State Budget Recommendations

FY 2025

On November 17, 2023, DignityMA sent a letter to Governor Healey and Lieutenant Governor Driscoll with additional information (listed below).

Media Release

Advocates Advance Proposals for a Dignity Budget
Suggestions for a Massachusetts State Budget that’s Age-Friendly and Able-Friendly

BOSTON – A statewide, non-profit coalition of organization and individuals dedicate to advocating for the needs of older adults, people with disabilities, and caregivers, is proposing budget enhancements aimed at creating an “age-friendly, able-friendly Commonwealth.  Dignity Alliance Massachusetts is asking the Healey-Driscoll Administration to consider to budget funding increase, new funding, and directive language in the budget that will be submitted to the Legislature next January.

“The Dignity Budget,” as it’s been dubbed, contains proposals that cover all six Constitutional Offices, most of the Cabinet-level agencies, and even some quasi-independent agencies.  The proposals are grouped under three overarching priorities:

  • Dignity for Long-Term Care Residents in Nursing Homes – including increase and enforce nursing home staffing, increase inspection and oversight by Department of Public Health, and increasing the resident Personal Needs Allowance that has been stagnant for decades.
  • Dignity for All Older Adults and People with Disabilities in the Community – including increasing support for accessible, affordable housing grants and alternative housing vouchers, increasing support for independent living centers, and increasing funding for elder mental health outreach teams.
  • Dignity for Caregivers of Older Adults and People with Disabilities – including enhanced support for both family and career caregivers, increasing pay and benefits for nursing home, home care, and community programs staff, freezing nursing home admissions when there is continuing non-compliance with staffing ratios.

Each priority includes action steps in the form of funding and budget directives to create a Fiscal ’25 budget plan that would achieve progress in state government efforts to support the growing population of older adults, those whose abilities are challenged, those who care for both groups.

Paul Lanzikos, Coordinator of Dignity Alliance, and a former Secretary of Elder Affairs in the Dukakis Administration, explained that the advocates see the “Dignity Budget” as “aspirational in that it suggests goals for the Commonwealth.”  However, he and his fellow advocates hope that progress on, at least, some of the priorities can be realized in the coming year whether as submitted in the Governor’s Budget, or offered by legislators as amendments during the budget process.

The “Dignity Budget” represents a collaborative effort by individuals and groups participating in the Alliance, and led by Lanzikos of Beverly and former Senator Richard T. Moore of Uxbridge. Dignity Alliance Massachusetts was formed during the early stages of the COVID-19 Pandemic and is currently in its third year advocating through legislation, litigation, and education to improve the lives of some of the most vulnerable residents of Massachusetts.

Overview

Dignity for Long-Term Care Residents in Nursing Homes

Nearly 75% of Massachusetts nursing homes fail to meet the minimum staffing of 3.58 required by regulations, yet the Department of Public Health has not kept pace with inspection of nursing homes or responding to resident complaints.  Insufficient nursing home staff places residents at risk.   Staff training is limited, and state survey agency training is insufficient to provide effective oversight.

Residents are unable to afford basic personal care supplies not provided by nursing homes, since low personal care assistance has been stagnant for many years.  State analysis of nursing home ownership and finances is difficult to obtain and not easily analyzed for detection of fraud. 

Action Steps:

  • Increase AND enforce nursing home staffing standards.
  • Increase support for inspection and oversight by the Department of Public Health (nursing homes and rest homes) and Executive Office of Elder Affairs (assisted living).
  • Confirmation of Compliance with Direct Care Cost Quotient (75% of nursing home revenues for nursing staff).
  • Increase the Nursing Home Resident Personal Needs Allowance to $160/month, plus COLA (it’s been $72.80/mo. for decades, far too long).
  • Require nursing home cost reports and related third party financial reports to be in Excel format, in a searchable data base, and publicly available within six months of the end of the filing year or from the date of closure.
  • Establish and fund a program to combat inappropriate use of antipsychotics with nursing home residents.
  • Preserve nursing home bed holds for resident medical and social leaves of absence to protect the resident’s home.
  • Equalize rights of nursing home residents with those in state care (e.g., DMH, DDS).
  • Increase employment and vocational rehabilitation for older adults.
  • Increase funding for production of older adult state-assisted housing units and accessory dwellings.
  • Update regulations to accommodate and promote the development and operation of “Green House” and other “small house” model nursing homes. Require nursing homes to have a full-time social worker for every 60 residents.
  • Require a full-time infection preventionist, as recommended for nursing homes by the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC).
  • Require that the name(s) of the beneficial owners and their business addresses be publicly posted on a state-managed website.
  • Require that the names of the administrator, director of nurses, and medical director be publicly posted in a directory on a state-managed website.

Dignity for All Older Adults and People with Disabilities in the Community

Housing assistance is limited and not affordable for most.  Even if the housing crisis can be addressed, many units are not accessible for those with mobility issues.  Home care services, and staff, including personal care attendants are in short supply.   While there are many people who could receive care at home rather than in a nursing home, funding for expensive institutional care outpaces what could be used to keep people out of nursing homes or to help them leave nursing homes at a savings to taxpayers and a benefit to the dignity of older adults and people with disabilities.

Action Steps:

  • Increase support for the Accessible, Affordable Housing Grants program and Alternative Housing Vouchers program.
  • Increase support for Independent Living Centers to help people leave and stay out of nursing homes or assisted living facilities.
  • Increase funding for Elder Mental Health Outreach Teams (EMHOT)
  • Address trend of increasing numbers of older adults among the homeless.
  • Establish a Commission on the Status of Older Adults.
  • Provide energy assistance support for cooling during hot months, increase support for heating in cold months, and prevent utility shut-off during both periods.
  • Support Elder Justice Unit in Attorney General’s Office and efforts to prevent elder abuse or exploitation.
  • Increase resources for dementia care in the community.
  • Increase funding for suicide prevention programs for older adults and people with disabilities.
  • Encourage state universities and community colleges to adopt “age-friendly university” concepts similar to the UMASS system.
  • Establish and fund an Office of Tenant Advocate to prevent bullying in housing.
  • Address the needs of older and/or incapacitated individuals who are incarcerated.
  • Fund a grant program for councils of aging to advance “Age Friendly” policies, programs, services, and community infrastructure consistent with the state’s “Age Friendly Massachusetts Action Plan.

Dignity for Caregivers of Older Adults and People with Disabilities

A major problem in recruiting and retaining staff for nursing home and home care is that those choosing such employment fail to receive a living wage and are asked to care for an unreasonable number of older adults and people with disabilities, creating a job that is unappreciated, underpaid, and lacks dignity while being over-worked.  Little investment has been made to provide technology that could support the caregivers both in nursing homes or in private homes.  Until the causes for high turnover are addressed, new employees will be difficult to find and retain, even if immigration laws were reformed and language differences addressed.  Nursing home residents will receive better care from the same caregivers over time, rather than continually adjusting to new caregivers or temporary personnel.

Action Steps

  • Enhance support for caregivers – both family and career.
  • Increase pay and benefits for nursing home, home care, and community program staff.
  • Audit compliance with the Direct Care Cost Quotient requirement and penalize non-compliance.
  • Freeze nursing home admissions when there is continuing non-compliance with staffing ratio. Seek federal and state authorization of spouses to be compensated and trained.