The head of the Virginia Department of Social Services told lawmakers Tuesday that aggressive action is needed to correct problems in the state's assisted living facilities, including more inspectors, increased funding to care for poor residents and measures to improve the industry's shrinking, untrained labor pool.
"I've seen bad expensive places and bad inexpensive places. . . . The key is training and management . . . and staffing," Maurice A. Jones, commissioner of the Department of Social Services, told a subcommittee of the General Assembly's Joint Commission on Health Care.
The long-term care subcommittee held the meeting to address concerns about the industry after The Washington Post published a series of articles last month documenting thousands of harmful incidents in assisted living facilities, including avoidable injuries and deaths.
The state has more than 627 facilities licensed to care for more than 34,000 residents who need help with daily activities but are not sick enough to live in a nursing home.
Jones said assisted living is facing increasing challenges: Large numbers of baby boomers will need care in coming years, and the downsizing of state mental health institutions has generated a demand for housing for former patients. He said that the state needs an additional 20 inspectors so homes can be inspected more often. In addition, he said, regulators need the power to close troubled facilities quickly, and training and staffing requirements should be tightened.
Current regulations, which do not specify a required number of workers on duty, are "just not working," he said.
Del. Phillip A. Hamilton (R-Newport News), who chairs the subcommittee, encouraged Jones to put together "an aggressive" legislative and budgetary package on assisted living for the coming session. "It's long overdue and much needed," Hamilton said.
David Sadowski, president of the Virginia Coalition on Aging, an advocacy group, said problems in the facilities have been noted in state studies since the 1970s. "Hopefully, you are as outraged as we are that this has been going on for 30 years," he said in a written statement.
"We have taken a system and used it as a provider of last resort and dumped everybody in it, expecting these individuals . . . to take care of them," he said.
Joani Latimer, the state's long-term care ombudsman, whose agency investigates complaints against the homes but has no authority to order changes, reminded lawmakers that residents are being harmed. She warned of "not just a disaster waiting to happen but, unfortunately, a disaster already in progress."
She called for various changes, including restructuring the system so the frail elderly would not be living with the mentally ill.
Grant Goldman, past president of the Virginia Adult Home Association, acknowledged that there are bad homes, but he also spoke of "owners, administrators, staff and volunteers dedicated to providing quality of care with ever-dwindling resources and increasing burdens and expense."
Goldman argued, as did some other speakers, for higher state reimbursements to homes that take in low-income residents. Some of those homes are barely meeting minimum standards in providing food and activities to their residents, he said.
"Many facilities have worn-out furniture, walls in need of paint and staff in need of benefits and salaries reflective of the task that is set before them," he said.
Beverly Soble, vice president of regulatory affairs for the Virginia Health Care Association, which lobbies on behalf of some assisted living facilities, told lawmakers that administrators of the homes should be licensed. She also said the regulatory system should be restructured to distinguish homes that serve the elderly from those that serve the mentally ill.
"One size does not fit all," she said in her presentation.