The May 23-26 front-page series about assisted-living facilities should be a catalyst for regulatory change.

The Virginia Center for Assisted Living, an arm of the Virginia Health Care Association, recently asked the Virginia Board of Health Professions to require licensing of assisted-living administrators to increase accountability for services and institute a professional practice to promote residents' safety and well-being.

The center also supports an increase in the state's reimbursement rate -- because it is unrealistic to provide services and meals for only $28 a day -- and has called for regulatory restructuring. Virginia's homes that serve the mentally ill should be reclassified from "assisted living" to a more accurate regulatory term. Even without reclassification, the Virginia Center for Assisted Living holds that the mentally ill and the frail elderly should not be housed in the same facility.

Finally, the center supports increased training requirements for direct-care staff and routinely offers such training to improve residents' quality of care.

Many excellent assisted-living providers offer compassionate, quality care for Virginia's elderly. With administrator licensing, an increase in public care reimbursement and regulatory restructuring, more of Virginia's elderly and individuals with mental illness will get the care they need to lead the fullest lives possible.

STEPHEN C. MORRISETTE

President

Virginia Health Care Association

Richmond

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It is a tragedy when innocent people are harmed as detailed in David S. Fallis's series on assisted-living communities in Virginia. It is also a tragedy, however, when all such communities and thousands of dedicated professionals are maligned because of the incompetence of a few.

Mr. Fallis's expose indicated that "about 400" of 825 of Virginia's assisted-living facilities were cited for licensing violations from 1998 through 2003, which suggests a nearly 50 percent failure rate. But on an annualized basis, the number of communities cited for violations (of any kind), averaged 66 per year -- less than 8 percent of the total. Eighty-six communities committed violations severe enough to warrant a fine, yet this would amount to only 1.7 percent of communities statewide in a given year.

Readers of Mr. Fallis's series should know that Virginia offers assisted-living services of good quality, is the home of the nation's largest industry association and provider of senior housing and is an industry leader in advancements and education in the field.

ANDREW J. CARLE

Director

Program in Assisted Living Administration

George Mason University

Fairfax

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The conditions in Virginia's assisted-living facilities are a tragic yet predictable result of the state's decision to underfund community-based housing and care for its most vulnerable citizens. By warehousing people with mental illnesses and other disabilities in large or isolated "adult homes" that are beyond its ability to monitor, the state guarantees poor outcomes for all residents.

Lawmakers in Virginia and other states have reduced public investment in and oversight of services for people with mental illnesses. Adjusted for inflation, state mental health budgets are now smaller than they were in 1955. Rather than building a comprehensive system, Virginia has slashed funding and privatized services for thousands of people with mental illnesses. Rather than fitting the housing and services to individual needs, Virginia seeks to fill "beds" and "slots," as if adult home residents were nothing more than income streams.

Until lawmakers in Virginia and other states begin to think comprehensively about the kinds of housing and care that people with mental illnesses need and deserve, assisted-living horror stories will continue.

MICHAEL ALLEN

Senior Staff Attorney

Bazelon Center for Mental Health Law

Washington