Assisted Living: What can we

expect?

What Principles does PANPHA use in its Assisted Living Advocacy?

• Public Policy Positions Booklet

• Who do you know? Form

• How you can get involved

Strategic Focus Area: Alignment

• Help members align services with consumers’ wants and needs– Advocate for increased public money through

Medicaid waivers and/or increasing the personal care home state supplement for personal care/assisted living residences

– Advocate for assisted living/personal care legislation that reflects the components of our assisted living public policy position

PANPHA Public Policy Positions on Assisted Living/Personal Care

• Several new definitions will be needed for a public policy position on assisted living:

• Assisted Living Services

• Assisted Living Residence

ALS Definition

• Assisted living services should be defined as personalized supportive services provided to physically and/or cognitively impaired adults that assist them in living in the residential environment of their choice and take into consideration their formal and informal support network. Supportive services include, but are not limited to, assistance with tasks of daily living such as transportation, bathing, food preparation and housekeeping.

ALR Definition

• Any building, publicly or privately funded, profit or not for profit, in a congregate living setting for four or more adults who have been assessed as needing assistance or supervision in areas such as dressing, personal hygiene, food preparation and serving, daily living tasks, financial management, emergency evacuation, and who may need the services of hospice care, home health care, or typical ongoing medical services available in one’s home.

ALR Definition, Continued

• This does not include the private home of a person who is rendering care to relatives. This does not include a residential living unit in a continuum of care campus or a subsidized housing apartment. ALRs should be allowed to choose to serve residents with special needs unless the resident has been determined in a medical and/or functional assessment to need a higher level of care than can be provided by the ALR.

Medical Assistance Funds

• Medical Assistance funds should be used to support the needs of persons living in a variety of settings and at all levels of care.

Flexibility

• Consumers’ values are best served by allowing greater flexibility, thus providing potential residents with a variety of living choices, service options and funding mechanisms. Examples of flexibility in living choices would be the ability to select the appropriate physical environment and the level of care.

Public Funding

• Pennsylvania’s public funding for residents of personal care homes/assisted living residences should be increased to a level that would improve access by consumers and allow service providers to be adequately reimbursed for care provided to program beneficiaries.

Flexible, Outcome-Oriented

• Flexible, outcome-oriented accreditation standards or regulations should be used to allow for and encourage the creating of new models of care.

Consideration for Different Providers

• In developing standards and regulations for personal care homes/assisted living residences, separate consideration should be given to those facilities which are integrated into a multi-level-of-care system, are accredited, and/or have specialized in care for certain populations. Consideration should also be given as to the operator’s capabilities to provide services.

Fire Safety for Immobile Residents

• For homes choosing to provide care for immobile residents, standards and regulations governing safety can be assured through staffing, programming, or building design. Sprinklers should be provided in personal care homes that choose to provide specialized programs and care for immobile residents; and staffing and programming should be sufficient to address safety needs of temporarily immobile residents.

Fire Safety, Continued

• Temporarily immobile residents are defined as those unable to evacuate the building for a limited time period (of six months or less). It is the responsibility of the provider to advise residents of the risks involved in the situation. Evacuate the building is defined as exiting to a point of safety, including a fire tower.

Social Model of Care

• We support the concept of a social model for personal care homes/assisted living residences (ALRs), including regulation by the Department of Public Welfare, rather than a health care model, regulated by the Department of Health. However, residents of personal care homes/ALRs should be able to receive home and community-based services that are available to a person in one’s own home, upon agreement between the operator and the resident.

Access to County Services

• Residents of personal care homes/assisted living residences should be able to access county services available to their peers at no penalty to themselves or the personal care home/assisted living residence provider.

Housing and Services Package

• The choice of a combined package of housing and services is appropriate in some circumstances and should not be ruled out through legislation.

Option to Remain PCH

• There should be an option to remain a personal care home and a transition period set forth for current personal care homes that may choose to qualify as assisted living residences when these are defined in statute. Personal care homes in good standing should have the option of converting to assisted living residences at any time, providing they meet all of the standards required.

Termination of Residency

• The provider must have the ability to terminate residency in an appropriate timeframe for residents whose needs cannot be appropriately met by that provider. The provider’s policies with regard to termination should be disclosed to the resident upon admission to the assisted living residence.

Concerns People Want Addressed

• What is “Assisted Living”?

• Consumer confusion

• Bad outcomes/federal scrutiny

• Increased acuity of personal care residents

• Lack of affordable assisted living

Two Things to Keep in Mind

• Starting January 2003

– New Administration

– New General Assembly

What has the Government Been Doing about Assisted Living?

• Administration– DPW Personal Care Home Advisory Committee

– IntraGovernmental Council on Long-Term Care

– Cross-Systems Licensure Project

• Auditor General (Nov. 1998 Report, 2001 Report Released 10/9/01)

• General Assembly

DPW Personal Care Home Advisory Committee

• Futures Subcommittee (Nov. 1994 began; Report approved Nov. 1998)

• Waivers Work Group (Began Oct. 1994; Guidelines & Recommendations - 1995 )

• Staff Waivers Study (Issued June 1995)• Cost Study Work Group• Legislation and Regulation Subcommittee

Convened Nov. 1999; Recommendations 3/2000)

IntraGovernmental Council on Long-Term Care

– 1996 Report: Convene Assisted Living Task Force

– Assisted Living Task Force Provided Definitions, Philosophy, 58 Recommendations; 1998 Report

– Administration Response– Assisted Living Focus Groups

Cross-System Licensing Project

• DPW, Health and Aging Human Services• Began 1995

– Draft Human Services Statute– Internal changes to licensure/inspection process, including

“Licensing Compliance Prediction System”– Regulations rewrites

• Adult Residential Regulations Project – Draft discussion tool (March 2001)– Meetings on ARR draft (May 2001)– Decision to work on PCH regulations ONLY (June 2001)

PCH Regulations Rewrite

• 1,000 comments• Beginning from discussion draft• Working on three issues:

– Written Agreement– Assessment– Service Plan

• New discussion draft by Dec. 2001?• Goal: Final regulations before December 2002• What will next administration do?

Affordability Bills This Session

• H.B. 49 Maitland Amendment 199-0 - $15

• S. 301 (Lisa Boscola) - $35

• S. 477 (Mary Jo White) - $7

• S. 276 (Jane Earll) - $35

• H.B. 490 (Steve Maitland) - $15

• Budget bill: $2 per day increase

Legislative Activities Last Session

• 1999-2000 Legislative Session– H.B. 1930 (Incorporated aspects of ALWG and

Personal Care Home Advisory Committee Futures Group)

– H.B. 2700 (Incorporated many aspects of ALWG recommendations)

Legislative Activity Current Session

• 2000-2001 Session• HB 49 (Schuler bill; passed House in May 2001;

now in Senate Aging and Youth Committee) (6 additional bills)

• SB 888 (Mowery bill; referred to Senate Aging and Youth Committee)

• HB 1300 (O’Brien bill; referred to House Aging and Older Adult Services Committee)

• Tobacco Settlement

House Bill 49

• Status: – Passed House May 22, 2001– In Senate Aging and Youth Committee– Hearings?– Referral to Appropriations for fiscal note?

HB 49 Highlights

• Adult Living Residences defined– Category I = Personal Care Homes– Category II = Assisted Living Residences

HB 49 Definition of ALR

• “Offers, provides or coordinates a combination of personal care services, recreation and social activities, 24-hour supervision and assisted living services, whether scheduled or unscheduled and that coordinates other health-related services for consumers.”

• Subsidized housing and CCRC residential living units exempt

Service Providers Under HB 49

• Assisted Living Services also defined

• Providers of Assisted Living Services to be licensed by the Department of Health; IADL providers exempt

PCHs Under HB 49

• New to Personal Care Homes– Comprehensive assessments – Service plans– Increase of $15 per day for SSI residents– Reiteration that criminal history checks and

abuse reporting apply to PCHs

ALRs under HB 49

• Labor and Industry to issue regulations for ALRs

• DPW to develop standards for a Category II license (ALR)

• No physical room requirements in statute

• Assessment and service plan determine services needed and received

SB 888

• Background and status– Senate Aging and Youth Committee

• Highlights

SB 888

• Definition: “Offers, provides and/or coordinates a combination of personal care service,s activities, whether scheduled or unscheduled, and 24-hour supervision and health-related services for four or more consumers who are not related to the operator.”

SB 888 Highlights

• Subsidized housing and CCRC residential living units exempt from ALR definition

• Resident may arrange for receipt of supplemental services if ALR doesn’t need to fundametally change its program or residences and service provider meets ALR’s criteria

SB 888 Living Unit

• Self-contained unit 100 Sq. Ft. per person• Shared only by choice of resident• Capable of being locked by resident• Readily available bathroom, toilet and sink

and shower or bath• Space and outlets for microwave and

refrigerator• Sleeping and living area

Specialty Assisted Living Residences under SB 888

• Special designation required

• Additional requirements for restricted units

• Including disclosure requirements

Funding in SB 888

• No additional funding for PCH residents; although it would add COLA increase to asset threshold to qualify for SSI

• Creates housing supplement to be used with HCBS; $1 Million appropriation

• “Fair Share” formula for first day MA beneficiaries in ALRs

Licensure

• Similar in both bills

• Four classes of licensure– Exceptional quality licensure– Compliance licensure– Provisional licensure– Provisional licensure with a ban on admissions

Administration Views on Assisted Living

• One license is enough• No additional entitlement to housing/no provider

entitlement• Generally prefer unbundled services• Enforcement mechanism• No mandated structure (physical plant)• No licensure for attendants• Discharge criteria

Locked Units

• Current Policy

• Recommendations of DPW’s Advisory Committee

• PANPHA’s Locked Units Task Force– Need regulations on this issue– Need clarification and consistency regarding

definitions of secure units, buildings, and doors

What Has PANPHA Been Doing About Assisted Living?

• Testimony on H.B. 1930, December 1999

• Comments on H.B. 1930, May and November 2000

• Participation in Stakeholders groups

• Assisted Living Task Force Review August 1, 2001

• Comments on S. 888

PANPHA and Affordable Assisted Living

• SSI Increase Advocacy Network• District Meetings; Individual Meetings• AAHSA-led initiatives with HUD• Studies conducted to prepare data for these

affordability initiatives• Testimony on S. 1494 November 2000• Visits with legislators at Public Policy

Forum

What Principles does PANPHA use in its Assisted Living Advocacy?

• Who do you know? Form

• How you can get involved