Substantive proposed changes to rules governing Maine’s assisted living and residential care communities across the state were developed without meaningful provider input and will accelerate the closure of communities, according to senior living industry advocates.
The Maine Department of Health and Human Services unveiled proposed changes to assisted living and residential care home regulations last fall, saying they would simplify the licensing process. Following an outcry from the senior living industry, which characterized the proposed rules as “impossible,” however, the state put forth a new proposal that reduced staffing requirements and would allow communities two years to phase in changes.
The original proposal would have reduced the state’s current 10 levels of assisted housing to two and would have doubled the number of direct care workers during night and overnight shifts, as well as set more stringent staffing rules in memory care.
The updated proposal scaled back staffing ratios, including returning requirements for memory care staffing to those lower than in nursing homes, according to The Maine Monitor. The new proposal would require communities with more than 10 beds to have one direct care worker for every 12 residents during the day, 1:18 in the evening and 1:30 overnight. Memory care units would be required to staff 1:8 during the day and 1:15 overnight.
Although an update to the assisted housing programs licensing rules was needed, Maine Health Care Association President and CEO Angela Westhoff said during April 1 testimony before the Maine Joint Committee on Health and Human Services, providers continually care being asked to do more with less.
“If this bill were to pass, Maine would have among the highest overall combined assisted housing and residential care staffing ratios in the country,” Westhoff said, adding that the provisionally adopted rules no longer would allow ancillary staff members such as housekeeping or dietary staff or volunteers to be counted toward the ratios. “So, providers will be forced to meet higher ratios with fewer staff members who can count toward meeting them and zero dollars to support these new requirements.”
Westhoff also addressed a “subtle, yet consequential,” change in the new rules that assisted living communities no longer would have licensed beds for people living with Alzheimer’s disease and other forms of dementia. Rather, assisted living communities that want to continue to care for memory care residents would have to become licensed as residential care facilities. MHCA estimated the change would affect at least eight communities and 240 beds.
LeadingAge Maine & New Hampshire similarly said that without new funding for the proposed staffing radio mandates, the rules changes would cause “significant harm created by financial burden to those providers who serve MaineCare [Medicaid] members.”
Denise Vachon, LeadingAge Maine & New Hampshire’s member services and government affairs director, said that assisted living provides a safety net for residents who don’t meet eligibility criteria for nursing facilities or who have depleted their personal resources, as well as serving as a safety net for families who need care for their loved ones.
“Assisted living environments bridge these gaps when nursing home care isn’t the right fit and home- and community-based services don’t fill the need,” Vachon testified.
Vachon told McKnight’s Senior Living that the industry is awaiting a work session on the bill at the committee level, saying “Our work here is not yet done.”
DHHS said in a statement that its goal is to adopt a rule that promotes resident health and safety without overburdening providers.
Argentum Vice President of Government Relations Paul Williams also testified, encouraging lawmakers to “revert back to a true collaborative rule writing process” that includes all stakeholders.
Speaking from a national perspective, Williams said that holding providers to a certain standard to meet residents needs is more impactful than minimum staffing ratios that are numerically specific. He also said if residents are displaced from residential care and assisted living communities, it will have budget ramification for the state, specifically for its MaineCare program. The cost to the state and federal government, Williams added, will be two to three times what the governments would pay for assisted living under the MaineCare program.
“If, in fact, the proposed staffing ratios are adopted, there has to be a corresponding increase in reimbursement for MaineCare providers to cover the cost to provide care based on the increased staffing,” he said.
Source: McKnights Seniorliving