Guest Blog: "Assisted Living Scrutiny"
The following is a guest blog from Anthony Cirillo:
The first of the year brought new standards to my state of North Carolina's rating system for assisted living facilities. The highest rating for these centers, classed as adult-care homes by the state, will move from three to four stars and will require consistently high performance over two years. Ratings will factor in recent penalties for violations such as medication errors and failure to stop residents' wandering. Other factors include whether the facilities meet standards on staffing, handling residents' medications, training and sanitation. In the past, about 95 percent of the centers got a top rating.
Of course when everyone is "perfect" it makes it very hard to judge a facility's care based on a rating system. The three star system was passed into law in 2007. The Division of Adult Care Licensure started issuing star ratings for adult-care homes last January. "When the four stars start being issued, you'll see a truer reflection of the care being provided," said Jeff Horton, head of the state Division of Health Service Regulation, which oversees the centers in an interview with the Charlotte Observer. Will we?
Advocates for older people fought for the law, but some have noted that the ratings may sound stricter than they are essentially pointing out that the system does not give maximum stars for going above and beyond minimum standards but simply awards meeting minimum standards. Of course I applaud North Carolina for at least trying to address the issue. Minnesota too has made inroads in trying to rate and regulate assisted living, implementing laws that include background checks for all staffers and a nurse on-call at all times. So have many other states.
But here's the thing. Just like in the infancy of nursing home ratings, there are gaps and there is more work to be done. Lack of federal regulations defining minimum practice standards for assisted-living facilities has prompted states to develop their own regulations, leading to varied standards from state to state. A universal, reliable method of measuring care and life quality in assisted-living facilities is needed. There is no central database like Nursing Home Compare to judge apples to apples. (Let's not go into the merits of this for the nursing home industry!)
But even beyond this, I have observed a more disturbing issue. I am clearly no medical expert but I do spend hundreds of hours in assisted living facilities every year. I see residents who are inappropriately placed and who should be in nursing homes. I know there are standards for this but I can see firsthand that they are not always followed. Some of the sensational deaths reported in the media for residents of assisted living facilities may have been avoided if the person was in a more closely supervised environment. Of course my feeling is based on gut not some checklist.
I do know that some facilities, once bringing a resident on board, are reluctant to lose that resident as a revenue source should their condition deteriorate. And I am sure vulnerable and guilt-ridden caregivers feel much better knowing their loved one is in an assisted living facility rather than a nursing home. After all nursing homes are places you go to die right? That is the perception of 99 percent of the public. And assisted living facilities, with their nice wallpaper, carpeting and amenities must be nicer right?!
Perhaps in 2010 it is not state and federal regulations that police the industry. It is the industry that is honest with itself. And it is vulnerable caregivers, assisted by the industry, who must be guided to informed choices that are absolutely right for their loved ones. I am for more objective decision support for care selection but as we have seen in other aspects of long-term care, there is a lot of discrepancy and debate as to what constitutes an effective rating system. So it is up to us to be more diligent until something better comes along.
Anthony Cirillo, FACHE, ABC is a health care consultant, senior advocate and blogger for Wellsphere, Medpedia and others in the area of aging, person and patient-centered care and marketing. He consults with long-term care facilities and is available for management retreats and association keynotes. He is the author of "Who Moved My Dentures? His company, Fast Forward Consulting empowers organizations to change the healthcare experience and leverage it in their marketing. Hear him speak at both the American College of Healthcare Executives and the National Council on Aging annual conference in Chicago in March. More at www.4wardfast.com and www.anthonyssong.com.