On June 3rd, 2010, the Independent Regulatory Review Commission (IRRC) approved the regulations that will guide the licensure of assisted living residences in Pennsylvania. The Department of Public Welfare released the regulations (in “final-form”) in early May 2010 and interested stakeholders submitted comments to the IRRC, the Standing Committees in the Pennsylvania House (Aging and Older Adult Services) and Senate (Public Health and Welfare), and individual legislators prior to IRRC’s public vote. The regulations take effect in early 2011.
The regulations establish licensure standards for assisted living residences (ALRs), which provide food, shelter, personal care assistance and some health coverage to older adults and people with disabilities who are not so sick as to require ongoing skilled nursing care. About 50,000 Pennsylvanians live in facilities that may call themselves assisted living but that are actually licensed by the Commonwealth of Pennsylvania as personal care homes.
From 2008 to 2010, the Pennsylvania Assisted Living Consumer Alliance (PALCA), a collaboration of consumers, family members, and local and state wide organizations (including PHLP), advocated for safety, freedom of choice and high legal standards for residents in assisted living facilities in the state. PALCA was pleased to see that the regulations included many changes they recommended such as:
- a requirement that ALRs provide a written decision when an admission is denied due to a supposed inability to meet a person’s needs;
- the inclusion of an appendix listing all residents’ rights in one place;
- defining core packages that will help consumers compare ALRs;
- a requirement that assessments and support plans be completed prior to admission, in most cases. The support plan outlines the care needs of the new resident and how ALRs will address them; and
- a requirement that the final support plan be incorporated into the resident-ALR contract.
Despite these improvements, PALCA believes several provisions will harm consumers. Areas of specific concern are:
Inadequate Requirements for Administrators and Direct Care Staff: The regulations remove requirements for any educational qualifications (including a high school diploma) for administrators of assisted living facilities. PALCA is concerned that minimal training requirements for administrators and direct care staff will compromise residents’ health and safety. Unlike personal care homes, ALRs will be permitted to serve individuals who need the level of care traditionally provided by a nursing home. As a result, assisted living residents will be sicker and will have higher care needs than people currently served in personal care homes; however, administrators are only required to have 100 hours of training (the same amount required for personal care home administrators) and direct care staff are only required to have 18 hours of training under the final-form regulations.
Inadequate Room Size Requirements: PALCA disapproves of the reduction of square footage requirements for new and existing living units for single and double occupancy; permitting room sizes even smaller than those set forth in previous drafts of the regulations. Under the regulations, new construction units may have single occupancy units that are only 225 square feet. For existing structures, a single occupancy unit can be as small as 160 square feet. These small room sizes limit a person’s ability to move a wheelchair and can decrease their independence. PALCA maintains rooms should be sized in accord with “marketplace” standards of at least 250 square feet for a single occupancy unit, and up to 500 square feet, for a single bedroom living unit.
Also troubling is a new provision permitting an exception to the room size requirements at the Department’s discretion. This is problematic because the regulations do not include standards for ALRs seeking an exception or for the Department to grant an exception. Unlike the process for seeking waivers for any other provision of the regulations, the exception process does not provide for public posting of the exception request or a period of public comment prior to final review and decision. Since an “exception” is in fact a “waiver,” the same requirements should be in place.
The regulations also do not ensure appropriate use of bed rails: Although the regulations added language limiting the use of bed rails, these requirements do not meet or exceed the rules for bed rail use in personal care homes as required by Act 56 (the statute creating the licensure status for assisted living residences and requiring DPW to issue the assisted living regulations).
Inadequate fire safety requirements: PALCA is alarmed residents will not have sufficient protection from potential fire hazards such as kitchen areas where electric appliances will be used.
To review PALCA’s full comments on the assisted living final-form regulations, click here.