Plan would monitor assisted-living homes, limit types of residents Proposal restricts choice, witnesses say

March 24, 1998|By Marcia Myers | Marcia Myers,SUN STAFF

In late January -- two years after suffering a mild stroke and within a month of experiencing kidney failure -- Art "Janney" Janushek, the retired News American sports columnist, died at age 82 in the assisted-living home in Annapolis where he chose to spend his final days.

It was a choice anyone should have, his daughter, Cathee Smith, testified yesterday in a packed hearing room before state legislators. Instead of moving him to a hospital or nursing home that was unfamiliar, the family brought in nurses to help care for him, she said.

But under regulations proposed by state health officials, Smith and others fear that some residents would lose that choice, even if the doctor, patient and family agree it is the best option.

"He died with dignity in the place he had come to know and love," Smith said during yesterday's hearing. "My concern is that these regulations could make a difference in the way you and I live the last days of our lives."

Two years in the making, the state's plan seeks to correct loopholes and contradictions in law that leave virtually unregulated most of the state's more than 5,000 assisted-living homes, a number that has doubled in recent years with the homes' popularity.

Assisted-living homes typically are set in neighborhoods and offer a lifestyle that is less regimented, less costly and less institutional than nursing homes.

Among the more controversial of the state's proposals are: Limits on who can reside in an assisted-living home. Persons needing high-level care including intravenous therapy, ventilator services and more than intermittent nursing care would be restricted from assisted-living homes.

Training for staff in administering medication and cardiopulmonary resuscitation, first aid, food safety and emergency disaster plans. Smaller homes say this training might be so costly, they would be forced out of business.

Detailed reports on residents' needs and other documentation of care and treatment. The plan also calls for regular inspections and sets minimum standards for beds, furniture, bathrooms, telephone service and access to writing and mailing materials.

More than 120 people attended to testify yesterday at an all-day hearing before the Joint Committee on Administrative, Executive and Legislative Review, who will vote on the proposal.

The plan has produced criticisms, although nearly everyone seems to support setting quality standards and monitoring the homes. Few seemed prepared to endorse blocking the plan. In most cases, they asked legislators to re-examine the details.

A bill, endorsed by the health department, would delay enforcing the regulations for small homes for more than a year.

Nursing homes say the state's plan could create problems if it allows unqualified assisted-living homes to provide skilled nursing services.

"If you really want to test this, let's do it in a pilot program first and make sure it works," said Michael Johansen, an attorney for Manor Care Inc.

Small assisted-living homes predicted that the additional costs of training and other expenses would put the smallest homes out of business.

The Maryland Assisted Living Association predicted the average home would incur $11,650 in additional costs per year.

But Martin P. Wasserman, secretary of the Department of Health and Mental Hygiene, said his agency's plan reflects a balanced approach that helps assure safety of residents while respecting their privacy, dignity and the need for affordable options to nursing homes.

Under the plan, assisted-living homes would be licensed based on the level of care they provide. They could obtain a waiver if a resident's health declines, and the home must provide a higher level of care than it is licensed for. The home would have to prove the resident would be adequately cared for, and no more than 50 percent of the residents in a home could obtain such waivers. In cases where a resident's illness surpassed the highest level of care category, waivers could still be obtained, but no more than 20 percent of residents would be eligible.

Pub Date: 3/24/98

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