Nursing home room limit, care standards proposed

BOSTON -- Long-term care facilities would need to phase out residential rooms that hold more than two people and meet a minimum staff care level under regulatory changes the Department of Public Health outlined on Wednesday.

The updated regulations, summarized at a state Public Health Council meeting, aim to improve infection control procedures in nursing homes and other residential care facilities where thousands of patients died this year amid the ongoing COVID-19 pandemic.

Staff who presented the proposed changes said they complement nursing home reforms the Baker administration announced in September, which will direct up to $140 million in new funding for facilities and restructure Medicaid rates. The reforms also recommended similar occupancy and staffing updates.

"The goal of this initiative is to hold facilities to higher standards of care in infection care," said DPH Director of Policy and Health Communications Marita Callahan.

Under the regulatory revisions, facilities would need to convert all residential bedrooms to single- or double-occupancy rooms by Jan. 31, 2022. Current regulations allow for up to four beds per room in most nursing homes and only impose a cap of two after construction or renovation.

The proposal also updates square footage requirements to reflect the lower capacity per room, a step officials say will help keep patients spaced further apart for safety.

Nursing homes would be required to provide at least 3.58 hours of care per resident per day under the change, with a minimum of .508 of those hours involving a registered nurse. That threshold would replace language in the current regulations that mandates only "sufficient nursing personnel" based on factors in each facility.

Officials plan to hold a public hearing to solicit feedback before seeking final approval of the changes.

Experts and advocates have warned about gaps in the state's long-term care infrastructure, including staffing shortages and outdated reimbursement rates, for years.

Facilities such as nursing homes have sustained some of the most acute impacts during the COVID-19 pandemic. Roughly two-thirds of the deaths attributed to the highly infectious virus in Massachusetts occurred in long-term care, where residents are more vulnerable and where transmission can occur easily.

The regulatory changes and the new package from the Baker administration respond in part to the pandemic's devastation, but members of the council argued Wednesday that officials should impose additional requirements.

Edward Bernstein, a doctor and professor at Boston University's School of Medicine, said the changes should go beyond increased spacing between patients to address ventilation, aerosol spread, and other infection control-related topics.

"I didn't see in the regulations a section that really enhanced the infectious control," Bernstein said. "I'm really concerned about this since I feel our eldest have a right to life and we didn't do a very good job, in my opinion, protecting them from COVID."

"The idea of having separate rooms is excellent and spacing, yes, but even six feet isn't an adequate distance (to prevent) aerosol spray of COVID," he continued.

Staff replied that they would continue to look at every aspect possible and noted that the department provides guidance to shut doors during any aerosol-generating procedures and deploys ongoing COVID-19 testing for patients who are on nebulizers or similar treatments.

Lucilia Prates-Ramos, director of Massachusetts Medicare and Medicaid Outreach and Education Program at the Elderly Services of Merrimack Valley, cautioned that some facilities still have not complied with a 2016 regulation requiring a certain number of full-time employee hours allocated to a staff infection preventionist.

"Some places have abided by this, I know a lot of places have not," Prates-Ramos said. "As we all know, the care in our long-term care facilities has long had lots to be desired, and COVID really shed a light on that, unfortunately, at the cost of many lives."

Federal regulations that apply in Massachusetts require each nursing home to have an infection preventionist on staff, and Prates-Ramos suggested that the state version could mirror that language given that "long-term care facilities are a petri dish for infections."

DPH is also working with the federal Centers for Disease Control and Prevention to develop a new COVID-19 infection control training, which officials at the meeting said could be rolled out this fall.

The Massachusetts Senior Care Association could not be reached for immediate comment on the regulatory changes Wednesday. The group's president, Tara Gregorio, praised the Baker administration's similar announcement in September, describing the effort as "clearly prioritizing the health and safety of our residents and their caregivers."