they’ve been cared for by the skilled nursing and the aides. And, they’re being loved and that’s what you can do for your parents, right? And, so it’s given us great peace of mind…”
The emergency policy was extended by the Legislature and the governor until July 15 or the end of the Commonwealth’s public health emergency, a reasonable measure as the circumstances around the pandemic shift and with the policy always intended to be temporary. What we need now is a more permanent solution that comes from the Legislature. We are grateful that the Committees on Elder Affairs and Health Care Financing have reported out An Act Authorizing Common Sense Health Services in Assisted Living favorably. Now we need to get the bill across the finish line to ensure older adults in assisted living maintain continuity of care.We have an opportunity to permanently improve assisted living, empowering people to remain active and independent in the communities they love.