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Support S406 – Small House Nursing Homes

Download Jim Lomastro’s testimony (docx): Elder Affairs S406 Small Homes DAM.

Good morning.  Thank you for the opportunity to speak about Senate Bill 406, “An Act Relative to Small House Nursing Homes.” 

My name is Jim Lomastro, and I am a member of Dignity Alliance Massachusetts.

This bill is a strong start toward the transformation of long-term care necessary to ensure the dignity, self-determination, and quality of life of those in need of nursing facility-level care. 

While the majority of older adults and individuals with disabilities  – who currently reside in nursing facilities are unnecessarily institutionalized and could be served in their homes and communities -we recognize that there is a need for specialized congregate care.  We feel strongly that, to ensure high  quality and high value care –  centered in dignity and independence, it must be delivered through the small house model of care. 

While the small house design most clearly involves architectural plans – residential environments with private rooms and bathrooms, home-like living and dining rooms, and accessible kitchens and outdoor spaces – it is far more than simply a building. 

Small house model design is a radical change in the delivery of care, embracing best practices for providing community-based care and avoiding the impersonalization and stigma associated with institutions. 

It requires a cultural metamorphosis away from the medical/institutional model of care that serves the needs of the institution and towards a focus on the needs and preferences of each individual resident.

A more comprehensive bill is necessary to ensure that the nursing facility industry does not superficially change congregate care settings by adopting the façade of the small house model of care while neglecting the true transformation of the culture and delivery of care.  

A small house culture centers on the residents and surrounds them with a self-managed team of care partners.  The model of service delivery is person-centered and founded on the core values of an empowered staff and highly collaborative relationships.

Ultimately, we support the spirit of this legislation, if not the current version.  What is needed is a comprehensive overhaul of the delivery of long-term care to the Commonwealth’s older adults and individuals with disabilities.  To achieve this vision, legislation must address more than just the physical plant of nursing facilities.  To truly provide a quality of life centered on a holistic view of residents that preserves their dignity and independence, legislation must address changing the mindset and culture of institutional care through training, education, and accountability.