Assisted Living Residents Need Stronger Protections

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

The title of this blog (and an excerpted subtitle in one of the reports) sums up the findings of two (2) significant reports this year on the status of Assisted Living. The February 2018 GAO Report examined state and Federal oversight of assisted living services using Medicaid monies. The GAO report offered three (3) conclusions as well as these three (3) recommendations to CMS:

  1. The Administrator of CMS should provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states using HCBS waivers are required to report on their annual reports.
  2. The Administrator of CMS should establish standard Medicaid reporting requirements for all states to annually report key information on critical incidents, considering, at a minimum, the type of critical incidents involving Medicaid beneficiaries, and the type of residential facilities, including assisted living facilities, where critical incidents occurred.
  3. The Administrator of CMS should ensure that all states submit annual reports for HCBS waivers on time as required.

I encourage you to read my blog (link provided in the 1st paragraph) as well as the linked GAO Report. If you read it back in February, review it again now as a refresher. If you missed my blog in February, now would be a good time to review it in preparation for reviewing the 2nd report concerning assisted living services.

On Wednesday, October 24, 2018, the Long Term Care Community Coalition issued Assisted Living: Promising Policies and Practices for Improving Resident Health, Quality of Life, and Safety. “The goal of this report is to provide consumers, providers, and policymakers with information and insights into best practices and policies for assisted living. The report focuses on areas of public interest and concern which we have identified as particularly important to ensuring resident safety and the ability of residents to realize assisted living’s “promise” of a resident-centered and directed, home-like environment.”

“Despite the billions of dollars in public funding every year, there are no federal rules governing the standards of care in ALFs. This lack of federal oversight not only means that care in ALFs is completely regulated by individual states, but also that, even when their needs and vulnerability are similar, ALF residents do not have a comparable right to quality care and quality of life that nursing home residents are entitled to under federal law.”

The LTCCC report references and supports the findings of the GAO report but also goes further to meet its goal of informing all stakeholders with information and providing recommendations for best practices and policies.

There is a wealth of information on these critical topics:

  • Staffing Requirements: Registered Nurses
  • Staffing Requirements: Administrators
  • Staffing Requirements: Staff Ratios
  • Staffing Requirements: Recreational Activities Directors
  • Staff Training Requirements
  • Dementia Care
  • Oversight & Quality Assurance
  • Resident and Family Councils
  • Abuse and Neglect
  • Transfer and Discharge
  • Consumer Information & Disclosures
  • Public Information: Ownership
  • Public Information: Survey Reports & Complaint Investigations

In each of the above sections, you’ll find key best practices and recommendations, information on selected state policies and sample language for inclusion in policy or regulation.

There is also additional information and resources available within this 52-page report in the form of seven (7) appendices. For example, the differences in staff training requirements for assisted living (as well as the differences in licensure designations) is clearly evident in this table in Appendix 3:

direct care

Don’t neglect the links to additional references in multiple places within this report! You’ll find links at the bottom of many pages as well as vignettes to the side of many pages including this one on page 11:

AL cust.png

Dementia care is addressed in this report. “About 70 percent of assisted living residents live with Alzheimer’s Disease or some form of dementia. Sadly, and all too often, policies and practices to address the needs of individuals suffering from dementia are lacking in these communities. A recent study found that, while two-thirds of sampled assisted living facility (ALF) residents had dementia, staff only identified 40 percent of these residents.”   The LTCCC report cites four (4) best practices and recommendations to improve dementia care in AL communities. You’ll want to pay attention to those recommendations.

If you follow my blogs, you’ll often see me say that a particular subject is a must-read. I’m saying it again with this blog as this LTCCC report is definitely one that will help you and your team improve the quality of life and care in your assisted living community. This and the February GAO report should also encourage you and the elected officials in your state to take a good look at how assisted living communities are regulated and surveyed.

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