Mike's Column

As we head into a new year, sliding past family gatherings, it’s a great time to reflect upon the future of the assisted living industry. Did the RCFE Reform Act give you pause? It allows facilities to accept feeding tubes, staph and other serious infections, stage 3 and 4 wounds. Why this law?
A manager at DSS answered that question and it should not shock you—the Affordable Care Act (ACA). Despite all the controversy currently associated with this federal law, it has forever changed health care in America. Caring for all Americans is great, but the elderly seem to be on the periphery. Instead of being allowed more days for recovery in acute or skilled nursing settings, they are now going to assisted living homes “which are not primarily medically oriented,” and “represent a humane approach,” and “can provide a homelike environment” so states Health & Safety Code 1569.1.
A regional manager recently stated at an assisted living conference, “TB remains prohibited.” That’s true, given the new laws enacted by the California Legislature. Should facilities accept prohibited health conditions, who provides the care should hospice be discontinued and home health runs out of visit authorizations? Your caregivers, who else? The new law requires facilities to assist residents with “accessing home health or hospice,” but does not address any “what ifs” about those services being discontinued, under the ACA, as this care has become too expensive. Your staff will be forced to do stage 4 wound care or tube feedings. But then again, facilities do not have to accept these clients…but you know RCFEs will for the revenue.

Post date: 11/30/2016

I guess I’ve been preaching it for the 15-plus years I’ve been a vendor, but now it is even truer. During the so-called RCFE Reform Act, 1569.39 was added to state law allowing RCFEs to accept and retain “prohibited conditions,” a shock to the industry. The only condition placed upon facilities in the new law was assisting “residents with accessing home health or hospice services, as indicated in the resident’s current appraisal, to ensure that residents receive medical care as prescribed by the resident’s physician.”

DSS has not revised Title 22, but instead created an “implementation plan,” claiming Title 22 section 87616 is still enforceable which makes facilities seek an exception for prohibited conditions. The new law did not require this but DSS is bypassing the legal provisions deferring to old state regulations. The law must be upheld and not the opinions of a few state employees who write interpretations instead of updating regulations to reflect new laws. 

Post date: 09/19/2016

Many licensees are questioning their desire and motivation to remain in the residential care industry. It’s not that they can’t or don’t provide good care. Rather, it’s a combination of cumulative factors such as new laws and regulations, more demanding families, pressure to lower fees, worker’s compensation, minimum wage, inconsistent enforcement by DSS, and the list can go on and on.  I understand those struggles. I recently spoke to a licensee in the business for 29 years, and she said what many are saying, “I’m just tired.”

I’m often asked the question, “What’s the future of residential care?” It depends. Are you an optimist or a pessimist? To become an administrator today, one must take the 80-hour initial course with a 100-question exam, and to get a new facility license, if the administrator has been certified over five years, they, too, must take the 80-hour course. On the positive side, that means less competition and fewer care facilities. Do you see that as good or bad? The elder care industry can be very rewarding, but it is also very hard work. Caregiving is the most stressful job and occupation in the United States, and California is not “business friendly.” In fact it ranks last in the nation for finding qualified employees and for supporting businesses.

My hope is that those facilities that are resident-focused, provide excellent care and comply with laws and regulations weather the storm, and those who really aren’t committed to their residents leave the industry.

Post date: 10/01/2016

What predictions are being made about 2017? Prosperity? Economic uncertainty? A health care crisis? For the assisted living industry, will the legislature continue its legal, punitive barrage? Will DSS continue moving toward a medical model? What would an RCFE look like under skilled nursing regulations? I don’t know the future, and it seems no one does, or anyone who does know is not willing to confess.

Since RCFEs can accept prohibited conditions, is accepting TB residents in a private, isolation rooms next? Will RCFEs be forced to hire nurses taking residents with IVs, infused under caregiver supervision? Will the “caregiver” disappear entirely and only certified nurse assistants be allowed? Can facilities cope with $11.00/hr. minimum wage and increased sick time allowances?

Will assisted living facilities be admitting sicker, needier clients allowing the state to avoid higher health care expenditures found in skilled nursing? Then, in so doing, will the legislature punish facilities with stricter laws forcing facilities to close and relocate clients into more expensive settings or into skilled nursing? The legislature wants to avoid costly placements of the aging population, but then punishes facilities that help. It can’t be both ways!  

Post date: 11/30/2016
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