Virginia's commissioner of social services said yesterday that he would push to improve conditions and oversight of the state's assisted living facilities, suggesting increased fines for homes that violate regulations and the removal of obstacles that make it difficult to close troubled facilities. He also said he wants to make records on the homes much more accessible to the public by putting them on the Internet.
"We clearly need to make some serious changes," said Maurice A. Jones, commissioner of the Department of Social Services. "We are going to focus on . . . the things that promise to make the biggest impact."
In a series of articles this week, The Washington Post reported that residents at the facilities have suffered thousands of incidents of harm, including death, abuse, neglect and serious injuries. The state is home to 627 facilities licensed to care for more than 34,000 residents who need supervision and care but who are not sick enough to qualify for a nursing home.
The problems stem from several causes, including poor staff training, insufficient resources and relatively weak enforcement by state regulators, according to records and interviews.
Jones was among several people calling for changes in state regulations covering assisted living.
Gov. Mark R. Warner (D) said the problems "raise the question of how we are going to deal with long-term care. . . . There is no single silver bullet."
He said top aides would be reporting to him on their recommendations. "This issue is not going to go away," Warner said. "I don't think it's the case just in Virginia. I think it's the case across the nation."
He said two pieces of legislation adopted this year by the General Assembly should help counter the problems. One requires social services officials to investigate complaints of abuse or neglect within 24 hours. The other raises penalties for abuse and neglect by caregivers.
"If caregivers know there are going to be heightened penalties," it could serve as a deterrent, Warner said.
Jane H. Woods, the state's secretary of Health and Human Services, said she would like to improve training for inspectors and significantly increase the state subsidy that pays for indigent residents in assisted living.
"It is a ludicrous amount of money to pay for room and board for these folks," she said, referring to the state's subsidy of about $28 a day per patient.
She also suggested a requirement that the homes' owners be licensed individually, similar to the requirements covering nursing home owners.
Industry representatives said the problems are not universal and that abuse and neglect are not widespread.
"The vast majority of facilities provide quality care and do have safeguards in place," said David Kyllo, executive director for the National Center for Assisted Living, a nonprofit association that represents homes nationally.
Kyllo urged that Virginia move toward a system that places residents in homes more specifically licensed and designed for their conditions, rather than the current system of mixing residents of varied needs, such as dementia patients and schizophrenics, the mentally retarded and other types of disabled adults.
"The premise that the needs of a 30-year-old individual who is schizophrenic and psychotic, to think their needs are the same as an 85-year-old widow, logic would demand that you need to have a different kind of place," he said.
The Post found numerous incidents of violence and injury caused by residents abusing or assaulting housemates and staff workers.
Sen. Jeannemarie A. Devolites (R-Fairfax) said she has contacted Jones and would meet with him next week to discuss solutions. She also said she would work with Rep. Vivian E. Watts (D-Fairfax) to draft legislation aimed at correcting the problems.
"As legislators, we had no idea this was going on," she said. "People are accepting this as status quo."
In an interview, Jones said he believed that most of those working in the industry were dedicated. At the same time, he called for numerous changes, including increased training for workers who administer medication and more inspectors. He recommended inspections as often as five times annually, and monthly for troubled facilities. The current requirement is two inspections a year.
Jones also said he would urge that homes be required to have a certain number of workers on duty, depending on their size. The current requirement simply states that there be a "sufficient" number to meet the needs of residents and evacuate them in case of an emergency.