The Long Term Care Community Coalition released recommendations for best practices for the assisted living industry on Wednesday, citing an “urgent need” given the findings contained in a February report from the federal Government Accountability Office.
The GAO report, prepared at the request of four senators, contained a to-do list for the Centers for Medicare & Medicaid Services related to state reporting of deficiencies in care and services provided to Medicaid beneficiaries in assisted living communities.
Among other points, the GAO found that for various reasons, 26 of the 48 state Medicaid agencies studied could not report the number of “critical incidents” — such as abuse, neglect or exploitation — that occurred in the assisted living communities located in their states. Additionally, states had varying definitions of what they considered to be critical incidents; all states included physical, emotional and sexual abuse, but seven did not include medication errors, and three did not include unexplained death. Also, although 34 state Medicaid agencies made information on critical incidents available to the public in some way, 14 did not.
“The GAO’s report provides clear evidence of the urgent need to address the health and safety of assisted living residents,” LTCCC Executive Director Richard Mollot said in a statement. “In the absence of strong and clearly defined quality of care and quality of life standards, residents will continue to be susceptible to inappropriate care and potentially unsafe conditions when they move to an [assisted living community].”
LTCCC’s 52-page report, titled “Assisted Living: Promising Policies and Practices for Improving Resident Health, Quality of Life and Safety,” includes LTCCC-recommended best practices in 13 areas; a sampling of existing state policies in these areas; and the organization’s suggested language for government and community policies related to topics. In addition, LTCCC compiled a separate chart of state requirements.
“We dedicated significant time and resources into research — academic journals, government reports, industry reports, state laws and regs — and developing a framework that we thought would be most useful to a range of stakeholders,” Mollot told McKnight’s Senior Living, explaining the time gap between the GAO’s report and the LTCCC’s report.
Mollot highlighted two areas in the LTCCC report, dementia care and resident councils, as examples of where the organization hopes its report can be useful to the industry.
“If a provider is considering providing special dementia care, this report provides ideas for staffing and staff training and facility environment that, I hope, will be useful,” he said. “If residents or families want to start a resident or family council, it provides some insights into how that can be beneficial to the [assisted living community], such as by fostering happier customers.”
Regarding dementia care, LTCCC recommends secured entrances and exits, appropriate pathways and suitable lighting for areas of the community to which residents with cognitive impairment have access; “aging-in-place” opportunities; three hours of direct care staff time per resident per day, with staff present at all times; the employment of an on-site RN for at least one shift per day, every day, with staff access to an RN at other times; and a minimum of 12 and four hours of dementia care training within 30 days of hire for administrators and direct care workers, respectively, and then four and eight hours of additional dementia care training, respectively, annually.
Regarding resident and family councils, LTCCC’s advice to communities includes encouraging the formation of councils, informing residents of their existence and providing space for meetings. Community staff should attending meetings only if invited, the organization said, and staff should respond in writing to council grievances within 14 days.
Other recommendations in the report address staffing ratios; staffing requirements for nurses, administrators and recreational activities directors; staff training; oversight and quality assurance; abuse and neglect; transfers and discharges; consumer information and disclosure; and public information regarding community ownership as well as survey reports and complaint investigations.
Industry efforts underway
Organizations representing senior living operators have developed guidelines and standards and continue to do so.
The National Center for Assisted Living has posted on its website guiding principles for assisted living, leadership, quality in assisted living, dementia care, and providing information to consumers, a spokeswoman shared.
And earlier this month, Argentum announced a new Senior Living Standards Commission, which will develop and maintain voluntary standards for the industry related to emergency preparedness, memory care, medication management and other aspects of resident safety. In December 2015, the organization had announced 12 standards that, beginning in January 2016, its independent living, assisted living and memory care community members were asked to meet.