Legitalk:

[Rep. Jane Garibay (House Chair, Aging Committee)]: Good morning, everyone. Good morning. Thank you, and thank you for being patient with us. We are gonna begin with what we have as the first five speakers, and then we'll have the rest of the list. So happy to be here today and to have all of you here. Pass it over to my senate co chair.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Good morning, everyone. Very excited to have these discussions around the bills. So I'm ready to get started.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Rep Balinski.

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: Thank you, Madam Chair. Thank you, everybody for being here. It is wonderful to see a full room of advocates. And excited for our first public hearing of the year. Just so that everybody knows. You will see some activity today. There are multiple hearings, multiple committee meetings, and and more appropriations meetings and subcommittee meetings than any human being should ever have to attend going on today. So you'll see people up and about coming back and leaving and all reps, that kind of other stuff. But, understand that, what you have to say is important and we, love the fact that you're here. Thank you so much. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, Repolinski. Senator Huang, do you have any comments?

[Sen. Tony Hwang (Ranking Member, Senate)]: Very quickly, I I appreciate everybody who signed up to participate in a public hearing. Looking forward to hearing some insights and perspective in helping us draft policies that make an impact on the Asian community. So thank you. Thank you to all the people who are participating.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. I'm gonna pause for one minute. Okay. We'll start with our first speaker. Again, thank you for your patience. Commissioner

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: Porter.

[Amy Porter (Commissioner, Department of Aging and Disability Services)]: Good morning. Senator Hockadell, representative Garibay, senator Wong, representative Balinski, and distinguished members of the aging committee. It's nice to be back. My name is Amy Porter and I'm the commissioner for the department of aging and disability services. I'm here today to offer strong support of three bills being heard today. Senate bill one twenty four, house bill five one four one, and high house bill five one four two. To begin, I'd like to thank the committee for raising our agencies proposal as senate bill one twenty four, and act concerning the department of aging and disability services recommendations regarding municipal agents for aging, and to offer a bit of background. By law, municipalities must appoint a municipal agent to help older adults learn about community resources, file for benefits that might be available to them. And you might recall that one of the provisions within house bill 5,001 in 2024, the omnibus bill in support of older adults, that bill made the agent's duties mandatory, and expanded their duties to help include helping access housing resources. In most cases, the agent is a current municipal employee, but it's not always the case. They might be a staff member of a local non profit, they might be a private citizen volunteer, and as a result, they're not bound by a common consistent, code of ethics. So this summer, the office of the health care advocate alerted ADS to an issue where a licensed independent insurance agent selling Medicare plans was serving in the role of municipal agent. And they were they were asking us whether there was some remedy for that. We believe the spirit of the law is unbiased consumer education, and most, sharing the most appropriate health insurance plan choices. So this bill adds language that explicitly prohibits the appointment or reappointment of an individual with a real or perceived conflict of interest. It requires agents to certify to this fact in writing. It defines a conflict of interest, and it requires the municipal agent to immediately report any conflict of interest to their appointing authority to see if the matter can be reassigned. This last point as we were thinking about it, we're aware that potential conflicts might occur more often in small towns because they have limited staff and they're more likely to hold multiple roles. So therefore, the bill would allow two or more municipalities the option of sharing a municipal agent through an established memorandum of understanding or memorandum of agreement. And lastly, the bill updates reference to the elderly, a term that's no longer being used in the field of aging services. Again, we appreciate the committee raising this bill to protect the reputation and effectiveness of this important resource for Connecticut's older adults. House bill five one four one would require assisted living service agencies to provide annual in service training to staff concerning residents fear of retaliation. Part of the driving factor of this experience is the inherent power imbalance that exists between staff and long term care homes and the residents who must rely on them for their care. This training developed by our ombudsman program has been required of nursing home staff since 2013, and this bill extends the requirement to assisted living residents

[Catherine “Kathy” Holt (State Healthcare Advocate)]: as well. And

[Amy Porter (Commissioner, Department of Aging and Disability Services)]: house bill five one four two would extend residents protections in nursing homes for virtual monitoring and visitation to residential care homes. As you may recall, the 2021 law expanded the nursing home patients bill of rights to include the right of residents to purchase and use technology of their choice to facilitate virtual monitoring monitoring or physician and establishes related notification, use, and consent requirements. Since then, our ombudsman program, who you'll hear from shortly, has received numerous complaints of facilities and staff that are not complying with this law. The Department of Public Health is investigating, but there's currently no financial penalty to discourage repeat violations. Under this bill, any facility that interferes with, restricts, or fails to administratively support a resident's lawful use of this technology would be subject to a financial penalty. In closing, we truly appreciate the committee's unwavering support of older adults by continually seeking to redefine what quality care looks like here in Connecticut. On behalf of ADS, we thank you for your time, consideration, and ongoing support of our agency's mission, I'm happy to answer any questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you very much. Do we have any questions?

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: I don't have a question. I have a comment. Thank you, madam chair, for recognizing me. Commissioner Porter, the work that you guys do is the finest example of accountability in government and and integrity in the care of our seniors that I can imagine. I thank you. I really do thank you. And I hope that at some point, we can actually have a budget line for your, for your ombudsman as opposed to having to sort of cobble it together every year. But, you know, one one day at a time, your work is very appreciated.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, representative. Thank you. And I think we all say ditto to that. So absolutely. Is there anyone online? Seeing none, thank you very much. Thank you. Next we have our ombudsman, Marie Painter.

[Mairead Painter (State Long-Term Care Ombudsman)]: Thank you for having me here to testify today. I submitted written testimony on several bills, but I'm going to speak to just a couple this morning. House bill five one four one, an act requiring the fear of retaliation training for persons providing assisted living services in managed residential communities. We are looking to extend this to managed residential communities because we have learned time after time that individuals fear retaliation. And I focus on the word fear. It doesn't necessarily mean that they're experiencing it. But when there's a loss of control and autonomy, people really worry about complaining or saying something that makes them uncomfortable. And so this training, it's free. It's on our website, and we think that extending it to our managed residential communities would allow for better outcomes for the individuals that we serve there. We have found that in nursing homes, it's been very effective. It's brought up conversation where staff might not even realize something that they're saying or something that they're doing might come off as intimidating to the individual they're serving or their family member. So we really hope that this is in partnership with the industry and that we're able to support, the best outcomes possible for those individuals that we're all working to provide for. House bill five one four two, an act concerning the use of technology technology for virtual visitation and monitoring in nursing homes and residential care homes. We've seen firsthand how the law that was previously passed related to using cameras and technology in nursing homes has benefited our long term care communities. I think it's benefited the residents as well as when there's a question or concern related to something that's happened. We have, that footage and it's able to clear up some questions at times.

[Rep. Jane Garibay (House Chair, Aging Committee)]: One of

[Mairead Painter (State Long-Term Care Ombudsman)]: the challenges we've seen is that, and some of you know and have sent them to me, that we've seen individuals go in and repeatedly turn off cover or obstruct the view of a camera so that you can't see what's happening during care. We've addressed this with the administration in the nursing homes. We've addressed this with the Department of Public Health, and they have gone out and tried to have that level of accountability that we want. But unfortunately, when people don't do the right thing for the right reasons, we need to take other measures to protect the rights of the individuals being served in these settings. So that's why we're asking for other penalties to be put in place to have that level of accountability. We're also asking to extend this bill to residential care homes. In talking with the industry, I do understand that there's different levels of documentation, and different expectations related to what kind of settings, have technology in them, and we are willing to work with them on this. But we think that having them also educated would help in the outcomes for the individuals that are being served in that setting as well. Again, this is free on our website, and we wouldn't go on and and take it. We've updated the video. We heard from nursing homes that they've watched it for years now, and they were looking for something a little more relevant and something that would impact the individuals that are working and living in these communities. It's not only offered for staff, it is also for We have a resident component and a family member component as well. So we'd like to see that added. But we're Again, we're willing to work with the industry to make sure that it's not burdensome, on them. SB 123, an act concerning public hearings for certain rate increases in assisted living facilities. This is an area that we have seen an unexpected number of complaints over the past few years, and a lot of them do come from legislators where constituents are reaching out because they have planned for. Right? They've gone into into assisted living or managed residential communities, and they've kind of planned out how long their finances will allow them to stay there and have appropriate rate increases to their plans of care. We know that people are going to have changes, and they're gonna have to have expanding care plans that might increase the rate that they're paying. However, we've seen as much as 40% rent go up, And people can't plan for that. I think it's also as taxpayers we need to pay attention to that because then people go through their funds faster than they planned for, and they end up in a higher level of care, and end up on Medicaid a lot faster. So putting these protections in place while also balancing out the ability for these settings to appropriately raise and meet the cost of living, and what they're paying for. I thank you all for, and we absolutely support. S b one two five, an act restricting private equity ownership in nursing homes. Nursing home residents deserve a safe person centered and stable environment. Our work is rooted in the lived experiences of residents and family members, and we consistently see that when facilities ownership changes or control becomes more complex, it's harder to identify who's actually accountable, and those layers break down. We're actually trying to hold someone accountable. Layered ownership structures can separate nursing home operations, real estate, management, staffing, and consulting entities as they withdraw revenue from the facility. The quality concerns raise as we see different companies come in and set up these structures. This moves Connecticut in the right direction by addressing core system problems. The growing presence of investment driven ownership models in nursing homes that may prioritize short term financial returns over the long term stability, quality improvement, and resident well-being. While many facilities face real financial pressures, resident residents should not bear the cost of business models that depend on high related party payments. Aggressive cost cutting or frequent restructuring that hides responsibility. A key strength in this proposal is the concept of requiring ownership stability over a sustained period of time. I really think this will prevent the individuals that kind of swoop in, draw a lot of money out of the home, and then leave, and that creates real instability for our individuals living in these long term care settings. We've had to do nursing home closures, and when you transfer an individual, there's transfer trauma, and the impact to them is substantial. So we're really thankful that you all are addressing this and looking to put this in place So we can have that stability while also supporting the long term care settings that provide this care. Because we want healthy nursing homes, we want the industry to thrive, and we want people to live in long term care settings. And the correct word is live there. Live and prosper, not just go there and be there. So thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Do you know have an idea of how prevalent the swooping in is? Like, we know there's many good facilities, etcetera, but how big is this problem that we're looking at?

[Mairead Painter (State Long-Term Care Ombudsman)]: I don't have an exact number, and I can get that for you. How many companies have changed, where we've seen some of the challenges. It has been more frequent, I would say. At least we're seeing

[Rep. Jane Garibay (House Chair, Aging Committee)]: Becoming more now?

[Mairead Painter (State Long-Term Care Ombudsman)]: Yes. The changes in ownership happening more frequently, more than one or two a year, which we would technically see. We're seeing many more. And some are for a benefit. Right? Sometimes we're seeing some bad actors leave, and we're seeing positive changes, but we wanna continue that, and we wanna continue to have that level of accountability and oversight.

[Rep. Jane Garibay (House Chair, Aging Committee)]: For the few that need it. Mhmm. Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Yeah. I just wanna say thank you again for all the work that you do, for looking out for, our aging population and all the different facilities that they're in and really being the voice that connects to us and helping us, to make it better

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: for them. So I just wanna

[Rep. Jane Garibay (House Chair, Aging Committee)]: thank you. Is there anyone else? Rep.

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: Echoing what, what the good senator just said. Thank you. The, we're we've been struggling with the the the whole concept of the of, of change of ownership for quite quite some time, and there's always the two sides to each of these stories. So we're trying to navigate our way, just so everybody knows. We're trying to navigate our way, to sorting out the bad actors, and and understanding the, the, you know, the financial makeup and the the history involved with those that are good actors, the ones that we want to see own homes that are currently in trouble. So, you know, I'm not certain we're gonna we're making progress every day, but I'm not certain just exactly when we're gonna hit the Holy Grail. But the information we get from from you and and the folks in the field is invaluable. It's the early warning system. Thank you.

[Mairead Painter (State Long-Term Care Ombudsman)]: Thank you. And, yes, my team. Senator Wong?

[Sen. Tony Hwang (Ranking Member, Senate)]: Thank you, madam chair. And thank you, miss Porter for your work in in advocacy. I I just wanted to ask in regards to, Senate Bill one twenty three, requiring public hearings. We we we addressed this issue last year, in committee. It passed out. And I think at the last minute, ran into some roadblocks in regards to, organizations. And and and can you offer a little bit more, feedback in regards to why this bill was important, in in the sense that many of the residents and their family members get a surprise notice when these rate increases occur and they really don't have a choice. And it's either take it or completely have to alter their their setting and and move to a new location. At least this kind of transparency and and, a public notice is critical. Can you offer some input related to that?

[Mairead Painter (State Long-Term Care Ombudsman)]: Sure. Thank you. Thank you for the question. Yes. Individuals, as they're planning on going into managed residential communities, often find out they're now allowed to because we passed a bill a few years ago. Look at what the history of the increases have been. Right? So they can have that look back period. However, we've seen, again, other companies come into our state and unexpectedly raise these increases. And not just on the plans of care, but on the rent side. And people plan. Right? People want to be good stewards of their health care, of their finances, and so they plan ahead, and they put money aside, and they try to project out the best they can what their needs are going to be. And so having these increases change more than once a year. So it's not just annual increases, but sometimes we're seeing them twice a year. We've seen companies that they've said, well our costs have gone up without really defining it. And that has surprised individuals living there. They have sold their homes, they've moved out of their apartments, and their life is really within these communities. They've built relationships, and we're seeing people live in these communities longer and longer. They're choosing to receive their long term services and supports in this setting, and they're willing to pay for the services that they receive. It's just when there's gouging, and they're being taken advantage of related to their finances. And then we're getting notices that they're being evicted because they don't have the finances to stay there. It really destabilizes the individuals who are living in these settings.

[Sen. Tony Hwang (Ranking Member, Senate)]: One of the pushbacks on on this legislation and the intent for transparency and notice is the fact that that that we're imposing on a a private transaction, a private entity making business decisions impacting their residents, and and where is the state's role in asking for this public notice. But but I think one of the lessons learned from last year is it it it is not imposing on their ability to make business decisions, but to give more greater transparency and and public notice so that family members and residents are not surprised. But, also, I think it it it raises awareness to some of these pricing increased policies that some of these homes may not want the public to know. So I I think what do you answer to that in regards to how we as policymakers are looking to engage and impose on a private transaction? What is the the the justification? For me, it seems very important to give transparency, but but how would you pose that argument in regards it's a private business transaction. Where do you come across as as a state policy maker to say, you need to have a public hearing and let people be aware of these pricing policies?

[Mairead Painter (State Long-Term Care Ombudsman)]: I think that we already demonstrate that as a state when we're looking at fair rent commissions. Right? Rent between a landlord and an individual is a private contract. However, we have fair rent commissions to ensure that people have appropriate housing, that they have stability, and that they are also not being gouged with large fee increases. And that stability of housing is so important. One of the largest groups of individuals being unhoused at this time is older adults. That's so incredibly frightening to me. I've gone out to some of the areas where individuals are living who have been unhoused, and there's many older adults. And that is heartbreaking. And I think we need to ensure that we're protecting these individuals. We are maintaining a level of honesty and protection within our state, and we're demonstrating that under the fair rent commissions, and I think including that for individuals who have planned well. Right? They've planned well. They've tried to do the right thing, and we need to protect them as well.

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: I I

[Sen. Tony Hwang (Ranking Member, Senate)]: really appreciate that, and and you you you serve that role as ombudsman so very well. And I wanna give some kudos to the chair of this committee because in the past, we have discussed the ability to have a, senior's bill of rights to be able to have some of the standards of of protection and and and respect and courtesy. I hope that we continue to focus on that issue, and and this may be a part of that solution to give the same rights and and and considerations to our aging population. So I I appreciate your thoughts and feedback. And thank you, madam chair, for the opportunity to ask these questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Is there anyone else? Seeing none, as always, thank you very much. Thank you. Next is, Catherine Holt, State Office of the Healthcare Advocate.

[Catherine “Kathy” Holt (State Healthcare Advocate)]: Good morning, Senator Hakkadel, Representative Garibay, Senator Huang, and Representative Bilinski, and distinguished members of the aging committee. I'm Kathy Holt. I'm the healthcare advocate for the state of Connecticut and my office assists consumers with all types of health insurance and how to find health insurance, and how to overcome obstacles to getting health insurance. I wanna thank you for considering Senate Bill one twenty four. I submitted testimony, written testimony on multiple bills, and and also on this one, but I wanted an opportunity to come and speak to you because I have some very strong feelings about what we're doing with our municipal agents. So, Senate bill one twenty four would close a loophole that allows people such as Medicare insurance brokers, real estate agents, financial advisors, accountants, and others from benefiting at the expense of older adults by leveraging the position for personal gain. We saw this, over the last year with a particular example that, made me realize how vulnerable our older adults are, when there's a position that is so highly respected and there's so much integrity in each community that the municipal agent holds. I have a unique relationship with municipal agents. Prior to coming to the office of the healthcare advocate, I was the lead Medicare trainer for the, Center for Medicare Advocacy for about a dozen years. And my relationship with municipal agents came because we did boot camp training, about fifteen hours of specific Medicare related training with individuals who were municipal agents. And mostly, they worked in senior centers. They were part of, the the, municipality in some way. Sometimes they were, they're just very interested volunteers. But what we see happening at this point is, an opportunity to come to these municipal agent positions and provide, some rather biased information. So going back to the choices training, I would say, one of the rules, to take choices training is that you cannot have a conflict of interest. So we would get great brokers who would come to the Center for Medicare Advocacy and say, I'd like to take your training. And we'd say, no, because you're biased. You have a financial stake in this opportunity. And in order to be a CHOICES counselor, in order to be one of the state health insurance assistance program counselors, you need to be unbiased. You need to present all of the opportunities that a person has to obtain a Medicare plan and go through all of the, opportunities in a way that is purely for the benefit of the consumer, the beneficiary, and not for your financial gain. Even if you have the best of intentions, there's always going to be an issue with financial problems. So one of the issues that came up with, the way that Medicare is structured is that the private Medicare Advantage plans offer a much higher commission than the public Medicare plans. And so I would talk to agents who had no idea who I was at different conferences, and they would say, oh, I never recommend traditional Medicare to a patient or to a to a beneficiary. Which concerned me significantly, because there are people who should be in traditional Medicare, just by virtue of their health care circumstances. So I would like to just provide one example why I believe it's so important for municipal agents to avoid conflicts of interest. And I'm gonna focus not on the other issues that I talked about, which were, you know, real estate, there's there's housing involved that that municipal agents give advice about, there's financial issues, there there's any one of these that could be ripe for conflict of interest, but particularly on health care. 20% of medic Sorry. 20% of Connecticut residents are Medicare eligible. They have Medicare. That's about 750,000 people in Connecticut. Out of those 20%, or out of the 750,000, approximately 200,000 are, dually eligible for both Medicare and Medicaid. So if we look at 200,000, people who are trying to figure out what's the best place for me to be in terms of my Medicare benefits. We can compare, for instance, the resources that go into an organization like Access Health Connecticut. I I happen to be on the board of Access Health Connecticut. I know it is incredibly well run and well resourced, and they do so much for every single person that comes to Access Health Connecticut. So who properly advises dually eligibles on the appropriate Medicare plan to choose? Mostly in Connecticut, it's only Choices counselors and municipal agents. Brokers often seek out duals as they provide the highest level of compensation and commission. And that has to do with the fact that because someone is dually eligible, the private Medicare Advantage plans add on additional compensation for risk assessments and other administrative charges. Being in the wrong Medicare plan can cost Medicaid a great deal of money. If Medicare doesn't pay, Medicaid will pay as the payer of last resort. If brokers are municipal agents, there's less protection for beneficiaries and more costly health care for the system and for Medicaid in particular. We need to hold the We need to hold tight to the integrity and the respect that have come from the last fifty years of municipal agents in every town in Connecticut. And trust in local communities that municipal agents will be able to avoid conflicts of interest that are so important to the people that they serve. Thank you very much. I'm happy to take any questions. And I appreciate, again, the opportunity.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you very much. And I think this is just the tip of the iceberg. It's one case that just became so blatantly obvious. But it means that it's been happening in other areas, so it's a way long past due. Anyone else? No? Okay. Thank you very much. Next, we have Michael Werner, CW at CSEO.

[Michael Warner (Lead Aging Policy Analyst, CWCSEO)]: Good morning, Senator Hockadell, Representative Garibay, Senator Huang, Representative Balinski, Senator Miller, Representative Fortier, and the other distinguished members of the aging committee. My name is Michael Warner. I'm the lead aging policy analyst for the Commission on Women, Children, Seniors, Equity, and Opportunity. And today I'm joined by Yale students, from the School of Public Health, and our policy fellows, Amanda King and Leila Henry. And we are here to testify in support of Senate bills one two four, and one two five, as well as House bills five one four two, and five one four three. And before I begin, I just want to echo the remarks by representative Polinski and the other members of the committee, just really expressing appreciation for our Department of Aging and Disability Services as well as the Long Term Care Ombudsman Program. We're so lucky in this state to have the leadership that we do, both here at the committee and in those agencies. And similarly just wanted to underscore that I hope we can also restore the state wide senior center coordinator position, because like the municipal agent position, it's very critical and important for helping with a lot of responses to what we need locally. So Connecticut's facing an aging population boom. According to the Connecticut Healthy Aging Data Report, older adults 60 and above have risen from eighteen percent of the population to 25% of the population since 2021. And we are positioned to grow significantly further in the next decade and a half. So these bills before you help to prepare us for that surge in a variety of very thoughtful ways. And Senate Bill 124, and that concerning the Department of Aging and Disability Services recommendations regarding municipal agents for aging helps to bring greater dignity and integrity to the role of municipal agents for the elderly, by first updating the title to municipal agents on aging to be more in alignment with the terminology used in the field of aging services. And secondly, the bill gives meaningful clarity to the importance of preventing potential conflicts of interest or its appearance by those who inhabit these important municipal guiding roles with, which help local residents to navigate various resources as we heard including taxes, housing, nutrition, health insurance, social security, and energy assistance. The bill calls for certification of no conflicts to be administered by aging and disabilities, services to ensure confidence in these trusted advisors. CWCSEO also supports house bill five one four three, an act requiring training for homemaker companion agency employees with the recommendation to include an oral health dental hygiene training for homemaker companions and caregivers. About sixty two percent of our population of older adults, 65, have four or more chronic conditions, and it's been shown that, there's very strong connections between poor oral health and these chronic conditions. So the more that we can do in terms of educating caregivers, the better in that space. We also recommend structured cultural competency trainings to ensure that caregivers understand how language, family dynamics, religious practices, and cultural values shape expectations around care. Connecticut is the most diverse state in all of New England as far as its population index, and we have particularly strong growing Asian American Pacific Islander populations who tend to keep their families at home too. So the more that we can help bring this cultural training, the better.

[CWCSEO policy fellow (unidentified)]: The commission also supports House Bill five one four two, an act concerning the use of technology for virtual visitation and monitoring in nursing and residential care homes. This bill affirms the right of residents to use the technology of their choice in their living space and strengthens the existing law by making two crucial changes in line with the legislature's ongoing work to promote independence and dignity for older adults and those living with intellectual and developmental disabilities. The first change extends the protection of technology use rights to those living in residential care homes. The second change establishes accountability. If a facility observes resident obstructs resident's lawful use of technology, this could be a class b violation under this change. And that class b violation would carry with a a civil penalty. In 2021, the legislature protected the rights of those living in nursing homes to use technology. The same rights that those of us living outside of facilities have. The proposed changes make these rights real by extending them to residents of care homes and establishing accountability.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: The commission supports SB, one two five, enact restricting private equity ownership of nursing homes. The proposed bill as written does not prohibit private equity investment, but rather it ensures the transparency necessary to safeguard long term care residents. Existing policy requires disclosure only at initial licensing. This bill mandates annual detailed reporting of of ownership entities. Representative Garibay, to answer your previous question, an estimate of about 5.4% of nursing homes in the state of Connecticut have private equity ownership according to the private equity risk index. However, this is likely an underestimate due to layered ownership, which is precisely why we need increased transparency. Currently, opaque ownership structures make it difficult for the state to track how public dollars are being spent and difficult to assess if and how ownership affects or for ownership type affects quality of care. This bill also addresses show short term ownership practices, an investment strategy that raises concerns in an industry stream needs. Section f requires approval from the commissioner of public health before a nursing home can be sold within five years of acquisition. Strengthening oversight duration could help realign incentives while preserving potentially stabilizing capital. Other states including New York, New Jersey, and California have already passed nursing home ownership transparency laws. We recommend that Connecticut follow suit so that the state can better evaluate market and quality impacts to promote a stable and accountable long term care system. Thank you for this opportunity to testify today.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. My first Question 4% Yes. Does that mean out of 100 owners? 5.4% are private equity. I believe so, but they could own 30% of the nursing homes.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Oh, that is a yeah. I am that

[Rep. Jane Garibay (House Chair, Aging Committee)]: is a good question. You can get back to me on that one. I'd be curious because I understand that it might only be 5%, which it just doesn't sound very much. But they could have a major ownership in the chains, etcetera. So Right. Anyone else with a question? Rep Fortier.

[Rep. Mary Fortier]: Thank you. I don't have a question, but I do wanna thank the young women. It first of all, for your detail and specificity about the the language in the bills, we appreciate that. I mean, not that for the public to hear that is is appreciated. And I have to say, I have a daughter who's a social worker, and a has a public health degree. So you're in a important field, and we wish you well, and you're on your way. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Can you tell how excited we are to have you here today? Senator

[Sen. Martha Marx]: marks. Thank you. Chair through you. Thanks for being here. So 5143 is so needed, right? I'm a visiting nurse. I've been a visiting nurse for a really long time. And the homemakers and companions have actually absolutely no oversight from their agencies. It's just the one of the fastest growing industries, but yet it's just it's not regulated, and that's a whole we can go down another rabbit hole with that. But one of the biggest things, that I see is infection control. So I think infection control really needs to be in there. You know, if I'm taking care of a wound as a nurse in in homes or if, even if you just touch a patient's, and then you go to touch your nurse's bag, you have to take off the gloves, you have to wash your hands, and then you can go into your clean bag to get supplies. There is no infection control teaching with the homemakers and companions, and sometimes they go they see three different clients in one day. And actually, I don't think that the home care agencies need to supply the home care agencies that need to sub supply give the homemakers and companions any supplies because many of them don't have the Purell. They don't have gloves. They don't have an apron if the patient did have c diff. And if you have c diff, actually, you have to wash your hands with soap and water for at least twenty seconds. It the the Purell doesn't work. So there is so much more that needs to be done, but in your I am really busy in the committee that I cochair, but I really can't believe that the agencies don't give supplies to these mostly women, mostly women of color, taking care of all of our seniors and disabled in our community and really aren't treated very well when it comes to I'd like to unionize them, but maybe when I'm 80, I'll be able to do that. So I don't know if you've encountered that, if you've talked to home care agencies or any homemakers and companions, what they see with infection control in the home.

[Michael Warner (Lead Aging Policy Analyst, CWCSEO)]: Okay. Thank you so much, Senator Marks, for that very thoughtful reflection. And I think, you know, one of the great things about this legislature is that we bring in folks from all over, from different industries to be able to share their expertise. So I I am in alignment with what you were just saying. I agree infection control is important. And, you know, one of the things that we're doing here in Connecticut, that's been a a main goal of ours since 2003 is is this idea of rebalancing. And, you know, we have folks in, long term care facilities, and then we have folks who are aging in place at home. And what we do know now is that we have, as I said, a booming senior population that's growing, in in the next fifteen years, it's gonna be tremendous. So the more that we can position ourselves thoughtfully, as you just suggested, and through these other recommendations, including oral health and cultural cognizance, the better we will be positioned to serve those populations.

[Sen. Martha Marx]: Thank you, Through can I ask another question? Sure. Okay. Thanks. And also with the cultural competency, it it works both ways. I mean, sometimes the patients can not be very nice to the homemakers and companions who don't look like what they look like, and my heart just goes out to them. But when it comes to cooking, right, like food is I mean, you know, and here you have somebody that's gonna cook for you. I mean, I don't know why I mean, it's not great getting old, but if you're gonna have some day that's gonna cook for you, that's pretty nice. And but they just have two completely different worlds about what regular cooking is, and they don't know. It's just I wish sometimes so many people could just go into some of these homes and just see what happens, and, they get abused. The homemaker's companions get so abused. It's it's sad. But I will tell you that when it works, it really, really works super, super well, and I tell people sometimes, you just have to try a couple different people. It's hard to live with anybody. Right? I've been divorced twice. I'm not too good at it. So that's you really just have to sometimes try to work it out. It can work, but we just have to put a little bit more elbow grease into it to get it to work a little bit better for all those. I know this is an agent committee about the elderly, but I want both peep both of the, people in the homes to be treated with dignity and respect.

[Michael Warner (Lead Aging Policy Analyst, CWCSEO)]: Thank you so much, Senator Marks. And, I'm so glad you raised that topic. I had the good privilege, this past fall of, co teaching a class at, Yale School of Public Health. And one of our students, Ronnie Hu, and, another fellow of our commission, Kat and the, we, did some research into, different older adults in our state through culinary cuisine that is tailored for the folks who are receiving them. And it turns out you know, there's there's there's two ideas that we were able to present at the Moving Beyond Implication Conference that was here, a couple weeks ago. And, we talked about food safety when it comes to preparation, when it comes to having awareness in the staff about the dangers of pneumonia and aspiration, which can be deadly, and it can be very expensive. And there's some ways to prevent that through training for kitchen staff in long term care facilities. But we also uncovered very interesting research when it comes to, folks who are in, long term care facilities, for example, who may have different cultural, ethnic backgrounds, who maybe they don't, maybe they refuse what's being served if it's a one size fits all approach. And it turns out that, states like Ohio have incorporated asking upon admission about a resident's relationship with food, what types of foods do they like, from their background, so we don't have this outright refusal. Because what happens is that certain folks that are in these facilities, if they're just going to keep refusing the food, they're going to develop what's called sarcopenia, which is a muscle atrophy condition. In this instance, the food is acting like a medicine. And food as medicine is another important area that we've been working on here at the legislature and at the commission. And so it turns out further that the sometimes these ingredients that are in different ethnic food, bay leaf, turmeric, others have other health benefits that are incorporated into that. So we were able to present on how it would be great if Connecticut could also require that so that when folks are being served, whether at home or particularly in the long term care facility, and they're being served food that's meaningful for them, because not everyone has a nearby relative who's able to bring it to them, that they actually will thrive and and not fail to thrive. So thank you for that question.

[Rep. Jane Garibay (House Chair, Aging Committee)]: One more short one.

[Sen. Martha Marx]: Yeah. I'm just gonna say thank you. Yeah. Thank you for that. But I'm just gonna bring a right back is infection control is the number one thing we have to worry about. I think we all forgot. We just went through this horrible pandemic, and we also have infection control didn't always work that well. So infection control. Alright. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, senator. No. Thank you. Thank you so much for coming today and for testifying.

[Michael Warner (Lead Aging Policy Analyst, CWCSEO)]: Thank you very much.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. We're gonna move on next. I'm gonna remind those following that you have three minutes to say your piece, and we'll appreciate that. There is a timer. The buzzer will go off if you go past. Next is Mag

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: Morelli.

[Mag Morelli (President, LeadingAge Connecticut & Rhode Island)]: Thank you so much. And I think I've signed up twice on the list, and I apologize for that. I couldn't remember if I had signed up or not. So but good morning, senator Hakadol, representative Garibay, representative Fortier, and all the the legislators that are on Zoom. My name is Mag Morelli, and I'm the president of LeadingAge Connecticut and Rhode Island representing not for profit organizations serving older adults across the continuum of aging services. Thank you for this opportunity to testify this morning. We've submitted written testimony, so my comments will be brief. First, in house bill five one four one, which would require assisted living service agencies to provide annual training on residents fear of retaliation. Nursing homes already provide this training, and we support extending it to the assisted living. The long term crown ombudsman recently updated the nursing home curriculum, and we would welcome the opportunity to work with our office to tailor it to the assisted living setting. House bill five one four two would extend the Connecticut's nursing home virtual monitoring and visitation statute to the residential care homes. We don't oppose extending these rights, but we wanna emphasize that residential care homes are fundamentally different from nursing homes. RCH residents generally live independently, and these settings are licensed and funded differently. The bill is drafted, applies nursing home reimbursement and infrastructure requirements to RCHs. Even though RCHs are funded through the state supplemental program and don't receive Medicaid reimbursement. So we urge to the committee to revise the reimbursement language to reflect these differences. The bill also proposes a penalty for tampering or delaying the installation of equipment. We believe that current resident rights laws already provide enforcement mechanisms against this behavior, but if the section is added, we if it's suggested a small edit. Senate bill one two five seeks to restrict private equity ownership of nursing homes, and we understand the interest in this issue and have submitted more extensive comments. We do urge careful consideration of any new statutory language so as to both avoid unintended consequences and to ensure that any new reporting requirements are not duplicative. In the meantime, please be assured that there's already comprehensive change of ownership statutes in place in the for nursing homes, as well as significant financial disclosure requirements provided for licensure and licensure renewal. We recommend replacing the term ownership entity with investment entity to distinguish private equity firms from other owners and limiting new DSS reporting requirements, to facilities involving investment entities, and those that have provider Medicaid provider agreements. Currently, all of the reporting goes to DPH. So this is adding a DSS reporting. We've added other suggestions too, and that's in our written testimony. The homemaker companion bill from five one four three, we request that the law ensure training options that are diverse in cost, location, sponsorship, and delivery method, and that agencies be allowed to submit their own training programs for approval. And finally on senate bill one, two, three, which will require public hearings for certain assisted living facility increases in 2024, leading age Connecticut as well as other, associations. Is that my timing? Sorry. Worked with the ombudsman's office to pry to, increase the consumer protections for those that are living in assisted living, and we believe, that that legislation, is appropriate. And so that this legislation is not necessary at this time. Thank you. I'd be happy to answer any questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. I know it's hard. You know, time it out and it just I thought it was my phone at first. I Thank you so much. Are there any questions? No. We look forward

[Mag Morelli (President, LeadingAge Connecticut & Rhode Island)]: to working with you. Thank you very much.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next, Karen, does anyone want me to read down the list a little bit so you know who's coming up? Or are you okay just going person by person? Okay. Next is Karen Carty from the Alzheimer's Association.

[Karen Carty (Alzheimer’s Association, Advocate/Educator)]: I I do. I'm good. My name is Karen Carty, and I'm here to testify about the support for required dementia training for homemaker and companion agency staff. Raise bill fifty one forty three. I'm an advocate and community educator for the Connecticut Alzheimer's Association. I was in my early twenties when my grandmother came to live with me and my mother because of her Alzheimer's diagnosis. I was totally unprepared to deescalate my grandmother's behaviors to keep her calm and get her cooperation, which was totally necessary because I was spending most of the day with her. Well, I finally figured it out. As a community educator now, I've heard from the public that many of our homemaker companions in Connecticut seem unprepared. Many of our companion homemakers are wonderful, dedicated people, so I don't want to disparage any of that. I've been told that companions hired for people's loved ones had no experience with dementia within the first first few days. Companions also left their jobs abruptly stating reasons like, the client wouldn't cooperate. They yelled at me. I didn't know the client would be like that. And we've all heard of companions, unfortunately, being on their cell phones and not engaging with the person unless they had to. We know this is not companionship. This homemaker companion training is a necessary bridge to essential caregiving knowledge for companions be because we know this job is extremely challenging. The companion is a stranger to the person with dementia, so that when they start the job, they need to already know the skills to gain the person's trust through patience and cooperate co compassionate communication. They also need the confidence to focus and keep the person with dementia safe, to supervise them in daily tasks in considerate and respectful way, monitor any changes in them, and most importantly, the homemaker companion needs to develop a structure to keep the person stimulated, but also calm as possible during their time with them. Thank you for listening to my testimony, and I'm happy to answer any questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much for sharing your story and advocacy. Are there any questions? Seeing none. Thank you very much. Next is going to be Natalie Shufelt and followed by Cecilia Livingston.

[Natalie Shirtliff (Associate State Director, AARP Connecticut)]: Good morning. My name is Natalie Shirtliff. I am an associate state director with AARP Connecticut. We will be submitting extensive written testimony later today, but I just wanted to share my kind of oral comments on a few of the bills before you today. So first, I wanted to express our support for HB five one four three, an act requiring training for homemaker companion agency employees. Homemaker companions can play a vital role in supporting people in their homes and providing support to family caregivers through that assistance that homemaker companions can provide. But it is important that they are given training so that they have the skills needed to support, folks in their home. You know, in as you all know, increasing the availability and quality of home and community based services is a top priority for AARP. We are fighting for older Americans to have high quality affordable options when it comes to long term care, especially at home. And we believe that, this bill will help support that goal. So, moving on, we also support HB five one four one, an act requiring fear of retaliation training for persons provided providing assisted living services in managed residential communities. This has worked well in nursing homes providing this training. We support extending it to to resident to assisted living employees. So then moving on, h b five one four two enact concerning the use of technology for virtual visitation and monitoring in nursing homes and residential care homes. Again, we have supported in the past extending the use of virtual visitation technology to, and monitoring to nursing homes and support expanding it to, you know, residential care homes also knowing that, you know, there may need to be some changes, you know, due to the different nature of those homes. And we also fully support adding penalties for tampering with or preventing individuals from using the technology, including, you know, making sure that employees aren't discouraging people from using it, making sure that, you know, everyone has the ability to use it if if they would like to. And then, the senate bill one two four, enacting concerning the Department of Aging and Disability Services recommendations regarding municipal agents for the aging. We'd like to also some offer our support for this bill to ensure that people don't have conflicts of interest that harm our our older residents.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: so much.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Are there any questions? Thank you.

[Natalie Shirtliff (Associate State Director, AARP Connecticut)]: Great. Thank you so much.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next is, Cecilia Livingston, who will be followed by Christy Coval. Okay. We don't see Cecilia online, so, Christy Covell.

[Christy Colville (Government Relations Director, Alzheimer’s Association CT Chapter)]: Good morning. Senator Hockett, Representative Garibay, distinguished members of the aging, committee. My name is Christy Colville. I'm the Connecticut government relations director for the Alzheimer's Association Connecticut chapter. It is my pleasure to be here today to talk about, raise Bill 5,143, which is, an act requiring training for homemaker companion agency staff. I'm also grateful that we had a number of advocates who have submitted written testimony and some that are going to be presenting today in person. And I just want to talk sort of overarching about where we are in Connecticut. So, for folks who are looking for services in the home, we have the skilled home care agencies, and then we have homemaker companion agencies. Both provide very vital services for those living with Alzheimer's or another form of dementia. When people will call our helpline, they typically will ask about different agencies based on the services they need, and we can provide some guidance about different agencies. And unlike the medical agencies, homemaker companion agencies provide non medical services. Things like companionship, meal preparation, transportation. But they also can provide this vital services for people that are living in the home and can monitor changes if there's changes in someone's loved one, in their condition. We do we do know that the number of homemaker companion agencies, according to a Connecticut Mirror article, it's now somewhere over 900 of these agencies. And these agencies, unlike the medical home care agencies, they're overseen by the Department of Consumer Protection, and they do not have any training requirements for those who are living with Alzheimer's or dementia. So, our ask, because there has been a number of initiatives in the last few years that I've been able to participate in, one was the Homemaker companion task force that we sat on, and a recommendation was to have dementia training. And then there was a report issued, in the beginning of last year, 2025, to have dementia training for the homemaker companion agency staff. So we believe having this training, you know, it's a long standing recommendation. It's necessary, it's timely, and it will have parity with the folks who are receiving home care services in the home. One thing to note. Is we would support consideration that this training be portable. So if a caregiver works for a certain agency, and they leave that agency to go to another agency, that the training can go with them. I think that this would remove barriers for family members who are trying to get a caregiver in the home, and it also would help the agency expedite being able to have that person trained if they're trained, and then they go to another agency within a short period of time. I am happy to answer any questions. You have my written testimony. And I thank you for your consideration.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Are there any questions? Repolinski.

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: Thank you so much for your your advocacy on so many, important issues. I do have a question and I and and I may got I'm gonna preface it with an apology because I walked this late. When we talk about the, you know these non medical Agencies. And training them. Are they also subject to the same background checks to make sure that. That we that we're not introducing, folks that might have a history of elder abuse, for instance. To a home.

[Christy Colville (Government Relations Director, Alzheimer’s Association CT Chapter)]: So I have to get you the answer that because, to be honest with you, I don't know the full scope of that. I believe there are some and there are, you know, I didn't mention this, but there are a number of care companion homemaker companion agencies that also provide dementia training. So some are doing it. It's just not required, but I certainly can get you the detailed information about what that looks like.

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: Alright. Thank you. Appreciate that. You want to look at it? Yeah.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. I think one of our goals has been these past few years to make sure that no matter where a person chooses to age that they have the same protections and care. So thank you for your advocacy. Sure.

[Mairead Painter (State Long-Term Care Ombudsman)]: Any other questions? Okay. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Next is, Erin Mahoney followed by Tanya Marr. Aaron's not here. Is Tanya here?

[Tanya Mower (Volunteer Advocate, Alzheimer’s Association)]: Before I actually start the timer, I I was hoping and I apologize. You might have gotten a preview. I I would like to play an audio. It's only, ten seconds, and it will also likely inadvertently support, bill fifty one forty two. It's of my mom. I'm her p o a. Is that okay? Okay. Senator Huckadel, representative Garvey, and distinguished members of the aging committee, my name's Tanya Mower. I am a volunteer advocate and community educator with the Alzheimer's Association. I'm here in support of Bill fifty one forty three, act requiring training for homemaker and companion agency employees. Before I share an experience, I wanna syringe with medication that needs to be given. There really isn't a need for clinical type training. I don't have clinical training, and I'm a caregiver for my mom who was diagnosed with Alzheimer's in 2017. However, there needs to be dementia training for all direct care staff, and that includes those that are non clinical. With that said, I will play this audio. That is my mom. She's 83. She has mid state Alzheimer's. Hold that image in your mind and hold that emotion when you heard her scream. How do you think I felt when I heard it? She simply wanted someone to help her, not barrage her with a bunch of commands. Note, she is not injured after this event. In that moment, do you really think somebody with training from a clinical perspective would help? The answer is no. It is evident because the folks that were helping my mom were clinical nurses' aids. The situation you heard was corrected, and it came down to training, specifically on how you work with someone with dementia, training that you have to go slow, pause, Let them process what is being asked, that you need to distract and redirect with kindness and compassion. Don't yell. Their brain just isn't working the same. It doesn't mean they're deaf. Use their name, smile at them. They are not something to check off on a list. They are human beings that need to be understood. They are human beings with shrinking brains. A portion of our population will be diagnosed with a type of dementia, and that is growing. Companions, homemakers are in high demand and they also need to support our family members and they need to be trained. In summary, someone does not need to be clinically trained to support someone with any type of the many dementias. They do need to be trained in behaviors, redirection, maintaining hygiene, maintaining nutrition, communication, and how to provide total engagement for the best quality of life. Doing all this with respect, with empathy, with compassion, while preserving dignity of the human they're caring for because I, the family, can't be there. And if we could, we would. Thank you for allowing me the opportunity to share my comments. Any questions?

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much for sharing your story with us. Rep Balinski.

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: I just I I'd like to just point out to the casual listener to this really important testimony how how incredibly real it is because, you know, we we sometimes sit in our chairs in the legislature and we, you know, we try to dictate, we try to mandate, and we sometimes get a little bit broad. But the role of the, you know, the non clinical treatment companion and family members. Our family our family participated in caring for for two fathers for ten years. And the ability to step back and listen and think, it's never occurred to me that that is something that needs to be learned by everybody. Mhmm. So, your testimony really is terrific. Thank you so much.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you.

[Tanya Mower (Volunteer Advocate, Alzheimer’s Association)]: It also goes to the power of having devices in rooms. Not as a monitoring term tool, but also as a training tool. I share that information with the folks that watch my mom.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much for that. And as it has to be a comfort also Correct. To be able to see your loved one and just at night whenever to know that they're okay. Exactly. So thank you for your testimony.

[Tanya Mower (Volunteer Advocate, Alzheimer’s Association)]: You're welcome.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Yeah. Next next is Marilyn Kowalski followed by Elise Couture.

[Marilyn Kowalski (Volunteer Advocate)]: Senator Hockadell, Representative Garroway, and members of the aging committee, my name is Marilyn Kowalski, and I'm a volunteer advocate on the Greater Hartford Walk Committee for the Alzheimer's Association Connecticut chapter. I wanna comment on bill fifty one forty three. In 2009, my husband Ted was officially diagnosed with Alzheimer's. For a while, he was able to manage fine while I was at work. He could get around, make his lunch, go for a walk. But when his condition deteriorated, I needed to have someone stay with him while I was out. Most days he went to a dementia daycare, but Fridays I needed help in the home. I tried hiring from an agency, but many were not familiar with people with dementia. They got frustrated and ended up leaving after one or two visits. I ended up finding an old acquaintance who had experience caring for someone like my husband. Caregivers need to be able to meet someone on their own reality. There are definitely ways to calm someone that is agitated. It's also important to help them keep their dignity and allow them to feel like they are valuable and cared for individuals. Small things like when it's time for lunch, don't ask what they want. Ask, do they want a grilled cheese sandwich or a turkey sandwich? Sometimes asking an open ended question is too broad and just frustrates someone with dementia. Care providers need to keep calm and not get bothered by repeated questions or comments. It sometimes takes time to get a thought out so patience is needed. If caregivers are trained in advance, they can anticipate this and be prepared to properly handle the behavior. At a certain point those with dementia aren't aware they can no longer cook safely, so even if the person insists they know how to do it, the companion needs to take care of it. I was lucky the person that stayed with Ted gave him assistance with dignity. It's very easy to react to someone with dementia. It's challenging for all that care for them. That's why a person with some amount of training about to know what to expect and how to handle different situations could make a big difference. I ask for your support for the dementia training for homemaker companion staff legislation. Thank you for the opportunity to speak today.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much for speaking because we do know that with training, we can learn not to take it personal, that it's the disease and not the person. And it's not easy, right? It's not easy, but we can but we can learn. Anyone else with a question or comment? Seeing none, thank you so much. Elise? Okay. We're gonna go on next to Carol Carol Scully. Oh, she's online right now. Carol, do you okay. Carol, can you unmute and put your camera on, please?

[Carol Scully (Family Caregiver Advocate)]: My apologies.

[Rep. Jane Garibay (House Chair, Aging Committee)]: There you go. Welcome.

[Carol Scully (Family Caregiver Advocate)]: Thank you. Thank you. So distinguished members of the aging committee. I'm here today as a daughter advocating for my mom, testifying on HB fifty one forty three in support of dementia training. My mom is 95 years old and living with advanced dementia. She received services under the elderly services waiver through the Connecticut home care program for elders. She is bed bound and unable to feed herself or perform any activities of daily living without a caregiver. Recently, she was abused by her live in caregiver. The incident was reported to her case manager who filed a report with elderly protective services. Our family is profoundly grateful for the Connecticut home care program for elders. Without it, my mom would likely be in a skilled nursing facility, which is where this journey began. In December 2020, my mom was hospitalized and discharged to short term rehabilitation for physical and occupational therapy. During that stay, she contracted COVID. Discharging her home required her family to demonstrate that she would have twenty four hour living care and appropriate medical supports in place. It was not easy to secure her reliefs. What followed has been a four agency journey marked by inadequate training, lack of dementia specific skills, and repeated safety concerns. We have worked with four homemaker companion agencies, nonprovided caregivers adequately trained in dementia care. One caregiver failed to feed my mom properly because she didn't know what my mom liked to eat. Another left my mom unattended in the bathroom while walking down the road away from the home. A long term caregiver frequently left for extended periods and replacements provided only minimal care. When concerns were raised with the agency, they were not meaningfully addressed. Caregivers accuse my mom of aggressive behavior rather than recognizing that dementia related distress often reflects confusion, fear, pain, or unmet needs. Most recently, one caregiver started a kitchen fire requiring emergency response. Another served unrefrigerated food leading to illness and malnutrition. I personally witnessed a caregiver taking my mom's face in her hands and whisper, don't say a word. Shortly thereafter, visible scratch marks were front along my mom's torso resulting in a referral to elderly protective services. Each caregiver claimed to have dementia experience, yet their care consistently demonstrated otherwise. Almost all of my mom's caregivers, well over ninety five percent, called her by the wrong name. For a person living with dementia being repeatedly misidentified as disorientating, dismissive, and deeply dehumanizing, it signals a lack of attentiveness and a failure to understand how critical identity, familiarity, and respectful communication are in dementia care. Not one caregiver consistently engaged my mom socially or emotionally. No conversation about her life or husband or her children or looking at family photos. No simple activities such as cards or puzzles to stimulate memory and connection. Dementia care requires more than physical assistance. It requires understanding, communication, changes, behavioral symptoms, emotional reassurance, and preservation of dignity. For these reasons, I strongly support Ray's bill five one four three, which appropriately requires ten hours of initial paid training for new employees, mandatory education, and continuing education. These are critical safeguards. However, I respectfully urge the legislature to amend subsection a to require completion of initial training within the first thirty days of employment rather than within ninety days. For medically fragile and cognitively impaired clients, three months is simply too long to wait. In my mom's case, significant harm occurred well within that time frame. Without early training in dementia care, respectful communication, abuse recognition, and safe toileting and feeding practices, funeral elders remain at serious risk. Thank you for your time and your attention.

[Rep. Bill Pizzuto]: We

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Did she leave us?

[Carol Scully (Family Caregiver Advocate)]: No. I'm here. Questions?

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. Thank you so much for, coming and testifying and telling your, very challenging story, to put it mildly. Any questions? Okay. Thank you so much. Next is, Tracy Wodock who's online, and that'll be followed by Jay Kiley.

[Tracy Wodatch (President & CEO, Connecticut Association for Health Care at Home)]: Thank you. Senator Hakadol, representative Garibay, representative Balinski, and representative Fortier, and all the distinguished members of the aging committee, I appreciate this opportunity to testify today. My name is Tracy Wodach. I'm the president and CEO of the Connecticut Association for Health Care at Home. I'm also a registered nurse with more than forty years experience in home based care. The Connecticut Association for Health Care at Home is the united voice for Connecticut's licensed home health and hospice agencies, and we also represent several homemaker companion agencies. I'm so sorry for not being there in person today, but I'm guessing you don't want my upper respiratory infection shared with the rest. Let me begin by saying we support the intent of improving quality and strengthening, training standards for homemaker companion agencies. That was the purpose of Public Act 2,348 passed in 2023, which began the process of transitioning these agencies from the Department of Consumer Protection over to the Department of Public Health. However, three years later, we have yet to develop that plan for transition and the raised bill, HB 5,143, has been put forth. We do support the concept, but we do have concerns around the specific training topics, number of required hours, and the compliance tracking process. Homemaker companion agencies are currently regulated under DCP regulations that date back to 2006. Regulations that really do not reflect today's realities, state funded initiatives, or the rapidly growing needs of older adults and individuals living at home. So yes, modernizing training standards make sense. But some of the training requirements in this bill are medically driven, including CPR, first aid and identifying changes in a client's condition. It is important to remember that homemaker companion agencies are required by law to provide solely nonmedical care. Mandating medical focused training creates confusion about scope of practice and could increase liability for agencies and workers. And notably, CPR and first aid are not required for licensed home health agencies, so it doesn't seem appropriate to mandate them for non medical homemaker companion. On the other hand, we fully support training requirements that are aligned with non medical care, such as personal care, communication, infection control, appropriate dementia and Alzheimer's support. I know Michael Werner mentioned the cultural competency and dietary needs, things like that, all all supportive. These are reasonable and necessary topics that will improve quality and safety. We also wanna emphasize the importance of training portability. I believe Christy Covell mentioned that many caregivers work more than one job. It's not just moving from a job to another one later down down the road. It's actually they work many jobs at the same time. It's important to make sure that we are efficient and, and cost effective in training purposes. Finally, we are concerned that the administrative and tracking requirements in this bill would create significant, unfunded mandates for agencies already operating in a severely underfunded and stressed environment. If our shared goal is truly to improve quality and build a stable workforce, the best solution is to invest in agency based Medicaid homemaker companion agency services so that we can recruit, train, and retain qualified staff. Our association, along with the Home Care Association of America, HCAOA, Connecticut have been working collaboratively on amended language last year in this, and we'd be happy to continue to work with the committee.

[Rep. Anne Hughes]: Minutes. Would you please wrap up your time?

[Tracy Wodatch (President & CEO, Connecticut Association for Health Care at Home)]: Yep. We'd be happy to work with the committee and other state partners to to formulate, training requirements that will really work. Thank you for your time and consideration. I'd be happy to answer any questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Are there any questions? Seeing none, we thank you very much for coming. Thank you. Next is Jay Kiley. Please post me. Okay. We're we're gonna move on to Matt Barrett followed by Marlene Ciccarella.

[Matt Barrett (President & CEO, Connecticut Association of Health Care Facilities/AL)]: On behalf of the Connecticut Association of Healthcare Facilities, a trade association of skilled nursing facilities and assisted living communities, my name is Matt Barrett, the association's president and CEO, and I thank you for the opportunity to present testimony in opposition to and with recommended revisions to raise bill number one twenty five and act restricting private equity ownership in nursing homes. As a first observation last session, there was a much more developed version of, this session, Senate bill one twenty five offered as a leadership amendment to Senate bill, fourteen seventeen. This is, identified as the LCO nine one six three to that bill, offered by, it was a leadership amendment, and I, provide a link to the amendment, and I and I, paste the amendment, verbatim to the end of my testimony. And while I don't, know that it was intentional intentional to draft this session's, legislation not reflecting any of the changes in LCO nine nine one six three, and I acknowledge there's no requirement, to do so, I do we are, as a first recommending recommendation, asking you to include those latest provisions as a starting point to this session's private equity, discussions. Even as our association is recommending additional changes, to this more developed proposal, l l c o nine one six three nevertheless did address a number of the technical issues previously identified and aligned more closely with the definition of investment entity with the CMS adopted definition of private equity. CMS has expanded nursing home transparency and ownership disclosure requirements. And finally, CMS's intention to for further review of these expanded ownership, disclosures. And I, source these comments, to, to CMS. Just for just to let you know, they're not specifically my own. These are CMS, provisions. And in CMS's own words, this transparency will, among other things, allow families to make more informed choices about the care of their loved ones, and I do wanna emphasize, I emphasize this, in my testimony, and it will enable CMS and others to scrutinize more closely how ownership types correlate with care outcomes and to determine which environments are more likely to to deliver better care for residents and patients. And, again, I source that. And on that point, I wanna say that adopting a state level evaluation provision similar to the one I just expressed recommended by CMS has even elevated importance this year as the CMS evaluation of the additional disclosure requirements that I've just discussed have been delayed. Three times in the previous federal administration, several times in the current administration, and in December it was announced that these provisions were suspended indefinitely, which was a language that I actually was not quite familiar with. CMS doesn't have the authority to, to repeal, unilaterally, a a a a regulation that was adopted in its final form, but nevertheless, it's suspended indefinitely at this time. And I think that elevates the stature or the or the need to to, on a state level, adopt the disclosure provisions that are were included in the LCO in a more detailed and technically correct fashion. And I do wanna, in the interest of time, I I I because I think my time is gonna expire. I wanna acknowledge that is a evolving and moving position of my association to be supporting these disclosure provisions with the additional, revisions. And I think we're doing so because I think we put a lot of stock in the idea that, the CMS, rules, first put forward and mentioned in president Biden's, state of the union address in 2023 were the most expansion, transparency, and disclosure requirements, I think, in the history of of the program. And there was a promise that they would be implemented, but I've just said they've, been suspended. And so I think, that causes us to reevaluate the need to adopt state level, disclosure requirements that are included in this bill. And so we're recommending, adoption of the disclosure requirements this year, but with some of the changes that, that are recommended by testimony principally. Please.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Can you please wrap up?

[Matt Barrett (President & CEO, Connecticut Association of Health Care Facilities/AL)]: Yeah. Can I just say this as a main recommendation, this year's bill doesn't include the, important evaluation that was included in the LCO last year, which is a an evaluation of the materials by the Department of Public Health and the Department of Social Services? It's an enormous amount of new disclosures, and I think the, the promise here was that the agencies would would evaluate all of this information from the perspective of whether it told us something about certain business organizations and whether or not they correlate to delivering, poor care or bad health.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Ask you to please wrap up. Okay. Thank you. Hopefully, it's in your written comments. Did you submit written Yes.

[Matt Barrett (President & CEO, Connecticut Association of Health Care Facilities/AL)]: I did submit written comments and I did, submit detailed substitute language in a lot of different areas and more expansive testimony in opposition to other provisions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Marlene Ciccarelli, I do see you online. Welcome.

[Marlene Ciccarella (Managing Partner, B&M Homemaking Companion Services; Chair, HCAOA Connecticut)]: Thank you so much. Good morning, representative Garibay, Sedita Hockadell, and members of the agent committee. Thank you for the opportunity to speak to you again, on SB fifty one forty three. My name is Marlene Ciccarella. I'm managing partner of B and M Homemaking Companion Services and chair of HCAUA Connecticut. My agency is nonmedical and provides home care services funded by Medicaid. I just wanna say I support the objective of this bill, but believe there can be improvements that would better serve our clients and caregivers. I also recognize the concerns driving this bill and agree that Alzheimer's and dementia training is essential. I also echo Tracy Wadash's comments and appreciate the testimony provided by the ad excuse me, the advocates. My agency and many other agencies already provide some of or additional training that is already noted in the bill. Training is delivered either online or instructor led, and administrative staff are needed to manage the training, documentation, and the caregivers are paid for their time. Right now, I just ask you to reference my written testimony to see my full comments, but I wanted to point out the cost as a Medicaid provider. So Medicaid does not properly fund this policy. It does not seem to be a consideration when determining Medicaid reimbursement rates. It will also cause an increase and raise an additional burden on private pay where the client will spend down faster and will need to move to a Medicaid program. Again, this is one policy. There's several it's accumulation of policies. Holding an agency accountable for the number of hours undermines the focus and the quality of the training each so the training should be based on role and the number of hours doesn't necessarily equate to the actual training. The cost per caregiver can double due to the cost of coverage. So it wouldn't be ten hours, but up to twenty hours of paid training per caregiver. The bill notes that agencies will require to provide CPR, which is viewed by DCP as a medical function. This is a conflict with DCP regulations. Liability insurance will increase and open agencies up to lawsuits in the event a client is inadvertently harmed while a caregiver is performing CPR. There is no recommendation on the delivery method of the training. Is it online, in person, instructor led? In order to properly maintain standards, and this to me is very important, the training should apply to all home care services to include caregivers hired by the client, self direct, and registries so that all homemaker companions, no matter who they work for, are receiving the same amount of training and quality training. Many caregivers work with multiple agencies at the same time and go from agency to agency, again pointing out therefore, training should be portable. The training must provide quality, ease of use, multiple languages. My agency is a bilingual agency and I struggle many times to transcribe documentation into Spanish, to make sure that they are getting the receiving the quality training they need. The recredentialing process, as Stacy pointed out excuse me. The recredentialing process at these p Part

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: part of

[Rep. Anne Hughes]: your name is Ciccarella. If you could wrap up your comments, please.

[Marlene Ciccarella (Managing Partner, B&M Homemaking Companion Services; Chair, HCAOA Connecticut)]: I'm sorry?

[Rep. Anne Hughes]: The three minutes have come to an end. If you could Sure.

[Marlene Ciccarella (Managing Partner, B&M Homemaking Companion Services; Chair, HCAOA Connecticut)]: I'll just conclude. I just ask once again that, HEOA and, serve as a resource to bring clarity to the bill and partner with the state as subject matter experts on this topic. Thank you very much. I appreciate the time.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Are there any questions? No. See, done. Thank you so much. Going to onto our last speaker, Marie Allen. Marie, can you unmute and turn on your camera?

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Yes. I can. Thank you so much for the opportunity. Good. Are we at the afternoon? Almost. Almost in the home stretch for lunch. My name is Marie Allen. I'm representing Aging CT. That is the association of all five area agencies on aging, and I'm here in support of HB 5,143. We strongly support an act requiring training for home care homemaker and companion agencies. The piece that we strongly support is the Alzheimer's and dementia training. We echo the Connecticut Association for Health Care at Home's concerns regarding the nonmedical care. Some of our area agencies on aging are the access agencies for the Connecticut home care program, the state's Medicaid waiver. We have thousands of older clients who are supported by Medicaid reimbursed home care agencies. I I would ask the committee to consider the financial burden of doing business within the home care program where Medicaid reimbursement has not kept pace with increases to minimum wage, health insurance, and other unfounded mandates. So the Connecticut home care program is relying on this network of home care agencies. If they are unable to stay in business because their costs exceed their their profit, their revenue, We find it more difficult every day to connect older residents to quality based home care agencies. So I would ask that you look at the entire scenario. As Tracy Wodach mentioned, homemaker and companions are not allowed to place a hand on a client. Even if the client needs a steadying hand, they are not allowed to. The regulations offer this option to PCA personal care attendants who may also work at those home care agencies. So we want to be very careful that the language in the bill does not preclude or require someone who is not allowed to have hands on contact to perform CPR or other medical situate programs. I'd also like to support bill one twenty four, an act concerning the Department of Aging and disability recommendations regarding municipal agents. The area agencies on aging, are the chose choices program. We are the ones who are out in the community making sure older adults, choose the correct Medicare programs that best suit their needs. Every year during open enrollment from October to December, we help upwards of 5,000 older adults choose the right prescription drug, Medicare program. And we are fighting a fight against all those, like, late night commercials that tell you that Medicare Advantage will do anything and everything for individuals. So by, requiring municipal agents who will also be in that counseling, position to remain conflict free and unbiased, We agree wholeheartedly, and we will continue as area agencies on aging in supporting the capacity and the knowledge of the community partners, municipal agents, and volunteers who provide this very necessary counseling to Medicare beneficiaries. Thank you very much for your comments. For

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: giving

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: me an opportunity to comment. Yes.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Questions? Refuse?

[Rep. Anne Hughes]: Thank you, madam Chair. Marie, I miss our roadshow.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: I know. I had a board meeting this morning, so I apologize that I couldn't be there with you.

[Rep. Anne Hughes]: Oh, that's okay. Can you, talk more about the pressures for the municipal agents in this current environment where we've seen some rollback of federal support and funding? And and what do you think what do you think our capacity with, even, s b one twenty four to, meet that need?

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Well, municipal agents have long been in state statute as a requirement for every municipality. Municipalities will handle it in different ways. Some have paid staff. Often, it's the senior center director for a municipality who also plays a dual role of municipal agent. Smaller towns may use volunteers, and I think the legislation that we're seeing today in Senate Bill, one twenty four is really an attempt to make sure that if we are using volunteers, that we're bringing in volunteers that do not have a profit motive. In other words, they're not an insurance salesperson who might be tempted to guide, an older adult in a direction that is not necessarily in their best interest. And we see this with Medicare Advantage Plans. We had a very difficult, open enrollment season this year because of changes to Medicare Advantage that really were a disadvantage to most of the Medicare beneficiaries. And once you're enrolled, keep in mind, you cannot make a change for a year. So if someone enrolls in a prescription drug, Medicare plan that does not cover their medications, they could be at risk of having thousands of dollars in prescription drug expense that is not covered under the, insurance company that they've selected. So it is so important that older adults, have trusted, unbiased information that allows us to look at all the medications they take, what type of procedures they need, and make sure we're guiding them to the insurer that best provides coverage for them.

[Rep. Anne Hughes]: Yeah. And I know that last year Thank you. Through you, madam chair, that last year, we really tried to put some limits on those Medicare Advantage plans that changed their drug, formulary mid year. Right? And and there's no way even for your trained choices counselors to be able to anticipate that. Right?

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: That's correct.

[Rep. Anne Hughes]: Yeah. So so it's like we're trying to plug a tsunami with a little with a little hole here, including with volunteers. And I'm just wondering what this moment calls for, among our 169 towns to, really support seniors who are getting caught in this, scam. I feel like it's a scam.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Well, it would require a a major reorganization of health care insurance, and I'm not sure that we're gonna be able to do that.

[Sen. Martha Marx]: Oh, I put that in

[Rep. Anne Hughes]: every year.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Go ahead. For the

[Rep. Anne Hughes]: record, but yes. Yes. But I'm just thinking in terms of supporting, the especially some of those, some of those volunteers in this climate where I think people are getting taken advantage

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: of. You're absolutely right. And that's why we so appreciate the aging committee's support of, like, our service navigation program and the choices program. Without that support, older adults would, really be subject to salespeople trying to sell them insurance, which it it just does not work. And, you know, our Medicare savings program, one, CHOICES volunteers and CHOICES staff are counseling older adults. We're looking at income and assets, and we're saying, oh, let's get you on Medicare savings program because we'll be able to cover some of those deductibles on the inch on your prescriptions. This is increasing the health of our older adults because we're making sure they have the money to pay for their medications. These are critical programs to Connecticut.

[Rep. Anne Hughes]: Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Repused. Senator Wong.

[Sen. Tony Hwang (Ranking Member, Senate)]: Thank you, madam chair. Marie, thank you as always with your work in SWACA. But but let me go to one twenty four. It's really about transparency, removing the conflict of interest. And and you pointed out something that that kinda needs to be reminded is the navigators. We funded the navigators, through some of the COVID, surplus funds, and now we're at a stage where we're gonna reevaluate to continue funding it. And I know it's a pivot from one twenty for senate bill to one twenty four, but but kinda reiterate how important it is for us as a committee and appropriations to to to to ensure that at the navigator role

[Rep. Mitch Bolinsky (Ranking Member, Aging Committee)]: and

[Sen. Tony Hwang (Ranking Member, Senate)]: and the objective and the insightful as well as value added support services for all of our senior centers, are and and how critical it is for us to fund that.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Thank you so much for the question. I appreciate an opportunity to talk about the navigators. We have three navigators in each of the five regions. So they're covering every city and town in the state of Connecticut. One of those navigators was funded by ARPA funding, which will, sunset for July 2026. Without, support for the five navigators, we've requested 500,000, a 100,000 for each of the five regions, we will be down in capacity by one third or about 35% down in capacity. The navigators last year helped 9,000 people with 21,000 applications for Medicaid, for SNAP, for housing, for through Medicare counseling, Medicare savings programs. These are all applications that were filed with the help of the navigator. I think it's hard for us, you know, well bodied people who are working every day to understand that an 85, a a 17 page application written in legalese is is really difficult to complete. And and trying to pull together, you know, birth certificates, a death certificate of a spouse or a divorce decree or a birth certificate from from Puerto Rico or down south, it's very difficult to pull that together. The service navigators go into homes. They go through shoe boxes full of documents, and they figure out what we need to get that application through. And those applications are making the difference for people to stay in the community rather than go into a nursing facility. This is actual care that they're receiving. In addition, Senator Wong, I want to bring up our relationship with the towns. Each service navigator meets with the municipal agents, the senior centers, the human services departments in the local municipalities. We are their next step, their escalation. So they have a a resident in the town of Fairfield who is having trouble getting their Medicaid application through. The staff in Fairfield have done everything they can, but they can't see into the state system to identify what what is that missing piece of information that will make this application get the application approved. They call the service navigator. We have access into impact. We can't change anything into impact. That's a state function. We are nonprofits, but we can see what's missing and then guide the client to get that piece of information in and get them onto the program. So we work we're building the capacity of the municipalities. People should go in the door in their local municipal, but when the municipality can't support them, they know they can come to the area agency on aging. And it's that step up escalation that this state legislature and especially this aging committee, has has put that capacity into the area agencies.

[Sen. Tony Hwang (Ranking Member, Senate)]: And and and I wanna reiterate that that what we had done in the past with the surplus ARPA funds and allowing these navigators to to demonstrate the value added. And and particularly, if you see the national landscape, Medicaid challenges, and and and reimbursement complexities growing even more. We're we're we're we're looking at building on a program. It does cost money. But but the fact is if if we build this and we build a a service delivery that's tremendously value added, but do you have cost benefit analysis? I think that's one of the hardest things when you look at Navigator and and very difficult appropriations and cost benefit. You how can you give a cost benefit analysis of the additional Navigator at at 500,000 for each of your five area agency units? It's hard, but can you kinda put into words for us to try to be your advocate when we go to, the funding mechanism to say, here's the value added. And if we lose it, you're gonna leave more people out there. And and and and maybe I'm just kind of stretching it and saying that the very intent of this bill is to ensure that that for profit players don't take advantage of that void and and be able to profit and and provide, you know, misleading or guiding information. So can you give me a cost benefit analysis that we can go to? Because that fund's gonna go away. And and it is critical for us in a very tight budgetary consideration to ensure that this continues, and if possible, even add to that to to address the needs that are growing.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Yeah. You know, this is cost avoidance because we're keeping people out of nursing homes, one of the hardest things to show actual dollars. But what I can tell you is the Kaiser Family Foundation and other foundations have done studies that say, what does it cost for, institutional placement, and what does it cost to keep people in the community? And, typically, we are saving about 35% in community based care plans like those through the Connecticut Home Care Program for Elders, the PCA, the acquired brain injury. Those are saving approximately one third of the cost of institutional care. So if we say that the institutional care in round numbers is approximately $8,000 per month, what we are saying is we're spending about $5,000 on a community based care plan. So we're avoiding that additional cost, that 3,000 for every person we got onto the Medicaid waiver program. Again, we had approximately, 9,000 clients that were supported last year. Not all of them went on to Medicaid, of course. But if even 500 of them got on to the Connecticut home care program, we're going to extrapolate that $3,000 savings per month times the 500 clients times twelve months a year. These are big dollars that we're talking about. And, in addition to the dollars, we're keeping people in the community with their families, able to connect to their, places of worship, all of those wonderful, humane things, as well as saving dollars.

[Sen. Tony Hwang (Ranking Member, Senate)]: Thank you for that analysis. And and if I may, through the chairs and the clerk, if you could provide this committee with the Kaiser research, but also if you could just maybe even a a rough sheet of the financial implications of a navigator and the and the critical role in in cost prevention, but also the the enhanced, you know, services and and quality of life considerations. I think that would be incredibly valuable for us to be able to be a a a, an advocate on your behalf in regards to these tough budgetary considerations. So, again, I wanna thank you for all your great work and and all of your, staff and and your caseworkers. It it really is important for people to understand that when you look at the critical services of the area agencies on aging, it is for those people that are economically, unable to afford the other spectrum of of senior care and retirement living that we have here we hear a lot about in regards to the cost. These are people that left for the services and our Medicaid allocations. They they would not have the services available. So thank you to your staff and and the workers across all the area of agency and aging. Thank you for your time. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, senator. Rep. Pizzulo, please.

[Rep. Bill Pizzuto]: Thank you, madam chair. Just briefly, miss Allen, thank you. I'm running between Zoom meetings like everyone else, I guess. But my constituents, I have companies in my area that do things like group life health, Medicare planning, Medicaid, and they are guiding people on what to do, especially people that are retiring and entering into Medicare. Has it been your experience that what they were doing was the insurance companies were giving them a small stipend to do this advising, and now they want them to do that for nothing. And so I'm saying, how does anyone operate a business? Have you heard of that, miss Allen, that these companies that did this advising, no they'll still they're still doing it, but they're not getting paid for it.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Yeah. Yeah. I I'm not an expert in the insurance industry, so I don't wanna misspeak. What I have heard is that there are certain agents, and based on the type of policies that they are able to sell to individuals, they may receive some type of a commission or some type of a a bonus based on selling certain policies rather than other policies. How that equates to the counseling that they're supposed to do, I really don't know. I do know we've had issues where, a salesperson will go into a senior center, for example, and they will do a presentation because they're representing a particular type of insurance, a certain brand. And they will bring pizza for all of the senior residents. And at the end, they'll ask them all to sign up for this particular insurance, and many of them do. So that's what, that's what I'm reacting to, the unbiased nature that could cause people to sign up for something that's not correct. Unfortunately, representative, I just don't I'm not comfortable speaking on on how they are compensated because I don't know.

[Rep. Bill Pizzuto]: Sure. No. I I mean, I you hit a nerve when you said how, you know, you're handling people that are old much older and handing them 18 pages to do some your term computerease. And I can see that escalating, so it may be something for us to consider with respect to a bill. But thank you for what you do, miss Ellen. I appreciate it.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: My pleasure. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, Marie. I think we all have to be careful how we, we portray things because even if I go into a senior center and there is a person there that might be a business selling something, I might feel safe because they're inside my senior center. And that's just an example. So I think in all areas, and thank you for your testimony.

[Marie Allen (AgingCT; Connecticut’s Area Agencies on Aging)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: And I kinda skipped over, but on the present list, last but not least, Maureen McIntyre.

[Maureen McIntyre (Chief Operating Officer, Atwood Dementia Group)]: So I'm about to violate the two most sacrosanct. Never do this for public speaking. Number one is be the last speaker before lunch. And number two is followed. Marie Allen. We all know that's a terrible position to be in. I would like to take a moment to, echo what Marie said about this committee support of the service navigators at the area agencies on aging. Cannot thank you enough for your time and attention to that incredible cause. So with that said, good afternoon. Esteemed members of the aging committee, Senator Hockadel and representative Garibay. My name is Maureen McIntyre, and I am the chief operating officer of the Atwood Dementia Group. And I'm here today to express my strong support of raised bill five one four three. In our work as dementia care consultants, we see how critical it is for individuals living in living with Alzheimer's disease and related dementias to remain in their familiar surroundings. Continuity, routine, and environment are not luxuries in dementia care, they are essential. For many families, in home care makes it possible to preserve independence, to protect financial stability, and maintain safety. That only works, however, if families trust the quality and competency of the care being provided. Raised bill five one four three stems from the companion homemaker task force, which was convened in response to substantiated concerns about the quality of care in some homemaker companion agencies, particularly around the area of dementia expertise. The task force heard troubling stories from families who experienced sometimes inadequate care and in some cases serious neglect as you've heard some today. The recommendation for a minimum of ten hours of initial dementia training with ongoing education is a measured and thoughtful response to these concerns. It is not excessive. It is foundational. I want to be clear. This recommendation is not an indictment of agencies and home care agencies than the services that they provide. The workforce is under tremendous strain. Nationally, demand for dementia capable care is rapidly rising, while turnover among those same direct care workforce is extraordinarily high. Agencies are struggling to recruit, train, and retain staff in a very difficult labor market. But those workforce challenges make training more important, not less. The Connecticut Long Term Care Planning Committee has already emphasized the need to develop and maintain a well trained home and community based workforce to provide education to direct care workers and ensure reimbursement structures. Reimbursement structures that support this quality. This bill aligns directly with those priorities, and I will wrap up. If we are serious about supporting long term care in the community, and offering families real alternatives to nursing home placement, then dementia specific training is essential as it strengthens quality, builds public trust, and supports safe nursing home diversion. Thank you very much. You have my written testimony as well with additional detail, but obviously, I am more than happy to answer any questions that you have. It's nice to see you here today.

[Rep. Jane Garibay (House Chair, Aging Committee)]: We thought we had lost you, but you're back in a new and very important role with our aging. So thank you for your testimony. Are there any questions or comments?

[Maureen McIntyre (Chief Operating Officer, Atwood Dementia Group)]: It's lovely to be here.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. We're just gonna check back in. Thank you, Maureen. We're gonna check back in. Is Cecilia Livingston online? Or here, Elise Courtois? Jay Kiley? Okay. I think this finishes our business today. Thank you so much for everyone for being here and for your patience. Have a great day.