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Connecticut nursing homes face pressure from all sides

A nursing home resident speaks with a staff member.
Nathan Howard
A nursing home resident speaks with a staff member.

An increasing number of families are choosing to keep their elder members home instead of placing them in nursing homes. Connecticut care facilities are struggling to adapt with the smaller population.

WSHU’s Ebong Udoma spoke with CT Mirror’s Dave Altimari to discuss this second article in a four part series written with Jenna Carlesso, “From shifting finances to changing populations, nursing homes are under pressure from all sides,” as part of the collaborative podcast Long Story Short.

WSHU: You say nursing homes in Connecticut are dealing with staffing shortages, less than ideal occupancy rates and reduced funding. This sounds like the perfect storm. How are Connecticut nursing homes dealing with it? Is there any help from state lawmakers?

DA: The nursing homes are still recovering from the pandemic and are in another crisis. The state DSS, the state agency that oversees the funding for long-term care facilities, is in the process of slowly diverting money from nursing home care to other home health care options with the belief that people more and more these days would rather try to stay at home than go to a nursing home. So the funding is shifting quicker than even the state anticipated because of the pandemic.

WSHU: Now, people prefer to stay in their homes. So what does that mean for nursing homes going forward? How are they dealing with it? I mean, I know they asked the state for more money, what was the outcome of that?

DA: They did go to the state and ask for $193 million to help them deal with severe staff shortages, the biggest issue, and inflation rates for other costs. And unlike during the pandemic, when the state several times gave millions of dollars to nursing homes, this time, they got rebuffed. And not only by DSS, but also at the legislative level. I guess the best way to categorize what's happened at the legislature this year is that there's been kind of a backlash against nursing homes. And rather than, say, 'sure, we're going to give you more money', they are considering a bunch of bills that would have a big impact on nursing homes, increasing the number of hours a day that they have to mandate them for caring for each resident.

There's a transparency bill that would require nursing home providers to provide more information on where the money's going that the state gives them. I think there's a lot of legislators who feel that the state pays them a significant amount of money. And then that money is going to ancillary things that aren't patient care. In the nursing home industry in general, there is this trend of private equity and hedge funds getting involved in quietly purchasing private homes. So that's also happening in Connecticut. And it's something that really the legislature doesn't have a very good handle on.

WSHU: There's speculation that they're not actually hurting for money, the fact that money is tight for nursing homes is not really the case. Could you just tell us what's going on there?

DA: I think that's part of the transparency bill, that the legislature wants to know more about where the money's going. We have nursing homes, providers, saying they're struggling financially, they can't get staff, they have to hire these staffing services that charge them outrageous rates, because they know they can do that, which is a big problem for these facilities. That's a national problem, not just a Connecticut problem. And so I think the legislators are looking at it, like we gave you a lot of money during COVID, and where did it go? I mean, is it going to hiring CNAs and hiring nurses and hiring food service workers? Or is it going to some LLC that the provider is, you know, 50% owner of and you know, they're paying rent to themselves or stuff like that.

So I think there's a lot of, I'm not going to say distrust, but there's certainly a lot of questions that have been raised by legislators about before we give you any more money, we want to know where the state's money is going. And then that's also coupled with the fact that the state is going to be giving them less money anyway, because they are shifting funds, moving away from nursing homes into more home health care situations, which is its own issue, which will be part three of this series next week.

WSHU: The big issue is that we are having a larger aging population in Connecticut. So there's going to be more people needing care in the state. And the issue is whether this is going to be in institutionalized settings like nursing homes, or whether people are going to age in their homes. So this is a time that actually should be a good time for nursing homes in the sense that we have an aging population, meaning they should have a higher occupancy. And so how are nursing homes trying to deal with this?

DA: We are the sixth, I believe it's the sixth oldest population in the country right now. And we are expected in the next 20 years to get a lot older. So this is a problem that is only going to get worse. And I think from a legislative level, and from the state level, we are at a point where something needs to be done as far as how much money are we going to put into the system, and how are we going to fix it? And what's it going to look like in the future?

There is no doubt that there will always be nursing homes, no question, there will be people who will be sick enough that they need 24 hour care or they need to be in a facility. I think what the state believes is that they'll be less nursing homes, who will take care of residents that have higher acuity issues. And everyone else will get some kind of care at home. And I think that's the future that they see from nursing homes. Right now I believe we have roughly about 200 nursing homes. I think the state ultimately thinks that number will decrease. By how much, I don't know. But even though we are an older population, there are more beds available in nursing homes now than there were before the pandemic.

WSHU: Now you give the example of the Jewish Home in Bridgeport, and they are tackling it by upscaling. Could you just tell us a little bit about that?

DA: Yes. So that is a nonprofit, you know, they decided they wanted to build what they in the business call like a greenhouse facility. Basically, you live in pods of six or eight. You have your own room, you have your own staff that are assigned to your group, there's a kitchen. It is as close to assisted living as you can get in a nursing home setting. There's a common courtyard.

So it is kind of the future that some want to see. It's very expensive to build and to staff. So I don't know, I don't think every nursing home is going to be like that. The other problem we have in Connecticut is a lot of our nursing homes are very old. Some of them are over 100 years old, and they are more frankly like hospitals than they are anything else. The one thing about the Bridgeport facility, it certainly does not look like a hospital. So I think that's what the state would like to see more of. But that's very expensive. And unless the state's willing to come forward with some significant money to help build those kinds of facilities, those are not easy to do.

As WSHU Public Radio’s award-winning senior political reporter, Ebong Udoma draws on his extensive tenure to delve deep into state politics during a major election year.
Molly is a reporter covering Connecticut. She also produces Long Story Short, a podcast exploring public policy issues across Connecticut.