Assisted living providers in Arizona that provide services for older adults living with dementia should be “gearing up for significant changes ahead” after the state published its proposed rules for memory care, according to a legal expert.
The Arizona Department of Health Services is in the process of drafting new rules to establish memory care service standards in assisted living communities and to set training requirements for staff members and managers.
The department published an updated draft of its proposed rule on Jan. 29 after collecting comments through Jan. 19. The rulemaking process was triggered when Arizona Gov. Katie Hobbs (D) announced her plans to advocate for a package of bills in an effort to ensure that long-term care facilities “cannot hide or erase their violation history,” increase fines, standardize inspections, and establish standardized credentials related to memory care, Alzheimer’s and other forms of dementia.
That push resulted in HB 2764 being adopted last spring, adding a definition of memory care and screening requirements for the hiring of individuals who provide direct care in senior living and other long-term care settings.
In addition, the bill implemented licensing requirements for assisted living communities that offer memory care services, increased fines for violations, and set minimum training requirements for assisted living staff members and managers who provide memory care services.
Attorney Jennifer Wasserman of law firm Davis Miles wrote in a blog post that assisted living providers “should be gearing up for significant changes ahead.”
The Arizona Assisted Living Federation of America submitted comments that it believes that the fees proposed for on-site monitoring and training for regulatory compliance are “excessive” and noted that the memory care training requirements would allow only registered nurses or others with bachelor’s degrees in certain areas to be eligible to provide training. Additionally, according to Arizona ALFA, the proposed violation and fee schedules are “overly prescriptive,” as are the civil penalties and monitoring fees for relatively minor regulatory violations.
The proposals
The ADHS’ proposed rules would require an initial eight hours of in-person training and four hours of annual continuing education for staff members, as well as specific training for managers. The rules also would create a process to approve and certify memory care training program providers.
In its comments to ADHS, the national Argentum organization said the proposed memory care trainer eligibility requirements would have “significant negative impacts” on the industry, including unnecessarily limiting the number of educators needed to provide training. They also would significantly increase training costs and create barriers for staff members in need of training, Argentum said.
“We ask the department to recognize that there are many well-qualified dementia care training professionals who are not registered nurses and/or do not have a bachelor’s degree,” the national association wrote. “This proposed change would not only exclude licensed practical nurses and other well-qualified individuals who are considered subject matter experts and specialists in Alzheimer’s and dementia care from providing this critical training, but will also limit the field of qualified trainers resulting in staff not receiving the required training they need.”
Argentum urged the state to consider trainer criteria that includes direct experience in assisted living memory care settings and those can provide practical insights and address the unique challenge in dementia care specific to the assisted living setting.
“Ensuring trainers process the knowledge of critical subject areas related to memory care services in assisted living settings, coupled with direct care experience, should be the overriding standard rather than educational qualifications and exclusionary provisions that exist in the proposed rule,” the national association wrote.
Argentum also addressed in its comments proposals related to on-site monitoring fees and in-service training fees.
The association labeled a proposed on-site monitoring fee of up to $1,000 as “excessive.” ADHS had proposed implementing a potential per-visit monitoring fee on a provider if it deemed monitoring necessary due to repeat deficiencies or the threat of harm to residents. Argentum suggested that the state further define the range of fees associated with monitoring visits and provide the specific factors used in determining on-site monitoring fees.
Argentum also called a proposed maximum $500 per hour fee for providing in-service training excessive, similarly calling for a more defined range of fees and factors that would drive up those charges.
“We feel an excessive fee structure will discourage assisted living providers, particularly those that operate smaller communities, from contacting the department to engage in this critical function,” Argentum’s comments read.
In addition, the national association noted that civil penalties that could be assessed on a per-resident basis have the potential to be “unnecessarily punitive and excessive.” The proposal would increase the per-resident-affected per-day maximum penalty to $1,000.
Source: McKnights Seniorliving