Proposal advances for minimum standards in nursing homes, special dementia care units

By Kay Lazar, Globe Staff

A loophole in Massachusetts law that allows nursing homes to advertise specialized Alzheimer’s and dementia care units, even though their workers may have no training in caring for such residents, is one step closer to being closed.

A proposal that would establish minimum standards for such units was approved by the House of Representatives Wednesday, and is headed for the state Senate.

The bill would require the Massachusetts Department of Public Health, which regulates nursing homes, to establish minimum standards for facilities with dementia care units.

Similar legislation has been proposed for the past seven years without success, supporters said. But this is the first time the measure has made it this far, this early in the year, they said.

“This is certainly way overdue,” said James Wessler, president and chief executive of the Alzheimer’s Association of Massachusetts and New Hampshire.

“Often nursing home placement is done in time of crisis, and families are then not good shoppers,” Wessler said. “So the state has an obligation to have a minimal level of guarantees that facilities are providing the level of dementia care that they say they are giving.”

Massachusetts is one of a handful of states without such requirements. A 2005 federal report noted that 44 states at that time had requirements governing training, staffing, security, and other areas for facilities that provided specialized dementia care.

The Massachusetts legislation would require all licensed nursing homes to provide dementia-specific training for all direct-care workers, activities directors, and supervisors. Supporters said it was important to mandate dementia training for staff at all licensed facilities because more than half of people in nursing homes suffer from dementia, even if they are not living in specialized dementia care units.

Additionally, the legislation stipulates that there should be activities programs in dementia special care units that provide activities geared to people with dementia.

Supporters said that too often nursing homes do not provide appropriate activities for residents with dementia, and that void can exacerbate agitation and wandering, two hallmark challenges with these people.

The proposal does not contain any language about minimum staffing requirements. Earlier versions stipulated specific staffing levels for dementia care units, but the nursing home industry has said that higher staffing levels did not necessarily guarantee good care.

A recent Boston Globe investigation, which analyzed data on nursing homes nationwide, found a clear link between nursing home staffing levels and the overuse of powerful sedatives called antipsychotics, which are often prescribed for residents with dementia to control agitation, despite government drug regulators’ warnings about safety risks.

Homes that most often used these drugs for conditions not recommended by regulators had fewer registered nurses, who direct care, and nurses’ aides, who provide most of the hands-on care, the Globe’s investigtion found. Nursing home specialists say it can be more time-consuming for staff to keep dementia patients calm without using drugs.

“You would be hard pressed to say staffing levels don’t make a difference in quality of care,” Wessler said.

But he said supporters are happy that mandatory staff training and appropriate activities for dementia care units were addressed in the proposal.

The legislation also directs the state health department to issue guidelines for the physical design of dementia special care units that can help ease residents’ inclination to wander.

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.