Regulation has played an important role in improving the quality of senior living and care options in our country. Nearly gone are the days of dark and depressing nursing homes. Today, for instance, aging Americans have numerous options for how and where they’d like to live, be it casual senior apartments or upscale assisted living communities and continuing care retirement communities (also known as life plan communities) that allow them to age in place.
Despite the improvements, numerous areas of senior housing still demand innovation. The recent report from the National Investment Center for Seniors Housing & Care, for instance, showed that more than half of middle-market seniors will be priced out of senior care options by 2030. Others believe assisted living communities are not equipped to deal with the complicated behavioral issues associated with dementia and Alzheimer’s disease. All of this while the senior living and care industry continues to face staffing and recruitment shortages overall.
How will regulation help — or hurt — innovations in those areas?
What’s so bad about regulation?
Many different types of regulations govern the senior living industry, as you know. These include not just senior protection and licensing laws, but labor laws, construction laws and zoning regulations, all of which vary by state. State regulations can govern everything from emergency preparedness processes to staffing ratios, employee training requirements, cannabis use, land-use and the maximum number of residents allowed in each unit.
On the surface, these regulations often make a lot of sense. The challenge to innovation is that they also inadvertently can effect things such as cost and quality of care. For instance, a state may determine that only two residents can share a unit in any given senior housing and care community. This, in turn, limits building design and also prevents the potential cost benefits of a triple or quadruple room to be passed on to residents.
According to John Schulte, vice president of quality improvement for Argentum, meaningful state regulation plays an important role in ensuring the quality of senior care. Regulation has its limits, however, he says.
“The problems arise when a regulation is onerous or inappropriate — when it doesn’t support resident choice, independence and quality of life,” Schulte says.
Twenty-seven states updated their assisted living-related regulations, statutes and policies from June 2018 to June 2019, according to the National Center for Assisted Living. Many of these changes strengthened, rather than eased, regulatory control. Keeping up with these regulations can be costly, confusing and time-consuming. To maneuver a future with so many aging people, operators will need more flexibility in delivering resident care. The following are a few recommendations.
- Focus on quality standards, not regulatory reforms
Rather than focusing on implementing statewide laws, Argentum’s Schulte recommends focusing on creating best practices and self-regulated standards that can grow and change with the industry.
“Standards provide operators with the flexibility they need to optimize care, innovate and manage costs to keep quality care affordable,” he says. “Standards are based on expert knowledge. They can change as the industry evolves, which is particularly important now in senior living, with new discoveries and information coming every day.”
On the other hand, government standards are very difficult to roll back once they’re in place.
- Involve experts
Regulations are meant to guide states to consistent resident safety and care. When experts in senior living and care are involved onsite or via telehealth services, however, those regulations are rendered unnecessary. For instance, if a community employs a geriatric psychiatrist, then staff members don’t need to reference regulations about resident mental health; they can work directly with an expert on staff to determine what residents need.
“We know there is a right and a wrong way of caring for older adults,” says Paul Nussbaum, Ph.D., a board-certified clinical and geropsychologist focused on brain health in aging. “We need to remember this is resident care. Overarching mandates can make innovation difficult and detract from the personal experience.”
- Make outcomes the goalpost
Once regulations are made, they often become the goal post, rather than simply the guidepost, for standards of care. Providers are stuck trying to meet regulations rather than improving resident outcomes.
“Rather than asking, ‘How much medication am I legally able to give this person?’ ask, ‘Why does he need this medication? What problem are we trying to solve here?’ Those types of questions will lead to better outcomes,” Nussbaum says.
- Allow for variance
The industry needs to open up to variances in traditional ideas of senior living to offer the most cost-effective solutions for older adults. New companies such as ppod, for instance, are bringing innovation to traditional senior housing design by offering portable at-home living options that can be placed directly in a family caregiver’s driveway or backyard. They use telehealth capabilities in an effort to keep costs low and residents safe. Aging services providers can focus on making greater allowances for these new resident care options to encourage greater innovation.
- Create a meaningful index
In 2016, data scientist Ben Hanowell did a study on land use regulation and its effect on the cost of senior housing for referral service A Place for Mom. Although his study didn’t find a direct correlation at the time, he recommended that the industry begin to create a meaningful index of regulations and how they affect things such as cost moving forward.
“The question isn’t simply ‘is regulation bad or good,’ but rather what level and kind of regulation will make senior housing safe and livable without bumping up base price and price growth to unaffordable and unsustainable levels?” Hanowell wrote.
Regulation plays an important role in keeping senior living safe for residents. Greater flexibility in the right areas, however, would create room for innovation in areas such as affordability and behavioral health.