The attacks on the senior living industry have gained a foothold in California. The state senate held hearings on how to increase accountability.

On Tuesday, February 11, 2014 the State of California Committee on Human Services held a public hearing, chaired by Leland Yee, designed to take a look at how to increase accountability in  California’s assisted living facilities, (“Residential Care facilities for the Elderly” or “RCFE” using California’s vernacular). Last month I published a story about how California State lawmakers have proposed more than 10 new laws to reform the industry.  This public hearing was part of the process of moving that package of laws forward.

State of Affairs in California

  • There are about 7,500 licensed RCFE’s in the state of California with a total capacity of just shy of 150,000 residents.  Nearly 80% of these buildings are licensed for 6 or fewer residents.
  • Larger facilities, those with 50+ residents, make up just 6% of the total communities but house 46% of the residents.
  • Prior to 2003 most assisted living buildings were inspected annually.  That has decreased to the point that today regular inspections are only required every 5 years. Yes, every 5 years, once in 60 months.
  • What follows is a long list of problems with the California system, but I present it with the caveat that most assisted living operators are doing a good to great job and there is an extremely high level of satisfaction by both residents and families.
  • There are big problems with the system as it exists today:
    • There are not enough evaluators
    • Complaints are often not handled in a timely manor
    • The schedule of fines is unreasonably low
    • There are reported abuses where operators, who should not be, are allowed to continue to operate.
    • There have been a number of alleged criminal abuses that have not received the criminal prosecution attention they should have.
    • The state’s data system is still mostly paper-driven and about the only way a consumer can find any licensing inspection or complaint information is to visit an assisted living community and ask to see the records.  Even then it is likely the bad communities won’t be able to find those records since there is little chance of consequences.
    • There must have been two to four dozen horror stories told over the course of the morning, all of which were really terrible.  There were things that should not have happened and, to the extent they were accurate stories, there should have been severe and significant consequences for the wrong doers and there were not. That said, it would take some serious deep digging to figure out if they are true horror stories or if in fact there is another side.  But they all had the advantage of working on emotions.
    • Licensing is primarily at fault for these bad situations except that they have been dealt a very poor hand, not having enough money to hire enough people to fix the problems.  It is hard to lay too much blame on them when they don’t have the resources needed to deal with the problems.
  • This has all come to light as the result of the Pro Publica stories targeting assisted living and a series of stories published in the San Diego Union Tribune newspaper.  The final straw was when licensing abandoned 19 residents after a building had their license revoked.

Some Thoughts

  • I need to start by commending the California Assisted Living Association (CALA) by being at the forefront of the issue.  They have been actively campaigning for an increase in licensing fees that would result in more frequent inspections, ideally annually. Because there are issues this is a terrific way to be a part of the solution and not the problem. Trade organizations are usually lobbying for lower fees, not higher.
  • There were a number of people who spoke to the issue that never saw a new law or regulation they didn’t like.  It is hard to know exactly what their agenda is, but I have serious questions that they represent the best interests of anyone but lawyers.
  • The biggest risk here is not new laws per se but rather that new laws will be so burdensome, so expensive for providers, that low and moderate income seniors will have no place to go. For instance, requiring high limit insurance coverage and fire sprinklers in small homes could put many out of business.  No doubt those things are ideal, but the state has a responsibility to figure out how those residents are going to be cared for on less than $1,000 per month (the current SSI allotment).
  • We, as an industry, should be developing a voluntary set of standards that go above the bare minimums for staffing, training, activities and how care is delivered.
  • We, as an industry, should be active in condemning that tiny minority of assisted living buildings that are putting the lives of seniors in jeopardy.
  • If the state needs help to get it right we should follow CALA’s lead in helping to make that happen, including offering real dollars to make it work.

How do you see it in your state? Steve Moran

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