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Rules for nursing home units proposed

Massachusetts nursing homes that advertise specialized Alzheimer’s and dementia care units will be required to provide workers with at least eight hours of initial training to care for such residents, and four additional hours annually, under proposed rules unveiled Wednesday by state regulators.

The rules would also require all licensed nursing homes, and not just those with special dementia units, to provide dementia-specific training for all direct-care workers, including medical directors, nurses, social workers, dietary aides, therapists, and activities staff.

Regulators said it was important to require the training at all facilities because roughly 60 percent of nursing home residents have some form of dementia.


“In nursing homes with both traditional units and [special care units], direct care staff may float between the units to cover vacant shifts or help during an emergency, and thus all workers must be trained on how to provide optimal care to all residents,” Dr. Madeleine Biondolillo, director of the state Public Health Department bureau that regulates nursing homes, wrote in a memo to the Public Health Council.

The council, an appointed body of academics and health advocates, met Wednesday to review the proposed rules.

Last year, state lawmakers approved legislation directing the health department to establish minimum standards for dementia care units, after years of lobbying by patient advocates who said a loophole in Massachusetts law allowed nursing homes to advertise special units without any extra training for their workers. Such training is required in most states.

Biondolillo said in an interview that in developing the regulations, her department met with nursing home industry leaders and patient advocates, in addition to studying dementia care rules in 16 other states.

“This is a population of [patients] who have historically struggled, and the behaviors related to dementia are challenging,” Biondolillo said. “This gives us the opportunity to put in play the best practices in a very fair way that everybody would be adhering to, and we think it will make a difference in the outcome of these residents.”


Nursing homes would have 90 to 180 days after the rules go into effect to complete the initial staff training.

Nursing home industry leaders said they agree on the need for minimum training standards but worry about how facilities will pay for it.

“We estimate that more than 40,000 nursing facility employees will require additional training under these proposed regulations at an annual cost of millions of dollars,” said Scott Plumb, senior vice president of Massachusetts Senior Care, a trade association. “These regulations come at a time when skilled nursing facilities are being underfunded by the state Medicaid program by more than $370 million a year and have not had a rate increase in six years.”

Advocates have said that too often nursing homes do not provide appropriate activities for residents with dementia, and that can exacerbate agitation and wandering, two hallmark challenges with these patients. Another issue addressed by the rules is the physical design of special-care units. Specialists say proper design can ease agitation, confusion, and difficult behaviors.

The Public Health Council is expected to vote on the proposals later this fall, after a public hearing slated for Sept. 18 at 1:30 p.m. at the Department of Public Health, 250 Washington St., Boston.

Kay Lazar can be reached at klazar@globe.com.