Assisted Living at a Crossroad

FL ALFA September 12, 2013

Monica L. Wilson

561-536-3670

AL – The New Nursing Home

Stakeholders

Is it inevitable?

Residents

• Increased frailty of residents

• More ADL assistance

• More chronic medical conditions

• More cognitive impairments

Regulation

• Fear of nursing home style of regulation

or

• Desire to increase level of regulation/change regulation with a focus on health care

Political Process

• Reactions to media stories

• Feds inching in on process

• Medicaid LTC Managed Care

Assisted living is a social/hospitality model

Myth

Coordination of health care and ancillary services

Consumers prefer

Senior Living

Assisted Living

Nursing home

to

Assisted LIVING

• Lifestyle

• Choices

• Amenities

• Environment

• Support

• Access to health care

Assisted LIVING Core Values

• Promoting Dignity

• Protecting Privacy

• Support for decision-making and autonomy

• Offering Choices

Quality of Life

AL Pioneers – the originators of “cultural change”

Barriers

• Political process • Low tolerance for

risk/paternalism • Emotional response to problems • Associations • Regulation • Facility/Company policy policies

and procedures (often a reaction to regulation)

• Shareholders/need to focus on profits

• Lack of Vision • Lack of Curiosity/Understanding

needs of stakeholders

Media

Newspaper, T.V. etc Consumers

• Close to 1 million living in AL

• Recent ALFA poll – satisfied, feel safe, enjoy high quality of life

• Little to no ALF regulation

• Poor enforcement

• Lack of federal oversight

• Suggests federal oversight desirable and necessary

• This is bad, bad, bad for consumers

Reactions

• Public/people typically react emotionally, think dramatically not quantitatively

• Politicians responses

• Pressure on regulatory agencies to show they’re protecting vulnerable citizens

• Associations try to change conversation/control message

• Industry leadership

Your leadership required/desired

Positive Outcomes

Quality

+

Industry Leadership

+

Good Regulatory Process

Regulation – Cary Coglianese

Supposed to Work

Supposed to effectuate some improvement in the conditions of the world.

Improvement means that the conditions with regulation are better than what they would have been without the regulation.

3 Steps

1. Regulation is implemented, which leads to changes in

2. The behaviors of individuals/entities targeted or affected by regulation, which ultimately leads to change in

3. Outcomes, such as amelioration of underlying problem or other changes in conditions.

Basic Elements of Regulation

Behaviors

Outcomes

Florida

Front End

• Add analysis to decision making process when introducing new regulation

• No formal lookback process/analysis of individual regulations

• ALF Workgroup & Negotiated Rulemaking

• Limited quantitative information – relies heavily on anecdotes and knowledge base of participants

How is regulation of AL in Florida working?

Characteristics of Desirable Regulatory Practice

• Open and transparent process

• Includes citizen participation

• Promotes flexibility for citizens and business/industry

• Analysis of relevant alternatives

• Minimizes burden

• Aims for simplicity

-- United States – European Commission High-Level Regulatory Cooperation Forum Common Understanding on Regulatory Principles and Best Practices , June, 2011

Consistent Approach to Regulation Development

• Identify the behavior/condition want to impact

• Identify the desired outcome

• Identify the regulatory options

• Apply decision-making criteria

Want to apply a more consistent, analytical approach to minimize

the inclination to implement a nursing home style of regulation.

Require regulatory entities to apply analytical approach and more transparency.

Decision-making Criteria

• ANTICIPATED IMPACT/EFFECT

• COST-EFFECTIVENESS

• NET BENEFIT

Adapted from Measuring Regulatory Performance EVALUATING THE IMPACT OF REGULATION AND REGULATORY POLICY, August 2012, Cary Coglianese

Decision-making Criteria

• What is the anticipated IMPACT/EFFECT?

– How much do we anticipate each option will change the targeted behavior or lead to improvements? (degree of change)

– Are there feasible alternatives?

– How does the option provide for flexibility for industry/allow for innovation and identifying least costly methods for compliance? Shouldn’t be overly prescriptive.

– Does this option also allow consumer/citizen flexibility and options?

Adapted from Measuring Regulatory Performance EVALUATING THE IMPACT OF REGULATION AND REGULATORY POLICY, August 2012, Cary Coglianese

Decision-making Criteria

• COST-EFFECTIVENESS

– What will each regulatory option cost?

– What is the anticipated cost-benefit?

• Does not just encompass monetary or quantitative evaluation. Intangible benefits should also be considered.

• Values/Equity/Fairness

– Will different groups be affected differently?

– Anticipated impacts on vulnerable population?

– Do nothing option

– Zero Risk illusions

Adapted from Measuring Regulatory Performance EVALUATING THE IMPACT OF REGULATION AND REGULATORY POLICY, August 2012, Cary Coglianese

Decision-making Criteria

• NET BENEFITS/EFFICIENCY

– Which option will yield the greatest net benefit?

– Least burden?

– Does this result in additional documentation requirements? Can they be streamlined?

– Do the regulatory options take into consideration all stakeholders?

Adapted from Measuring Regulatory Performance EVALUATING THE IMPACT OF REGULATION AND REGULATORY POLICY, August 2012, Cary Coglianese

Healthcare and Assisted Living

• Florida Framework

– LNS, ECC

– Both could benefit from updating and revisions

• Memory Care an emerging issue

Menu of Options

• Consumer & Provider Choice

• Disclosure