Assisted living homes fight new rules Providers say changes will mean price hikes or failed businesses

November 18, 1997|By Marcia Myers | Marcia Myers,SUN STAFF

Scores of small assisted living homes for the elderly are organizing an 11th-hour battle against new state regulations that they say would force them to significantly raise their rates or go out of business.

While many larger homes applaud the state's proposed changes, which are nearing a final draft, owners of homes with 15 beds or fewer say some of the new rules will create impossible financial burdens, particularly for those catering to low- or middle-income clients.

"The owners of these homes are scared to death over these regulations," said state Sen. Philip C. Jimeno, an Anne Arundel Democrat and chairman of the Joint Committee on Administrative, Executive and Legislative Review, which will schedule a hearing on the issue in coming weeks. "I know what the state is trying to do, but we can't have overkill."

Assisted living homes have become a popular, rapidly growing alternative to nursing homes.

Often set in neighborhoods, they afford residents a noninstitutional setting with a staff to help with such tasks as bathing, dressing or getting to a doctor's appointment. The cost is roughly half that of nursing homes.

In recent years, about 8,000 seniors in Maryland have moved into assisted living homes, which have doubled in number to about 5,000, state officials say.

The state's plan attempts to correct a multitude of loopholes and contradictions in the current law.

"Up to this point there have been very minimal regulations, and I've heard some horror stories," said Julie Buchwald of the Health Facilities Association of Maryland, which represents about 170 nursing and assisted living homes statewide and supports most of the plan. "The state has an obligation to make sure quality care is being delivered."

The more costly elements of the plan require training for any employee who administers medication. At a minimum, that involves dispensing daily medicines to residents who are unable to handle the task reliably because of dementia. All employees would have to be trained in CPR, first aid, food safety and emergency disaster plans.

In addition, the new rules call for detailed reports of each resident's needs, as well as visits every 45 days by a nurse or pharmacist to monitor residents' conditions.

The most controversial of the proposals would limit how many people at the sickest levels can be cared for in a home. Persons requiring any of eight types of care, including ventilator services, intravenous therapy or medication, or more than intermittent nursing care, would be ineligible for assisted living care.

Jimeno said he will explore whether those restrictions violate federal fair housing laws.

"If someone has a certain illness or condition, are we depriving them of living where they want to live?" he said. "Are they being denied fair housing because of their physical condition?"

Health officials say that is not the case.

"It's important and necessary for us to set these conditions for quality purposes," said Carol Benner, director of licensing and certification for the state Department of Health and Mental Hygiene.

She said officials are considering ways of allowing more latitude on those limits, particularly for people already in homes. If there are compelling reasons to keep a person in a home and providers prove they can adequately care for them, they should be able to stay, she said.

Mandatory training for people who administer medicine is not negotiable, she said.

"We know that the medicine these residents get ranges from anti-psychotic, anti-depressant and anti-seizure medicine to heart pills," Benner said. "If homes do not want to give medication, they don't have to have this training, but you can't give an elderly person medication without it. It's not safe, and we know it's not safe."

Among the owners of small assisted living homes raising objections is Dolores Rocklin, who cares for 15 residents in a sprawling 200-year-old farmhouse called Locust Lodge in Pasadena. The renovated home offers charm and comfort -- ample space for residents to socialize or spend time alone, a TV room lined with easy chairs and an aviary where a pair of lovebirds recently hatched four offspring.

She charges her residents $1,600 to $2,200 a month, but said the new regulations would cost her $50,000 and force her to raise her rates by $500 a month. Among the extra costs she expects: $20,000 for an employee to handle the additional paperwork and $14,000 for medical evaluations, which she believes are already being adequately handled by her residents' physicians.

"Most of these people are on limited or fixed incomes, and they can't afford the increase," Rocklin said. "If assisted living homes become inaccessible, there will be no choice for people. Doctors will get people Medicaid-approved, move them into nursing homes and the state will end up paying for it."

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