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