Wednesday, November 2, 2011

Assisted Living Facilities Regulatory Oversight and Reform

The Florida Legislature has been working hard on crafting proposals that would reform the health quality assurance system that provides regulatory oversight of quality and care that Floridians receive in state licensed assisted living facilities.

The current survey system now in use by the Agency for Health Care Administration has evolved over the last 30 yrs and was derived from the hospitals and nursing homes which are themselves medical models of care that require a citation driven deficiency model survey.

The major question for policy makers during the 2012 legislative session will be to answer one fundamental question; "If Florida were to purchase a new health quality assurance system today, would we buy the one we have today?"

It is my view that the current system is outdated and no longer serves the long term public policy interest of the state's need to have a cost effective system that provide regulatory oversight and contributes to the development of a robust system of ALF care that can meet the challenge of rising acuity.

Two major forces are underway that will create a need for substative change in how state's regulate assisted living facilities. As many states seek to manage their long term care costs many will seek to adopt policies that will place more people into managed care plans.

We know from Florida's experience with the nursing home diversion program that 50% of the placements in these long term care managed care plans are referred to assisted living facilities. It is a reality that the ALF can provide a comparable level of care due to a lower cost structure than the nursing home and managed care plans will increase their utilization of ALFs in Florida and should be expected to ask ALFs to do more and manage residents with higher levels of acuity.

The second major driving force that will affect assisted living facilities is the issue of rising acuity. It is expected that as the nation begins to age both the elderly and the adults with mental illnesses will begin to experience a rise in chronic medical conditions which impact on the rise in acuity that must be managed in the ALF.

The currentsystem now in use in Florida only focuses on the facility and not the system of care. The reality is the ALF only provides the residential function and some supportive services and DOES NOT provide medical care or clinical supervision. It is important how the clinical supervision is rendered and this is why any new system created should focus on the "system of care" that is in use as opposed to the narrow focus on the facility.

The basic elements that really matter most in my view to ALF residents and their families include the following;

1. Qualifications and involvement of the administrator.

2. The relationship between the frontline staff and the resident.

3. The presence of a well coordinated 'system of care" that promotes scheduled care over crisis care.

4. Collection of information on changes of condition and the speed with which information is linked to key decision makers in the system of care.

House Bill 397 by Representative Fresen is a real move towards a consultative model that includes a regulatory hammer for low performing facilities. It calls for higher standards for ALF administrators and creates a RFP for a statewide data collection system that can be useful in forecasting trends in resident care.

The need for real reform in how we consider or weigh the options for improvements to the oversight and regulatory system will play a critical role in how sucessful Florida will be in meeting the new challenges associated with an aging population and growing numbers of the mentally ill who need assistance in the next ten years.