Proposed assisted living regulations present “impossible” requirements for providers that will “threaten the viability” of essential services, according to senior living advocacy groups in Maine.
The Maine Department of Health and Human Services unveiled proposed changes in October to the state’s assisted living and residential care home regulations. The agency defended the measures, saying they would simplify the licensing process.
The Maine Health Care Association complained, however, that the newly proposed rules were crafted “without collaboration and meaningful provider input” earlier this month when stakeholders had an opportunity to respond.
The proposals target licensing, enforcement procedures, resident rights, infection prevention and control, physical plant standards and administrative requirements.
MHCA President and CEO Angela Cole Westhoff told McKnight’s Senior Living that the proposed rules introduced by the Division of Licensing and Certification present “impossible requirements for providers, threatening the viability of these essential services.”
“The new regulations impose unachievable staffing mandates, excessive training standards, and costly compliance measures that are unaffordable, particularly given the current workforce shortages and low Medicaid reimbursement rates,” Westhoff said. “These rules will exacerbate the labor crisis, forcing smaller and rural facilities to restrict admissions or close, further straining Maine’s healthcare continuum.”
The proposal would reduce the state’s current 10 levels of assisted housing to two — assisted living facilities and residential care facilities. It also would double the number of direct care workers during night and overnight shifts and set more stringent staffing rules in memory care that exceed federal and state staffing requirements for nursing homes. Provider groups said the proposals come without additional funding.
“This simplified structure is designed to improve licensee understanding of and compliance with the rule,” DHHS said in its announcement. “The provisions for the proposed rule have been updated to reflect current best practices in assisted housing.”
Social model of assisted living threatened
During the public hearing, providers raised concerns about the proposed regulations moving assisted living from a social model to a more clinical model that is more closely aligned with nursing homes, according to the Portland Press Herald. They also said the staffing ratio requirements would prove costly, and that those costs likely would be passed to residents unless the state increased provider reimbursements through MaineCare, the state’s Medicaid program.
MHCA urged the state to pause the rulemaking process to collaborate with providers in making “practical regulations, aligning Medicaid (MaineCare) reimbursement with the actual cost of care, and support workforce development initiatives.”
“It is essential to balance oversight with practical solutions to ensure that assisted housing facilities remain sustainable and accessible to the communities that depend on them,” Westhoff said.
In submitted comments, Denise Vachon, LeadingAge Maine-New Hampshire government affairs head, called the proposed changes to infrastructure, staffing, surveys and direct communications with DHHS, and capital investments “sweeping and onerous.” She was critical of the department’s silence regarding implementation timelines and recognition of fiscal impact on the provider community.
Although LeadingAge ME NH supports regulations that recognize the consumer and family voice, she said, “rogue instances” of mistakes should not paint the entire system of “outstanding and committed providers.”
LeadingAge ME NH offered several recommendations, including regulations structured to support the sustainability of long-term care, the use of existing tools to address increased care needs and correlating staffing needs, rate reform at the assisted living level, and transparency about the fiscal effects of the proposed changes.
Vachon asked the state to pause the process and collaborate with the provider community, partners, consumers and families.
“We ask for consideration of work groups to be established so that good faith discussions can occur, and solutions sought to creating positive and responsible changes to regulations that address the changing needs of the consumer, as well as the operational needs of the providers, to create a sustainable pathway to meet the goals, including an achievable timeline for ramping up and implementation, as well as a firm commitment for funding new mandates for capital improvements, new staffing ratios, new mandates positions and new administrative overhead,” Vachon wrote.
The regulations would cause small assisted living and residential care homes in rural communities to close, said Susan Stranahan, the president of the board of Island Commons, an assisted living home on Chebeague Island, ME, in an opinion piece published in The Portland Press Herald.
She added that older adults who rely on MaineCare would be most affected by the proposals if assisted living and residential care homes stopped accepting those residents.
“Under the new rules, the disparity between costs and reimbursement rates will balloon,” she wrote. “The rules come with no guarantee of additional funding. That would be up to the legislature, which historically has been reluctant to address funding shortfalls in a meaningful way.”
The proposed updates follow investigations into the state’s largest residential care facilities by The Maine Monitor and ProPublica, which reported on resident rights violations, elopements, and medication and treatment violations.
DHHS accepted written comments on the proposed rules through Nov. 25 and will review the public response before submitting its final proposal to the legislature in January.
Source: McKnights Seniorliving