assisted living regulations targeting persons with alzheimer’s disease: enforcement strategies...

ASSISTED LIVING REGULATIONS

TARGETING PERSONS WITH ALZHEIMER’S

DISEASE:  

ENFORCEMENT STRATEGIES & ACTIONS

TODAY’S PRESENTATION

• BACKGROUND ON ASSISTED LIVING

• DEMENTIA-SPECIFIC REGULATION

• ENFORCEMENT STRATEGIES

• ACTIONS TAKEN

BACKGROUND ON ASSISTED LIVING

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 200716,000

18,000

20,000

22,000

24,000

26,000

28,000

30,000

32,000

34,000

36,000

38,000

40,000Trend for Assisted Living Facilities

Num

ber o

f Fac

ilitie

s

Looking more like nursing facilities…Services Nursing

HomeAssisted

Living

Average number of services received 5.4*** 3.9

Dental Care 22% 23%

Equipment or devices 41%** 30%

Medical services 71%*** 46%

Mental health services 7% 6%

Skilled nursing services 56%*** 15%

Nutritional services 50%*** 26%

Occupational therapy 9%* 5%

Personal care 87%*** 64%

Physical therapy 23%** 15%

Prescribed Medications 93%*** 83%

Social Services 31%*** 11%

Transportation 31% 48%***

Note: * Significant at the 0.1 level; ** Significant at 0.05 ; *** Significant at the 0.01 level

Source: 2000 National Claimant Study Cohen & Miller, 2000

Primary residence for persons with AD

Cognitive impairment

Help with 3+ ADLs0

10

20

30

40

50

60

70

80

90

Comparison of Resident Characteristics

Board & Care

Assisted Living

Nursing home

DEMENTIA SPECIFIC REGULATION

Successful advocacy efforts…

0 1 2 3 4 5 6 7 8 90

1

2

3

4

5

6

7

8

9

10

11

12

Distribution for ALF Regulation Total Scores

Total Score

Nu

mb

er

of

Sta

tes

Still need to do some work….

Internal mod.

Staff train-ing

Required Staffing

Admin. Training

Admission policy

Activities menu

Discharge Policy

Disclosure0

5

10

15

20

25

30

35

40

Distribution for ALF Dementia Specific Regulations

Num

ber

of S

tate

s

ENFORCEMENT STRATEGIES

Enforcement Strategy Types

Basic Actions Inspections

  Notice of Violations

  Public Disclosures

Intermediate Actions Civil Monetary Penalties

  Restriction on New Admissions

  License Probation/Suspension

Potent Actions Decertification / Non-renewal

Here’s what is available…

C.M.P. Suspension Revocation Renewal Denial

Bar new admissions

Scarlet Let-ters

0

5

10

15

20

25

30

35

40

45

Distribution of State Enforcement Authority

Num

ber

of S

tate

s

Here’s what can be done…

0 1 2 3 4 5 6 7 8 9 10 11 120

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Distribution of Total State Enforcement Strategy Scores

Total Score

Nu

mb

er

of

Sta

tes

ACTIONS BEING TAKEN

-Low EffectivenessInspections and Penalties

-Moderate EffectivenessCivil Monetary Penalties

-High EffectivenessSuspensions

Inspections and Violations

0-50 51-100 101-150 151-200 201-250 >2500

1

2

3

4

5

6

7Distribution for Notices of Violation

Number of Notices

Num

ber of S

tate

s

Civil Monetary Penalties

0-25 26-50 51-75 76-100 >1000

1

2

3

4

5

6

7

8

9

10

11

12Distribution for Monetary Penalties

Number of CMPs

Num

ber of

Sta

tes

Wide variation in fines….

$0-1,000 $1,001-2,000 $2,001-3,000 $3,001-4,000 $4,001-5,000 >$5,0000

1

2

3

4

5Distribution for Average CMP Assessed

Average CMP

Nu

mb

er

of

Sta

tes

Reasons for Suspensions

0

1

2

3

4

5

6

7

8

9

10

Distribution for Penalty Reasons

suspensionsCMP

Category

Num

ber of

Tim

es M

entio

ned

Summary of Key Findings

- Low effective action is most common and tied to staffing

- Moderate to highly effective action occurs

- Not clear why some states take pursue highly effective actions

DISCUSSION

Agency Characteristics

Political Environment

Other Effects

Agency Characteristics

proportioneast 9 0.25

9 0.25south 11 0.31west 7 0.19

department of health and human services 11 0.31department of health 11 0.31

department of social services 5 0.14department of public health 3 0.08

department of aging 3 0.08Agency for Health Care Administration 1 0.03department of inspections and appeals 1 0.03

number of

states

midwest

Barriers to enforcement…

staffing resources industry characteristics workload none inadequate authority1

2

3

4

5

6

7

8

9

10

11

12

13

14Distribution for Biggest Barriers

Category

Num

ber of

Men

tions

Political Environment

• Ties to nursing facility industry

• Lack of champions - ideology

Other Characteristics

• Role of assisted living industry

• Role of consumer information– public disclosure– rating systems

THANK YOU