Massachusetts legislators moved Thursday to significantly tighten oversight of the state's nursing homes, with senators voting to raise maximum fines on troubled facilities from $50 a day to $10,000 and to require regulators to scour the homes' finances.
Governor Charlie Baker's office appeared to signal his support for the measure, which won approval in the Senate on Thursday.
"It is consistent with our ongoing efforts to improve nursing home quality and oversight to keep our elders safe and thriving in every community across the Commonwealth," Baker said.
The push to bolster the regulation of nursing homes comes amid revelations about the arrival in Massachusetts of an out-of-state chain beset by reports of substandard care and short-staffing.
State Senator Mark C. Montigny, who has long backed tougher nursing home rules, said he sponsored the overhaul because he is fed up.
"There's been a long history of watching rotten nursing home owners who have plied their trade on the most vulnerable seniors and disabled in our society and have gotten away with it," said Montigny, a New Bedford Democrat and vice chairman of the Legislature's Joint Committee on Health Care Financing.
Montigny's measure was adopted by the Senate as part of its proposed budget for the new fiscal year, starting July 1. The budget plan was expected to be approved Thursday night by the Senate. A House-Senate budget conference committee will iron out differences in the state spending plan before sending it to the governor.
House Speaker Robert A. DeLeo declined to comment on whether he supports the overhaul.
Called "Preventing patient abuse in nursing homes," the measure includes the steep increase in penalties for nursing homes that violate health and safety rules. It also dictates that money collected from the higher fines be used to establish a trust fund dedicated to improving nursing homes.
The money would go toward state inspections of nursing homes, state operation of troubled facilities as they work to correct the problems or face closure, and relocation of residents if the state closes a nursing home.
Regulators have said they are hesitant to close violation-riddled nursing homes because of the potential upheaval such an action would visit upon frail residents. Montigny said his initiative should help alleviate that concern.
"We can really punish people, and change behavior, and force bad people out of business," he said. "We are saying this is a real problem, and we shouldn't let evil continue."
The measure requires the state health commissioner to report annually to the Legislature how much money the trust fund received, and how that money was spent.
A series of Boston Globe stories over the past year showed how an out-of-state chain had assembled a string of nursing homes with scant attention from the health department. That company, Synergy Health Centers, was fined $288,400 last month by federal regulators for significant health and safety problems linked to two patient deaths since December in its Wilmington nursing home.
Earlier this year, a Globe review found that for-profit nursing homes, which constitute three-quarters of facilities in the state, frequently devote less money to nursing care compared to nonprofit homes, and often have more health and safety violations. The review also found that some nursing home owners were paying themselves salaries in excess of $1 million.
Montigny's measure requires the state's Center for Health Information and Analysis to conduct an in-depth examination of the finances of the state's roughly 400 nursing homes on an "institution-specific" and "industrywide" basis. The project must include an analysis of nursing home spending on patient care in relation to other costs, revenues, and profit margins.
The center is required to issue its findings to the Legislature by Jan. 1.
Massachusetts Senior Care Association, the state's nursing home trade association, issued a statement saying the organization was reviewing Montigny's measure.
"We welcome a financial analysis and believe it will show an industry in financial crisis," said Tara Gregorio, the association's vice president. "Any review must include a transparent analysis of [Medicaid] funding in relation to the actual cost of providing high quality patient care and a living wage for our dedicated caregivers."
Nursing homes are requesting millions more dollars from the state this year, and have pledged the money will be used to boost wages for low-paid nursing aides. Patient advocates have insisted that any additional money given to the industry come with strict requirements that all of it goes toward workers.
Advocates said the overhaul adopted Thursday by the Senate is sorely needed.
"This gives the Department of Public Health more tools but also makes them more accountable," said Wynn Gerhard, an elder-law attorney at Greater Boston Legal Services.
Arlene Germain, president of Massachusetts Advocates for Nursing Home Reform, a patient group, said the measure "sends a strong message that the failure of facilities to protect their residents will carry a hefty financial penalty, and that financial transparency is necessary to ensure that the highest level of funds are dedicated to direct resident care."