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assisted living and senior living california
CAL State Regulatory Review 2007: Trends Continue as States Respond to Higher Resident Acuity, Care Needs for Residents with Alzheimer’s
In 2006, one-third of the states made changes to their assisted living regulations with about seven making major regulatory changes, according to Assisted Living State Copyright 2007 by the American Health Care Association Page 8 Regulatory Review 2007, published by the National Center for Assisted Living (NCAL) in March. California, Ohio, and Utah began covering assisted living under Medicaid waivers. Only a handful of states now do not provide Medicaid coverage for assisted living.
Karl Polzer, NCAL senior policy director and editor of the report, found that many states made regulatory changes in response to increasing levels of resident acuity and needs for health services—continuing a trend in recent years. NCAL’s Regulatory Review summarizes assisted living regulation annually in more than 20 categories. Two states— New Hampshire and Missouri—created new licensure categories in part to accommodate higher resident acuity levels. Several states added requirements relating to fire safety, incident reporting, emergency preparedness, disease control, and other resident safety issues. Delaware, Maryland, and Virginia began requiring at least some facilities to have emergency power generators.
The trend toward creating enhanced standards for the care of residents with Alzheimer’s disease and other dementias also continued. Many states added staff training requirements, staffing requirements, and other standards to ensure appropriate care for people with Alzheimer’s disease. Massachusetts created a new “Special Care Residence” certification category that includes care for people with dementia. Florida began requiring facilities to monitor and manage residents that wander and are at risk for elopement.
Several states initiated or added to facility disclosure and information requirements. Other areas of regulatory change in 2006 include medication management, including delegation of authority to administer medications; staff training requirements; and resident rights.
Massachusetts began requiring every facility to have a quality improvement and assurance program. In addition, facilities in that state now must provide specified aggregate data to the state describing residents and their needs in a number of ways. As state regulators, fire officials, and assisted living providers have increased their attention to fire safety issues, NCAL has added a new section to Regulatory Review called “Life Safety” beginning with this year’s edition. This section includes a summary of standards for sprinklers, smoke detectors, and other life safety requirements as well as life safety codes and standards that states follow. In most states, assisted living facilities must meet statewide fire safety standards. In some, there is a combination of state and local requirements. In a few states, life safety falls mainly under local government jurisdiction.
In addition to the above, selected state regulatory changes in 2006 include:
Alaska: Added new safety and sanitation regulations, including fire safety.
Connecticut: Added Alzheimer’s disease training requirements. Delaware: Created exception so residents with completely covered subcutaneously implanted venous ports can be admitted and retained under specified conditions. Established specific record-keeping and reporting requirements for tracking completion of training course for “Assistance with Self-Administration of Medication.” Specified incidents, such as abuse, fire, injury, etc., that needs to be reported to the state immediately.
Idaho: Added staff training requirements; fire, life safety requirements; requirements for licensed nurse interventions/participation; incident reporting requirements; regulations specifying who is not appropriate for assisted living care.
Maryland: New legislation enhanced penalties for operating an assisted living program without a license to a felony and established penalties for false advertising.
Massachusetts: Added new requirements for disclosure, staff training, and information for special care category. Began requiring that each resident have an individual comprehensive emergency plan to meet disasters and emergencies. Began requiring facilities to implement communicable disease control plans.
Michigan: A statutory change requires enhanced background checks on staff that have direct access to residents, involving a required criminal background check including fingerprinting.
Minnesota: Provided title protection for use of the phrase “assisted living” (did not require any present housing with services providers to change). Created a uniform consumer information guide. Defined minimum level of services that must be made available.
Senior Living FacilityAccording to an article on SimplySeniors.com, more and more seniors are choosing to ..... Missouri: Created two new levels of licensure—Residential Care Facilities (RCFs) and Assisted Living Facilities (ALFs)—with varying levels of requirements within each level of licensure depending on facility circumstances. Began allowing hospice care in ALFs. Required newly built ALFs to be constructed in manner more homelike than institutional.
New Hampshire: Tightened regulations in several ways in response to growing levels of resident acuity. Moved to two levels of licensure so that nursing home eligible residents can remain in higher-level assisted living residences. Increased fire protection standards, including new requirements for carbon monoxide detectors and fire extinguishers on every level.
Texas: Prohibited use of certain restraints.
Virginia: Implemented additional requirements for care and services to residents; staff qualifications, training, and responsibilities; management of facilities; physical plant features; coordination with mental health systems; and emergency preparedness.
West Virginia: Added to existing Alzheimer’s training requirements.
To read the report in its entirety, go to www.ncal.org. Questions should be directed to Karl Polzer at kpolzer@ncal.org or 202/898/6320.
AHRQ Proposes Assisted Living Falls Project
The Agency for Healthcare Research and Quality (AHRQ) proposed a project to design, implement, and evaluate an intervention program that would prevent "injurious falls in assisted living," according to a notice published in the January 16, 2007, Federal Register. The AHRQ project will involve four major activities: (1) adapting a multifaceted, evidence-based falls prevention program to a protocol tailored to the assisted living environment; (2) implementing the pilot protocol and collecting clinical and process data pre- and post-intervention; (3) evaluating the results of the intervention; and (4) widely disseminating the protocol, training materials, and research findings.
The project design is a multi-component falls intervention program that will include medication review, resident assessment, environmental modification, and exercise. Its goal will be to reduce risk factors and fall and fracture rates among assisted living residents. Data collection for the falls intervention project will be approved by the University of North Carolina, Chapel Hill and Research Triangle Institute International Institutional Review Boards.
The evaluation will use several methods to examine the efficacy of the intervention, including record review, in-person surveys, and in-depth interviews. The in-depth interviews of residents and staff will use both open-ended questions and items with categorical response options to facilitate analysis. Items will include the degree to which the facility has changed its practice; the degree to which residents accept and adhere to the intervention; facilitators for and obstacles to implementation; report of staff and resident satisfaction; reactions and experiences related to the use of volunteers; and lessons learned. These data elements will be gathered in 60-minute interviews with up to four facility administrators or clinical personnel, and 30- to 40-minute interviews with up to four residents.
Senate Bill Introduced To Prevent Falls among Seniors
Senators Michael Enzi (R-WY) and Barbara Mikulsi (D-MD) introduced Senate Bill 845 that directs the Secretary of Health and Human Services to expand and intensify research and education programs that are related to preventing seniors from falling. According to the “Keeping Seniors Safe From Falls Act of 2007,” the bill, if enacted, would take a national approach to reducing falls among older adults, which focuses on the daily life of senior citizens in residential, institutional and community settings. The bill asks for $25 million annually over three years starting in fiscal year 2008 to help implement the research and education portions of the bill. The bill asks that a report be delivered to Congress three years after enactment.
There are three main purposes:
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“(1) to develop effective public education strategies in a national initiative to reduce falls among older adults in order to educate older adults, family members, employers, caregivers, and others;
“(2) to intensify services and conduct research to determine the most effective approaches to preventing and treating falls among older adults; and
“(3) to require the Secretary to evaluate the effect of falls on health care costs, the potential for reducing falls, and the most effective strategies for reducing health care costs associated with falls.”
Under the research portion, the bill lists specific goals including the following: “[C]onduct research to develop, implement, and evaluate the most effective approaches to reducing falls among high-risk older adults living in communities and long-term care and assisted living facilities.”
Assisted Living Conversion Program Available For Non-Profits
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The Department of Housing and Urban Development (HUD) announced that about $30 million is available in grants under its Assisted Living Conversion Program (ALCP). Applications must be received and validated by no later than June 7, 2007, according to the March 13, 2007 Federal Register. The $30 million in competitive grant funding includes $24.8 million authorized for fiscal year 2007 by the Revised Continuing Appropriations Resolution, approved February. 15, as well as carryover funds. According to the announcement, “only private nonprofit owners of eligible multifamily assisted housing developments specified in section 683(2)(B), (C), (D), (E), (F), and (G) of the Housing and Community Development Act of 1992 (Pub. L. 102-550, approved October 28, 1992) may apply for an ALCP grant.”
ALCP funding can cover the costs of converting some or all of the units of an eligible multifamily development into an assisted living facility, including unit configuration and related common and services space and any necessary remodeling, consistent with HUD or the state's statute or regulations (whichever is more stringent). Typical funding will cover basic physical conversion of existing project units, as well as related common and services space.
Those with questions about applications may contact the Multifamily Housing Service Coordinator contact person in their local HUD field office. According to the Federal Register, owners of Section 515 developments should contact the HUD field office that monitors their Section 8 contract. If HUD field staff are not able to answer questions, people can call Carissa Janis, Housing Project Manager in HUD’s Office of Housing Assistance and Grants Administration, at (202) 402-2487.
Nursing Home Los Angeles CaliforniaImportant Information on Nursing Home Compare Nursing Home Compare includes information only on nursing homes that are Medicare or Medicaid ..... NTSB Bus Fire Investigation Finds Assisted Living Actions "Reasonable"
The National Transportation Safety Board (NTSB) recently determined that the cause of the tragic deadly bus fire near Wilmer, Texas, was the motorcoach company’s failure to maintain its bus, and the faulty federal compliance review system that allows unsafe buses to continue operating. Twenty-three residents, patients and staff from a facility operated by Sunrise Senior Living perished on the Global Limo motorcoach. The motorcoach was transporting 44 residents and staff from the Bellaire, Texas facility during the evacuation during the onset of Hurricane Rita. Sunrise used the bus broker, BusBank, which hired Global Limo to transport the Sunrise residents and employees.
The NTSB cleared Sunrise of contributing to the cause of the bus fire.“Given the unusual circumstances and limited options, Sunrise [Senior Living] took reasonable action at the time in deciding to contract with BusBank for motorcoach transportation,” according to the NTSB report. During the NTSB February 21, 2007 board meeting, several board members voiced concern that bus brokers are not federally regulated.
NTSB’s investigation found that Global Limo failed to conduct proper vehicle maintenance, to do pre-trip inspections, and to complete post-trip driver vehicle inspection reports. NTSB’s report also states that the Federal Motor Carrier Safety Administration’s (FMCSA) ineffective compliance review system resulted in inadequate safety oversight of passenger motor carriers. The Board concluded that the FMCSA’s current process does not effectively identify unsafe motor carriers and prevent them from operating. NTSB reported that another contributing factor to the rapid propagation and severity of the fire and subsequent loss of life was the lack of fire retardant construction materials on the bus exterior and adjacent to the wheel well.
As a result of its investigation, the NTSB made recommendations to the FMCSA, the National Highway Traffic Safety Administration, the Pipeline and Hazardous Materials Safety Administration (PHMSA), the Motor Coach Industries, the United Motorcoach Association and American Bus Association, the Law Enforcement and Emergency Responders Associations. These recommendations include:
* Revising regulations to prohibit a commercial vehicle from operating with wheel seal or other hub lubrication leaks,
* Developing a standard to provide enhanced fire protection of the fuel system in areas of the motorcoaches and buses where the system may be exposed to the effects of a fire; and provide fire hardening of exterior fire-prone materials, such as those areas around wheel walls, to limit the potential for flame spread into motorcoach or bus passenger compartment,
* Developing detection systems to monitor the temperature of wheel well compartments in motorcoaches and buses to provide early warning of malfunctions that could lead to fires,
* Continuing to gather and evaluate information on the causes, frequency and severity of bus and motorcoach fires, and conduct ongoing analysis of the fire data,
* Revising product maintenance manuals to emphasize the importance of wheel bearing lubrication, specifically warning that daily inspection of hub oil levels and wheel seals is vital to prevent wheel-bearing failure and that bypassing this requirement is a dangerous practice that can lead to a wheel fire or other serious consequences.
Since the accident, Sunrise has contracted with Trailways to be its designated bus company that transports Sunrise residents for all recreation and evacuation purposes. Trailways’ carriers have a U.S. Department of Defense (DOD) safety designation, which is the most stringent in North America according to the company.
AHCA/NCAL is working with the motor carrier industry to resolve transportation problems that long term care experiences during emergencies. An online survey for long term care facilities and a second online survey for motor coach carriers were developed to help improve emergency evacuation planning for long term care facilities. The survey is available at www.ahca.org. More information on the surveys is available later in this Newsletter under “Clinical Corner.”
The NTSB also investigated the risk that medical oxygen tanks posed to rescuers during the fire. Three days after the accident, the Department of Transportation issued “Guidance for the Safe Transportation of Medical Oxygen for Personal Use on Buses and Trains.” For more information on that guidance, please see item under “Regulatory Developments” earlier in this newsletter.
To view the NTSB report, public meeting, and presentations, visit http://www.ntsb.gov/events/Boardmeeting.htm see February 21, 2007, Highway Accident Report - Motorcoach Fire on Interstate 45 during Hurricane Rita Evacuation, Near Wilmer, Texas, September 23, 2005.
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