A state task force on aging has prepared more than 20 recommendations to correct problems in Virginia's assisted-living industry and is getting ready to hand them to Gov. Mark R. Warner (D) for his support.
The plan calls for licensing facility administrators, increasing fines when homes violate regulations, requiring more training for workers who administer medication and doubling the state subsidy for low-income residents.
The recommendations coincide with a set of proposals offered by Maurice Jones, commissioner of the Department of Social Services. His proposals, which he plans to release this month, would bring more than 50 regulatory changes, such as more stringent requirements for people who wish to open assisted-living facilities.
The combined effect of his proposals and those of the task force, he said, "will be one of the most ambitious regulatory and legislative overhauls ever in Virginia that I am aware of."
The task force comprises about 45 people, including regulators, industry representatives, advocates and health professionals. Jane H. Woods, the state's secretary of Health and Human Resources, said she decided to expand a standing task force and focus this year on assisted-living facilities after a Washington Post series in May described serious lapses in care.
The series documented critical breakdowns, including preventable deaths and injuries of residents, and poor oversight by state regulators, who failed to identify or correct problems. Virginia is home to more than 630 licensed facilities that care for more than 34,000 residents with a wide range of disabilities. The residents need supervision and care but are not ill enough to qualify for a nursing home.
Woods's task force, which studied oversight, resident disabilities and funding, completed most of the recommendations last week. A few of the proposals are being refined, Woods said, but the group has started to draft legislation and budgetary recommendations to be presented to Warner.
"We have a moral duty to do this," said Jay W. DeBoer, commissioner of the Virginia Department for the Aging, who co-chairs the task force. "I think a lot of people who have been dealing with this for a long time realize this is the . . . best chance to make some significant changes."
Beverly Soble of the Virginia Health Care Association, who participated in the meetings and whose group represents about 75 facilities, said the changes would "raise the bar in a number of areas. . . . This will have far-reaching impact on assisted living in Virginia."
One of the major changes, many participants agreed, would be the proposal to license facility administrators as individual professionals, similar to what is required for state nursing homes. That would help ensure accountability in troubled facilities, Woods said, because "the administrator would have something at risk."
Other proposals would make it easier to suspend or close troubled facilities and increase fines from $500 per infraction to a maximum of $10,000.
The task force is still debating what type of training and qualifications should be required for workers who administer medication. Under current regulations, staff members need not be licensed health professionals to dispense medication.
"We feel strongly that certified nurse aides should be administering the drugs," said Dana Steger of the Virginia Association of Non-profit Homes For the Aging, which represents about 70 facilities and helped craft proposals.
The task force wants to double state funding for subsidized residents from about $29 a day to about $58 a day, DeBoer said. Members said the current rate is far from adequate.
Woods's group also advised enhancing the screening of incoming residents to more accurately identify their needs, disabilities and histories. A study by the Department of Social Services in May estimated that half of the residents have some sort of mental health diagnosis, such as dementia or mental illness. Advocates have complained that the homes are used as a dumping ground for a wide range of people with sometimes incompatible behaviors.
The task force is asking that facilities be required to disclose more to consumers about how many workers are typically on duty. But the group did not ask that lawmakers establish minimum staffing levels, as some states have done. In Virginia, the law requires only that homes have sufficient staff on hand to meet the needs of residents and evacuate them in case of a fire drill.
David Sadowski, president of the Virginia Coalition on Aging, an advocacy group, said he is encouraged by the proposals but said they will not get far unless Warner pushes the package.
"It's going to take his full support, with every executive and budgetary resource he can grab, to get this thing through," Sadowski said.