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General Assembly Raised Bill No. 1030
January Session, 2021
LCO No. 4720
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING LO NG-TERM CARE FACILITIES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective October 1, 2021) (a) As used in this section 1
and sections 2 to 12, inclusive, of this act, "long-term care facility" means 2
a nursing home, as defined in section 19a-521 of the general statutes, a 3
residential care home, as defined in section 19a-521 of the general 4
statutes, a home health agency, as defined in section 19a-490 of the 5
general statutes, an assisted living services agency, as defined in section 6
19a-490 of the general statutes, an intermediate care facility for 7
individuals with intellectual disability, as described in 42 USC 1396d(d), 8
except any such facility operated by a Department of Developmental 9
Services' program subject to background checks pursuant to section 17a-10
227a of the general statutes, a chronic disease hospital, as defined in 11
section 19a-550 of the general statutes, or an agency providing hospice 12
care which is licensed to provide such care by the Department of Public 13
Health or certified to provide such care pursuant to 42 USC 1395x. 14
(b) Each long-term care facility shall employ a full-time infection 15
prevention and control specialist who shall be responsible for the 16 Raised Bill No. 1030
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following: 17
(1) Ongoing training of all employees of the long-term care facility on 18
infection prevention and control using multiple training methods, 19
including, but not limited to, in-person training and the provision of 20
written materials in English and Spanish; 21
(2) The inclusion of information regarding infection prevention and 22
control in the documentation that the long-term care facility provides to 23
residents regarding their rights while in the facility; 24
(3) Participation as a member of the long-term care facility's infection 25
prevention and control committee; and 26
(4) The provision of training on infection prevention and control 27
methods to supplemental or replacement staff of the long-term care 28
facility in the event an infectious disease outbreak or other situation 29
reduces the facility's staffing levels. 30
Sec. 2. (NEW) (Effective October 1, 2021) The administrative head of 31
each long-term care facility shall participate in the development of the 32
emergency plan of operations of the political subdivision of this state in 33
which it is located which is required pursuant to the Intrastate Mutual 34
Aid Compact made and entered into under section 28-22a of the general 35
statutes. 36
Sec. 3. (NEW) (Effective October 1, 2021) (a) Not later than six months 37
after the termination of a public health emergency declared by the 38
Governor pursuant to section 19a-131a of the general statutes, (1) the 39
Department of Public Health shall have and maintain at least a three-40
month stockpile of personal protective equipment, including, but not 41
limited to, gowns, masks, full-face shields, goggles and disposable 42
gloves as a barrier against infectious materials, for use by long-term care 43
facilities, and (2) the administrative head of each long-term care facility 44
shall ensure that the facility acquires from the department and 45
maintains at least a three-month supply of personal protective 46
equipment for its staff. The administrative head of each long-term care 47 Raised Bill No. 1030
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facility shall ensure that the personal protective equipment is of various 48
sizes based on the needs of the facility's staff. The personal protective 49
equipment (A) shall not be shared amongst the facility's staff, and (B) 50
may only be reused in accordance with the strategies to optimize 51
personal protective equipment supplies in health care settings 52
published by the National Centers for Disease Control and Prevention. 53
The administrative head of each long-term care facility shall hold 54
quarterly fittings of his or her staff for N95 masks or higher rated masks 55
certified by the National Institute for Occupational Safety and Health. 56
(b) On or before January 1, 2022, the Department of Emergency 57
Management and Homeland Security, in consultation with the 58
Department of Public Health, shall establish a process to evaluate, 59
provide feedback on, approve and distribute personal protective 60
equipment for use by long-term care facilities in a public health 61
emergency. 62
Sec. 4. (NEW) (Effective October 1, 2021) The administrative head of 63
each long-term care facility shall ensure that there is at least one staff 64
member during each shift who is licensed or certified to start an 65
intravenous line. 66
Sec. 5. (NEW) (Effective October 1, 2021) Each long-term care facility's 67
infection prevention and control committee shall meet (1) at least 68
monthly, and (2) during an outbreak of an infectious disease, daily, 69
provided daily meetings do not cause a disruption to the operations of 70
the facility, in which case the committee shall meet at least weekly. The 71
prevention and control committee shall be responsible for establishing 72
infection prevention and control protocols for the long-term care 73
facility. Not less than biannually and after every outbreak of an 74
infectious disease in the facility, the prevention and control committee 75
shall evaluate the implementation and analyze the outcome of such 76
protocols. 77
Sec. 6. (NEW) (Effective October 1, 2021) On or before January 1, 2022, 78
every administrator and supervisor of a long-term care facility shall 79 Raised Bill No. 1030
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complete the Nursing Home Infection Preventionist Training course 80
produced by the National Centers for Disease Control and Prevention 81
in collaboration with the Centers for Medicare and Medicaid Services. 82
Sec. 7. (NEW) (Effective October 1, 2021) Each long-term care facility 83
shall, during an outbreak of an infectious disease, test staff and residents 84
of the facility for the infectious disease at a frequency determined by the 85
Department of Public Health as appropriate based on the circumstances 86
surrounding the outbreak and the impact of testing on controlling the 87
outbreak. 88
Sec. 8. (NEW) (Effective October 1, 2021) On or before January 1, 2022, 89
the administrative head of each long-term care facility shall facilitate the 90
establishment of a family council to encourage and support open 91
communication between the facility and each resident's family members 92
and friends. As used in this section, "family council" means an 93
independent, self-determining group of the family members and friends 94
of a long-term care facility's residents that is geared to meeting the needs 95
and interests of the residents and their family members and friends. 96
Sec. 9. (NEW) (Effective October 1, 2021) (a) On or before January 1, 97
2022, the administrative head of each long-term care facility shall (1) 98
ensure that each resident's care plan addresses (A) the resident's 99
potential for isolation, ability to interact with family members and 100
friends and risk for depression, (B) how the resident's social and 101
emotional needs will be met, and (C) measures to ensure that the 102
resident has regular opportunities for in-person and virtual visitation, 103
(2) disclose the facility's visitation protocols, any changes to such 104
protocols and any other information relevant to visitation in a form and 105
manner that is easily accessible to residents and their family members 106
and friends, (3) advise residents and their family members and friends 107
of their right to seek redress with the Office of the Long-Term Care 108
Ombudsman under section 17a-410 of the general statutes when the 109
resident or a family member or friend of the resident believes the facility 110
has not complied with its visitation protocols, and (4) establish a 111
timeline by which the facility will ensure the safe and prompt 112 Raised Bill No. 1030
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reinstatement of visitation following the termination of the public health 113
emergency declared by the Governor in response to the COVID-19 114
pandemic and a program to monitor compliance with such timeline. As 115
used in this section "COVID-19" means the respiratory disease 116
designated by the World Health Organization on February 11, 2020, as 117
coronavirus 2019, and any related mutation thereof recognized by the 118
World Health Organization as a communicable respiratory disease. 119
(b) On or before January 1, 2021, the administrative head of each long-120
term care facility shall ensure that its staff is educated regarding (1) best 121
practices for addressing the social, emotional and mental health needs 122
of residents, and (2) all components of person-centered care. 123
Sec. 10. (NEW) (Effective October 1, 2021) On or before January 1, 2022, 124
the Department of Public Health shall establish an essential caregiver 125
program for implementation by each long-term care facility. The 126
program shall (1) set forth visitation requirements for essential 127
caregivers of long-term care facility residents, and (2) require the same 128
infection prevention and control training and testing standards for an 129
essential caregiver of a resident of the facility that are required for the 130
facility's staff. As used in this section "essential caregiver" means a 131
person deemed critical, as determined by a long-term care facility, to the 132
daily care and emotional well-being of a resident of the facility. 133
Sec. 11. (Effective from passage) On or before October 1, 2021, the Public 134
Health Preparedness Advisory Committee established pursuant to 135
section 19a-131g of the general statutes shall amend the plan for 136
emergency responses to a public health emergency prepared pursuant 137
to said section to include a plan for emergency responses to a public 138
health emergency in relation to long-term care facilities and providers 139
of community-based services to residents of such facilities. 140
Sec. 12. (NEW) (Effective from passage) (a) On and after July 1, 2021, 141
each long-term care facility shall permit a resident to use a 142
communication device, including a cellular phone, tablet or computer, 143
in his or her room, in accordance with the requirements established 144 Raised Bill No. 1030
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under subsection (b) of this section, to remain connected with their 145
family members and friends and to facilitate the participation of a 146
resident's family caregiver as a member of the resident's care team. 147
(b) On or before June 30, 2021, the Commissioner of Public Health 148
shall (1) establish requirements regarding the use of communication 149
devices by long-term care facility residents under subsection (a) of this 150
section to ensure the privacy of other long-term care facility residents, 151
and (2) communicate such requirements to each long-term care facility. 152
Sec. 13. (NEW) (Effective October 1, 2021) (a) As used in this section, 153
"nursing home" means (1) any chronic and convalescent nursing home 154
or any rest home with nursing supervision that provides nursing 155
supervision under a medical director twenty-four hours per day, or (2) 156
any chronic and convalescent nursing home that provides skilled 157
nursing care under medical supervision and direction to carry out 158
nonsurgical treatment and dietary procedures for chronic diseases, 159
convalescent stages, acute diseases or injuries. 160
(b) On or before January 1, 2022, the Department of Public Health 161
shall (1) establish minimum staffing level requirements for nursing 162
homes of at least four and one-tenth hours of direct care per resident, 163
including three and three-quarter hours of care by a registered nurse, 164
fifty-four hundredth hours of care by a licensed practical nurse and two 165
and eighty-one hundredth hours of care by a certified nurse's assistant, 166
(2) modify staffing level requirements for social work and recreational 167
staff of nursing homes such that the requirements are lower than the 168
current requirements, as deemed appropriate by the Commissioner of 169
Public Health, and (3) eliminate the distinction between a chronic and 170
convalescent nursing home and a rest home, as defined in section 19a-171
490 of the general statutes, as such distinction relates to nursing 172
supervision, for purposes of establishing a single, minimum direct 173
staffing level requirement for all nursing homes. 174
(c) On and after January 1, 2022, each nursing home shall offer its staff 175
the option to work twelve-hour shifts. 176 Raised Bill No. 1030
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(d) The commissioner shall adopt regulations in accordance with the 177
provisions of chapter 54 of the general statutes that set forth nursing 178
home staffing level requirements to implement the provisions of this 179
section. 180
Sec. 14. (NEW) (Effective October 1, 2021) (a) For purposes of this 181
section: (1) "Ombudsman" means the Office of the Long-Term Care 182
Ombudsman established pursuant to section 17a-405 of the general 183
statutes; (2) "electronic monitoring" means the placement and use of an 184
electronic monitoring device by a nonverbal resident or his or her 185
resident representative in the resident's room or private living unit in 186
accordance with this section; (3) "electronic monitoring device" means a 187
camera or other device that captures, records or broadcasts audio, video, 188
or both, and may offer two-way communication over the Internet that 189
is placed in a nonverbal resident's room or private living unit and is 190
used to monitor the nonverbal resident or activities in the room or 191
private living unit; (4) "nursing home facility" has the same meaning as 192
provided in section 19a-490 of the general statutes; (5) "nonverbal 193
resident" means a resident of a nursing home facility who is unable to 194
verbally communicate due to physical or mental conditions, including, 195
but not limited to, Alzheimer's disease and dementia; and (6) "resident 196
representative" means (A) a court-appointed guardian, (B) a health care 197
representative appointed pursuant to section 19a-575a of the general 198
statutes, or (C) a person who is not an agent of the nursing home facility 199
and who is designated in a written document signed by the nonverbal 200
resident and included in the resident's records on file with the nursing 201
home facility. 202
(b) A nonverbal resident or his or her resident representative may 203
install an electronic monitoring device in the resident's room or private 204
living unit provided: (1) The purchase, installation, maintenance, 205
operation and removal of the device is at the expense of the resident, (2) 206
the resident and any roommate of the resident, or the respective resident 207
representatives, sign a written consent form pursuant to subsection (c) 208
of this section, (3) the resident or his or her resident representative 209
places a clear and conspicuous note on the door of the room or private 210 Raised Bill No. 1030
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living unit that the room or private living area is subject to electronic 211
monitoring, and (4) the consent form is filed with the nursing home 212
facility not less than seven days before installation of the electronic 213
monitoring device except as provided in subsection (e) of this section. 214
(c) No electronic monitoring device shall be installed in a nonverbal 215
resident's room or living unit unless the resident and any roommate of 216
the resident, or a resident representative, has signed a consent form that 217
includes, but is not limited to: 218
(1) (A) The signed consent of the nonverbal resident and any 219
roommate of the resident; or (B) the signed consent of a resident 220
representative of the nonverbal resident or roommate if the nonverbal 221
resident or roommate lacks the physical or mental capacity to sign the 222
form. If a resident representative signs the consent form, the form must 223
document the following: 224
(i) The date the nonverbal resident or any roommate was asked if the 225
resident or roommate wants electronic monitoring to be conducted; 226
(ii) Who was present when the nonverbal resident or roommate was 227
asked if he or she consented to electronic monitoring; 228
(iii) An acknowledgment that the nonverbal resident or roommate 229
did not affirmatively object to electronic monitoring; and 230
(iv) The source of the authority allowing the resident representative 231
of the nonverbal resident or roommate to sign the consent form on 232
behalf of the nonverbal roommate or resident. 233
(2) A waiver of liability for the nursing home facility for any breach 234
of privacy involving the nonverbal resident's use of an electronic 235
monitoring device, unless such breach of privacy occurred because of 236
unauthorized use of the device or a recording made by the device by 237
nursing home facility staff. 238
(3) The type of electronic monitoring device to be used. 239 Raised Bill No. 1030
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(4) A list of conditions or restrictions that the nonverbal resident or 240
any roommate of the resident may elect to place on the use of the 241
electronic monitoring device, including, but not limited to: (A) 242
Prohibiting audio recording, (B) prohibiting video recording, (C) 243
prohibiting broadcasting of audio or video, (D) turning off the electronic 244
monitoring device or blocking the visual recording component of the 245
electronic monitoring device for the duration of an exam or procedure 246
by a health care professional, (E) turning off the electronic monitoring 247
device or blocking the visual recording component of the electronic 248
monitoring device while the nonverbal resident or any roommate of the 249
resident is dressing or bathing, and (F) turning off the electronic 250
monitoring device for the duration of a visit with a spiritual advisor, 251
ombudsman, attorney, financial planner, intimate partner or other 252
visitor to the nonverbal resident or roommate of the resident. 253
(5) An acknowledgment that the nonverbal resident, roommate or the 254
respective resident representative shall be responsible for operating the 255
electronic monitoring device in accordance with the conditions and 256
restrictions listed in subdivision (4) of this subsection unless the 257
resident, roommate or the respective resident representative have 258
signed a written agreement with the nursing home facility under which 259
nursing home facility staff operate the electronic monitoring device for 260
this purpose. Such agreement may contain a waiver of liability for the 261
nursing home facility related to the operation of the device by nursing 262
home facility staff. 263
(6) A statement of the circumstances under which a recording may be 264
disseminated. 265
(7) A signature box for documenting that the nonverbal resident or 266
roommate of the resident, or the respective resident representative, has 267
consented to electronic monitoring or withdrawn consent. 268
(d) The ombudsman, within available appropriations, shall make 269
available on the ombudsman's Internet web site a downloadable copy 270
of a standard form containing all of the provisions required under 271 Raised Bill No. 1030
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subsection (c) of this section. Nursing home facilities shall (1) make the 272
consent form available to nonverbal residents and inform such residents 273
and the respective resident representatives of their option to conduct 274
electronic monitoring of their rooms or private living units, (2) maintain 275
a copy of the consent form in the nonverbal resident's records, and (3) 276
place a notice in a conspicuous place near the entry to the nursing home 277
facility stating that some rooms and living areas may be subject to 278
electronic monitoring. 279
(e) Notwithstanding subdivision (4) of subsection (b) of this section, 280
a nonverbal resident or his or her resident representative may install an 281
electronic monitoring device without submitting the consent form to a 282
nursing home facility if: (1) The nonverbal resident or the resident 283
representative (A) reasonably fears retaliation against the nonverbal 284
resident by the nursing home facility for recording or reporting alleged 285
abuse or neglect of the resident by nursing home facility staff, (B) 286
submits a completed consent form to the ombudsman, and (C) submits 287
a report to the ombudsman, the Commissioner of Social Services, the 288
Commissioner of Public Health or police, with evidence from an 289
electronic monitoring device that suspected abuse or neglect of the 290
nonverbal resident has occurred; (2) (A) the nursing home facility has 291
failed to respond for more than two business days to a written 292
communication from the nonverbal resident or his or her resident 293
representative about a concern that prompted the resident's desire for 294
installation of an electronic monitoring device, and (B) the nonverbal 295
resident or his or her resident representative has submitted a consent 296
form to the ombudsman; or (3) (A) the nonverbal resident or his or her 297
resident representative has already submitted a report to the 298
ombudsman, Commissioner of Social Services, Commissioner of Public 299
Health or police regarding concerns about the nonverbal resident's 300
safety or well-being that prompted the resident's desire for electronic 301
monitoring, and (B) the nonverbal resident or his or her resident 302
representative has submitted a consent form to the ombudsman. 303
(f) If a nonverbal resident is conducting electronic monitoring and a 304
new roommate moves into the room or living unit, the nonverbal 305 Raised Bill No. 1030
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resident shall cease use of the electronic monitoring device unless and 306
until the new roommate signs the consent form and the nonverbal 307
resident or his or her resident representative files the completed form 308
with the roommate's consent to electronic monitoring with the nursing 309
home facility. If any roommate of a nonverbal resident wishing to use 310
electronic monitoring refuses to sign the consent form, the nursing home 311
facility shall reasonably accommodate the nonverbal resident's request 312
to move into a private room or a room with a roommate who has agreed 313
to consent to such monitoring, if available, not later than thirty days 314
after the request. The nonverbal resident requesting the accommodation 315
shall pay any difference in price if the new room is more costly than the 316
resident's previous room. 317
(g) Subject to applicable rules of evidence and procedure, any video 318
or audio recording created through electronic monitoring under this 319
section may be admitted into evidence in a civil, criminal or 320
administrative proceeding. 321
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2021 New section
Sec. 2 October 1, 2021 New section
Sec. 3 October 1, 2021 New section
Sec. 4 October 1, 2021 New section
Sec. 5 October 1, 2021 New section
Sec. 6 October 1, 2021 New section
Sec. 7 October 1, 2021 New section
Sec. 8 October 1, 2021 New section
Sec. 9 October 1, 2021 New section
Sec. 10 October 1, 2021 New section
Sec. 11 from passage New section
Sec. 12 from passage New section
Sec. 13 October 1, 2021 New section
Sec. 14 October 1, 2021 New section
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Statement of Purpose:
To implement the recommendations of the Nursing Home and Assisted
Living Oversight Working Group regarding long-term care facilities
and make other revisions to the long-term care facility statutes.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]