Virginia Gov. Mark R. Warner (D) said he will sign legislation this week that supporters describe as the most substantial step in more than a decade to improve conditions in the state's assisted living homes.
The legislation passed last month includes requirements that administrators at the homes be licensed, significant increases in financial penalties for troubled facilities and more training for workers who administer medication to the residents.
Among the changes affecting Virginia's assisted living industry:
Administrators at facilities must be licensed by the state's Department of Health Professionals.
Staff members who administer medication must be registered with the state's Board of Nursing and receive more training.
Applicants seeking licenses to operate facilities must undergo background checks.
Facilities unable to meet minimum state standards must display a copy of their "provisional" licenses.
Regulators can more quickly suspend operations at a troubled facility.
Maximum penalties for infractions increase from $500 to $10,000. Homes with unpaid fines cannot get their licenses renewed.
Facilities "substantially out of compliance" with licensing requirements may be prohibited from receiving public funds.
New regulations and training requirements for "direct care" staff will be developed.
"This bill had the potential to unravel along the way, and legislators in both parties, the industry, advocates, all knew there was a problem and hung in together to work through the issues," Warner said in an interview.
Proponents called the measure a good start but said more remains to be done. Some argued, for instance, that Warner's budgetary increase in the monthly state subsidy from $894 to $944 per assisted living resident was inadequate to ensure quality care. With the new rate, the state will spend about $31 a day to subsidize low-income residents in the homes.
"It is extremely upsetting that we may charge more to board an animal than we do to take care of a person," said David Sadowski, president of the Virginia Coalition on Aging.
The final bill, which passed unanimously in the House and the Senate, was the culmination of work that began last summer with a state task force to study the industry, which comprises more than 650 facilities across the state. The group brought together an unusual alliance of activists, facility operators, regulators and lawmakers.
The changes were prompted in part by a series of articles in The Washington Post last spring detailing numerous preventable injuries and deaths. The failures often were rooted in poor staffing, insufficient resources, weak enforcement and a dangerous mix of residents, the investigation found.
"Providers themselves wanted to raise the bar," said Beverley Soble, of the Virginia Health Care Association, which represents about 75 facilities.
Warner is expected to sign the bill Wednesday. Some of the new requirements will take effect this summer, while others will be phased in. One of the most significant changes will be the requirement that facility administrators be licensed through the state's Department of Health Professionals, which is now the case for nursing home administrators. Homes that offer the most basic level of care, or "residential" care, will not be subject to the requirement because of the added cost.
The new requirement, proponents contend, will greatly improve accountability.
"That person's license is in jeopardy in the event something goes wrong," said Maurice Jones, outgoing commissioner for the Department of Social Services, who left the agency last week for the private sector.
The legislation will increase from $500 to $10,000 the maximum financial penalties homes face for violations. It will streamline the steps regulators must take to close troubled facilities in emergency situations.
Also, those who administer medication will have to be registered with the state Board of Nursing, which will help with training and oversight. The law is expected to affect tens of thousands of employees.
"What we clearly said . . . is what we have in place for medication aides today is not sufficient," said Jane H. Woods, Virginia's secretary of Health and Human Resources, who convened the task force.
Proposals that only licensed medical professionals be allowed to give medicine were scuttled because of concern that such a requirement would be too costly and would shrink a limited labor pool, Jones and others said.
Under the new rules, the state will improve screening of residents and staff training on how to respond to mental health problems.
Warner's budget allows for more inspectors to be hired and, in accord with the new rules, the inspectors also will undergo more thorough training, particularly on residents' disabilities, noted Sen. Jeannemarie Devolites Davis (R-Fairfax). "Typically, they have been going in and looking for health-type violations but not really looking at the residents to see how they are functioning," she said.
Left undone was any attempt to mandate minimum staffing levels with specified ratios of workers to residents. Woods said the problem with such formulas is that they do not take into account significant differences between facilities.
Woods said the new legislation strikes a balance among competing interests.
"There is no honor in being the strictest regulator in the country if what you have done is shut down an entire industry and put people into less-safe settings," she said. "Nor is there any glory in being so lax that people are at risk."