The Consumer Voice 42 nd Annual Conference October 2018 Richard Mollot The Long Term Care Community Coalition wwwnursinghome411org Residential LTC in the USA Nursing homes 15000 nursing homes ID: 1038156
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1. Assisted Living: State and National Advocacy PerspectivesThe Consumer Voice: 42nd Annual Conference – October 2018Richard Mollot The Long Term Care Community Coalitionwww.nursinghome411.org
2. Residential LTC in the USANursing homes:15,000+ nursing homes1.4 million residentsMost LTC paid for by Medicaid; most rehab paid for by MedicareResident protections under the federal Nursing Home Reform Law (OBRA ‘87)Assisted living: 22,000+ “residential care communities” (estimate)713,000 residents (estimate)Mostly private payNo federal standards (with some exceptions re. Medicaid waiver programs), varied state standards2
3. The Promise of Assisted Living3
4. The Reality of Assisted Living4
5. LTCCC Perspectives on Assisted LivingRecognize that the typical nursing home is a poor place to live and get careAssisted living facilities (ALFs) provides an attractive alternative for those who need or desire residential careLongstanding concerns about quality of care, safety, oversight, whether assisted living is fulfilling its promises in respect to quality of lifeHow to balance:Social model vs. people with clinical and other care needsPrivate pay vs. access for individuals with lower income (Medicaid)ALF “flexibility” vs. residents’ rights vs. residents’ desires.For example: ALF that does not want to – or cannot – have residents who are wheelchair bound. Isn’t this discriminatory against those residents? What about residents who do not want to be in an ALF with residents who are wheelchair bound?5
6. LTCCC AdvocacyAdvocacy in our home state, New York:Assisted living lawAssisted living regulationsInforming public on publicly available informationEducating LTC ombudsmen and others on residents’ rights.Policy research and advocacy, national:Research on the extent to which the “promise” of assisted living is being fulfilledGuidebooks for prospective residents, current residents, staff, and administration on fostering resident autonomy and independenceResearch on state oversight requirementsAssisted Living Consumer AllianceAdvocacy for federal standards (with varying success)Research on promising policies & practices6NEW!
7. Our Experience With State Advocacy… A Few ThoughtsThe assisted living industry is very powerful & connected Helpful to partner with other organizations (state AARP was great!)Consider what you are getting and what you are compromising on carefully7Lesson LearnedWe advocated for an RN in ALFs that are providing significant dementia care or aging in place.Though we compromised with the industry on limited RN staffing in the final regs, the industry immediately sued when the regulations came out and won.Result: NY has no RN staffing requirement, even for facilities caring for people with a nursing home level of need.We have advocated for a bill to address this, but it has not gone anywhere.Result: Many assisted living are accepting and retaining residents that they cannot care for safely.
8. Assisted Living: Promising Policies & PracticesQuestions:We know that there are good ALFs and bad ALFs – what are the good ones doing?We know that, though state regulations tend to be weak, there are some good standards out there – what are they?Following the GAO report, what are states doing to protect residents?Goal: To identify good policies and practices for…State and federal policymakersThe assisted living industryConsumers8
9. Assisted Living: Promising Policies & PracticesStaffing Requirements: Registered NursesStaffing Requirements: AdministratorsStaffing Requirements: Staff RatiosStaffing Requirements: Recreational Activities DirectorsStaff Training RequirementsDementia CareOversight & Quality AssuranceResident & Family CouncilsAbuse & NeglectTransfer & DischargeConsumer Information (Disclosures)Public Information: Survey Reports & Complaint Investigations9What did we focus on?
10. Assisted Living: Promising Policies & PracticesOnly 10 states have some kind of staff ratio16 states do not have a dementia care staff proficiency requirement (training and/or licensure)17 states do not have a requirement for an RN on staffHalf the states require less than annual inspections…10What did we find?
11. Assisted Living: Promising Policies & Practices11
12. Assisted Living: Promising Policies & Practices12Visitwww.nursinghome411.orgfor the report and chart of state assisted living requirements.We are developing additional advocacy resources. If you would like to sign-up for alerts on these or other LTC issues, please email info@ltccc.org.