California has become ground zero for assisted living reform and this ought to concern ever single assisted living operator in the country.

California has become ground zero for assisted living reform and this ought to concern ever single assisted living operator in the country.  It also ought to concern those who think seniors deserve to have affordable, high quality care.

Yesterday (January 14, 2014) a coalition of state legislators and senior advocacy groups announced the introduction of a series of bills titled   The RCFE Reform Act of 2014.  The series of bills include, among other items, more frequent inspections, higher fines, more specific training and licensing requirements for administrators and care givers, more detailed staffing requirements, more transparency with respect to complaints and regulatory actions..

Why This is Happening

Over the last several months there have been a number of high profile stories about assisted living abuses in California.  First up was the distorted Propublica/TV story and article series followed by the San Diego Union Tribune Series titled Deadly Neglect about assisted living in San Diego and, finally, the stories about the abominable abandonment of 19 seniors in Castro Valley. The Castro Valley story was terrible and, more than anything else, highlighted the failure of the State of California’s Department of Social Services  in three areas:

  • Most critically DSS failed to insure a safe transfer of residents after ordering the closure of the community.
  • DSS failed by allowing a person with a history of problems to get a license.
  • DSS failed to aggressively deal with problems in a timely manner.

The San Diego UT gets some credit for publishing a story written by Sally Michael the president of the California Assisted Living Association(CALA) that presented a more realistic picture of what assisted living in California looks like.  The ProPublica story was a broad brush expose designed to generate a sensationalistic emotional response, but cannot been seen as responsible investigative journalism.

Do We Need More Regulation?

My knee jerk reaction is a solid no, and yet even CALA recognizes that the state is not doing enough to ensure quality and compliance.  To this end CALA has proposed an increase in license fees in order to fund better enforcement and oversight.  CALA is also advocating for increased staff training, including dementia training, for all caregivers, a stronger administrator certification program and revisions to the state exam. It is pretty clear that licensing inspections ought to happen more than once every five years; that a maximum fine of $150 for the death of a resident is paltry; that assisted living communities ought to be required to carry a reasonably high level of liability insurance and that state inspection reports should be readily available.

The False Promise

The false promise of increased regulation is that it will make bad operators who are bad people become good people.  The idea that someone would be willing to put a resident’s life in jeopardy because the fine is only $150, but wouldn’t because the fine is $15,000 is ludicrous.  But will more regulations and more specific requirements make bad people in bad operators better? I am doubtful.

What is particularly important to remember, and to point out to anyone who will listen, is that these terrible stories of abuse are outliers, Each took place over a number of years and, in every single case, there were laws and regulations already in place that should have, in theory, prevented the abuse. Regulators had the tools to shut down facilities and prosecute operators, but they did not.

While I think that some of the specific proposals are good ideas I worry that, overall, they will increase costs to good operators, Operators will be forced to pass the costs on to seniors and their families. This will make quality care less affordable and less available. If affordable assisted living is not available, but is needed, it will open the door to more unlicensed, bootleg small operators who mostly operate on such a thin shoestring that the threat of fines or closure means nothing. As an industry we need to be helping each other to provide an excellent product. We should be brutally honest about providers who do a terrible job and we should be talking about what is reasonable legislation.

Steve Moran