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Holding nursing homes accountable, while paying them fairly

In a bill passed unanimously by the Massachusetts House of Representatives, oversight is paired with money to enhance workforce

Nursing homes were hit hard by COVID-19 outbreaks. Today, many are struggling to retain and hire staff.Shuran Huang/NYT

Even before COVID-19 hit, nursing homes were struggling. Occupancy was declining, labor costs were rising, and profits were shrinking. A 2020 report by a legislatively created nursing facility task force identified 18 facilities that were of chronic low quality and experienced low occupancy. Nursing homes were then hit hard by COVID outbreaks. Today, many are struggling to retain and hire staff.

A bill passed unanimously by the state House of Representatives on Wednesday would bring long-overdue reforms to the nursing home industry. It would impose stricter oversight by the Department of Public Health and harsher penalties for homes where residents are abused or neglected. Simultaneously, it would raise the Medicaid rates paid to nursing homes and enhance workforce training to ensure homes have the resources and staff to offer high-quality care. The bill has backing from nursing home managers and workers. The House was right to prioritize it. The Senate should follow suit and consider the bill when lawmakers return to formal sessions next year.


State Representative Thomas Stanley, a Waltham Democrat who chairs the Joint Committee on Elder Affairs and led work on the bill, said the issue is personal to him after his father spent the last years of his life in and out of nursing homes, where quality varied. “The last days of his life, my wife and I were visiting him in a nursing home, and he fell. I held him in my lap on the floor while my wife went running up and down the hallway trying to find help,” Stanley said. “I don’t want families to have to go through that.”

Several provisions of the bill relate to ensuring strong nursing home leadership and accountability. The bill would give the Department of Public Health new authority to scrutinize owners and management companies when a company applies for a nursing home license or to transfer ownership of one, and to examine their suitability based on background and legal checks. Nursing homes would be required to submit additional financial reports. DPH would obtain new authority to suspend or revoke a license or to appoint a temporary manager for a nursing home in cases of chronically poor conditions. Financial penalties for safety violations and for abuse and neglect would increase.


Nursing homes would have to develop plans for infectious disease control, and DPH would offer additional training in areas including infection control, resident care, and staff safety.

To address bottlenecks in hospital discharge, the bill would require insurers to approve requests for transfers from hospitals more quickly.

To ensure nursing homes have the staff and money needed to operate high-quality programs, the bill would create a fund to pay for workforce training and provide loans for capital projects. It would require MassHealth to update its rates biennially and provide additional money to care for patients who need extra staff, like those who are obese or aggressive.

The bill has widespread support. Both Tara Gregorio, president of the Massachusetts Senior Care Association, which represents nursing homes, and Tim Foley, executive vice president of 1199SEIU, which represents nursing home workers, praised the bill’s focus on increasing accountability, transparency, and oversight while also addressing pressing workforce challenges. Paul Lanzikos, co-founder of Dignity Alliance Massachusetts, a senior advocacy group that has been critical of nursing homes, said he appreciates the proposed new oversight and accountability even as his group pushes for additional reforms.


The details are complicated, and lawmakers and interest groups should scrutinize them as the legislation advances. But before this session ends in 2024, Governor Maura Healey should sign into law a version of this bill, which strengthens accountability and oversight while giving nursing homes the resources they need to ensure residents are getting the highest quality of care.

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.