Florida passes assisted living reforms

Assisted living professionals are lauding the passage of new regulations in Florida, but one group says they don’t go far enough to protect residents.

The state legislature will send Senate Bill 382 / House Bill 1001, unanimously passed by both bodies on Monday, to Gov. Rick Scott. If he signs it, these and other provisions will go into effect July 1:

• In assisted living communities that have a limited nursing services specialty license, nurses will be able to practice to the full extent of their abilities within the scope of a community’s license.
• Trained, unlicensed staff members will be able to assist residents with the self-administration of medication and related activities—including helping with prefilled insulin syringes and pens, nebulizers, glucometers, anti-embolism stockings, oxygen cannulas, continuous positive airway pressure devices, colostomy bags and equipment measuring vital signs—so that residents can avoid trips to the doctor for such things.
• Communities with one or more state-supported mental health residents will be required to obtain a limited mental health license.
• The Florida Agency for Health Care Administration (AHCA) will be required to adopt rules for uniform standards and criteria to determine compliance with facility standards and compliance with residents’ rights.
• An assisted living community will be fined $500 if it does not conduct a background check on a hired job applicant.
• The amount of a resident’s funds that could be held in safekeeping will increase to $500 from $200.
• AHCA will be required to pay to copy facility records during regulatory inspections.

“I am particularly proud of the oversight by AHCA to shut down bad actors, impose penalties for failing to do background checks and require specialty mental health licenses for facilities with one or more such residents,” state Sen. Eleanor Sobel, who has been working for three years to update Florida’s assisted living regulations, told Long-Term Living. She had introduced the bill in the Senate. Almost 90,000 older adults will benefit from the reforms, Sobel added. Florida is the third most populous state, according to the U.S. Census Bureau, and is topped only by California in the number of residents who are aged at least 65 years.

The Florida Assisted Living Association (FALA) says that ensuring enactment of the self-administration of medication provision had been its top priority in recent years. State Rep. Larry Ahern, who sponsored the bill in the Florida House of Representatives, told Long-Term Living: “Our statute wasn’t allowing for some of those things to take place and, unfortunately, it was causing [residents] to have to go to a nursing home early.”

Gail Matillo, president and CEO of the Florida Chapter of the Assisted Living Federation of America (ALFA), said in a statement that the legislation “provides for innovative reforms that will positively impact the assisted living industry and ensure Floridians residing in assisted living communities and memory care communities are well-protected and cared for.” ALFA members care for more than 29,000 older adults in the state, Matillo wrote in a letter published by the Tampa Tribune.

Reforms needed

Florida’s assisted living communities were scrutinized in a four-part Miami Herald series of articles, “Neglected to Death,” in 2011. The newspaper reported cases of abuse, neglect and death as well as lax enforcement by Florida’s AHCA. Scott subsequently vetoed a bill that would have relaxed regulations, and he formed a task force to examine related issues.

The legislation now in the governor’s hands was long overdue, Ahern said. “We hadn’t done any major reforms in the statute, as it turns out—I researched it—for almost 15 years,” he said. “We were lagging behind in a lot of ways. Even some of the smaller states around us—Georgia, Alabama and some other states—had been updating more frequently.”

The passed legislation, however, is not what residents and families expected after the newspaper investigation, Families for Better Care Executive Director Brian Lee told Long-Term Living. “They were hoping for tighter regulations to hold facilities more accountable, but this legislation actually loosens oversight on those assisted living facilities [ALFs] that care for the most vulnerable ALF residents in Florida,” he said.

Under the new legislation, assisted living communities that pass an inspection will have their next inspection two years later, as under current law. Communities with major violations will be inspected more frequently. Repeat violators could face license revocation.

Ahern said the legislation balances goals related to Florida’s AHCA, the assisted living communities and the residents. “We don’t always want to be legislating to that lowest common denominator, as sometimes happens; when you’re trying to punish the bad actors, you hurt the good ones, too,” he said. “So we tried to balance that. …We should be concentrating our efforts where we’re finding the violations.”

Lee, however, said that the bill’s “proponents argue that they are working to strike a balance between ‘good’ and ‘bad’ facilities, but how do consumers, regulators and operators know the difference unless inspectors are assessing quality?”

Ahern says that the bill provides an additional way for deficiencies to be revealed. “If any other government agency is inspecting—fire safety, electrical or whatever it might be—and they see any activity that would not be healthy for residents, they are required to report it to the abuse hotline that we have set up here in Florida,” he said.

No rating system

Passage of the legislation came after many unsuccessful attempts over the past several years. Some measures that had caused “significant concerns” for FALA members, according to FALA, were dropped from consideration by legislators. Those provisions would have required community living support plans for residents to be provided to administrators of limited mental health ALFs upon resident admission, made multiple changes to fines, and implemented a rating system for assisted living communities as well as a place for comments about communities on the Florida AHCA website.

The approved legislation does not create a rating or commenting system, but it does require AHCA, through a link on its website home page, to make it easier for people to compare assisted living communities and see information related to violations and amenities, Ahern said. “We think that, too, would encourage the owners to bring their standards up to the highest possible level—if they know people might be searching for a place for their loved one or to reside,” he added.

This provision is one of the legislation’s merits, Lee told Long-Term Living. “We believe that consumers will benefit from an improved database that provides in-depth information on assisted living quality by offering comparative inspection data,” he said. “These publicized data will challenge providers to strive for higher inspection ratings, positively resulting in better service and care to residents.”

Ahern said he learned much while working on the bill over the past three years, visiting ALFs of various sizes. “I think we ended up with a really good product here that maybe some other states might even end up taking a look at,” he said. “I think we got it right. We’ll know in the coming years.”

Lee said his group hopes that in those coming years, “more work can still be done to ratchet up accountability for a sector that has a historically pitiful track record.”

Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.