On Wednesday, November 2, the United States Special Committee on Aging conducted a two-hour hearing on the recent failure of Florida’s assisted living regulatory system and discussed how oversight of assisted living should be balanced between states and the federal government. The following content was provided by the National Center for Assisted Living (NCAL) in the November 2 edition of NCAL Connections. We are making liberal use of the information so members can access the testimony easily and understand the Minnesota-specific terminology used by national speakers at the hearing.

Sen. Bill Nelson (D-Fla.) called for the hearing after the Miami Herald published “Neglected to Death,” a three-part series documenting deplorable conditions that resulted in 70 deaths, 1,032 incidents of inappropriate restraints, and 181 cases of falsifying records since 2002. Below, in the order of their presentation, are the witnesses.

Barbara Edwards, the Centers for Medicaid and Medicare Services (CMS)’s director, Disabled and Elderly Health Programs Group Center for Medicaid, DHIP and Survey & Certification, said the agency lacked sufficient tools to enforce quality in Medicaid waivers. Short of shutting down a state’s funding, there is little CMS can do to close an assisted living residence if its operator or staff are causing harm to residents. Her eleven-page testimony can be accessed at http://aging.senate.gov/events/hr239be.pdf.

Martha Roherty, the executive director of the National Association of State Units on Aging, presented a summary of her ten-page statement including recommendations for a “federal framework for resident’s bill of rights and disclosure statement, along with a suggested tool for states to ensure quality compliance” and “increased federal funding for options counseling services delivered by I&R staff and ADRCS.” In Minnesota that means the Senior LinkAge Line® and mandatory transitional consultation.

Florida resident Alfredo Navas testified and submitted a three-page letter about his mother’s death. Her body was found in the pond behind the assisted living residence where she lived.

Representing national assisted living provider organizations, Steve Maag of Leading Age submitted seven pages of testimony saying that additional federal regulations are not the solution to lapses in quality of care. He and other witnesses pointed out that the majority of assisted living communities are committed to quality improvement and provide high-quality care.

Robert Jenkens, the director of the Green House Project, submitted three pages of testimony calling for the Centers for Medicare & Medicaid Services (CMS) to create a workgroup with stakeholder input to develop guidelines for quality assurance for Medicaid services provided in assisted living settings, including what minimum reimbursement rates are required for quality outcomes.

Several witnesses testified that states already have adequate regulatory systems in place, but some need to enforce existing laws. Larry Polivka, chair of the Florida workgroup appointed to address the issues highlighted by the Miami Herald, outlined steps the group will recommend to the state legislature to improve its system. Most of the discussion concerned what state or federal policy makers could do to prevent future tragedies from occurring. Sen. Nelson concluded the hearing by calling for a stronger ombudsman program and ensuring that states have greater consistency in their standards and that those standards are being enforced.

NCAL submitted an 18-page statement to the committee stressing that

1) Regulation of assisted living should remain at the state level.

2) The profession is making significant progress on quality improvement.

3) Medicaid reimbursement rates need to be sufficient to provide quality care.

NCAL also emphasized that CMS’ proposed rules defining home- and community-based services could eliminate Medicaid coverage for most Medicaid beneficiaries in assisted living settings.

Phil Manz
952.851.2484
pmanz@careproviders.org

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