Advocates for senior living and other aging services providers are asking the federal government to grant providers flexibility and not duplicate existing requirements as a potential federal workplace violence rule is crafted that would affect assisted living and other settings.
The Occupational Safety and Health Administration sought feedback from stakeholders, including residential care facilities, after a Small Business Advocacy Review panel met last month on a potential rule on Prevention of Workplace Violence in Health Care and Social Assistance.
Topics being considered for a potential draft standard including workplace violence hazard assessments and control measures, preventive training, violent incident investigations and recordkeeping, anti-retaliatory provisions, and approaches to avoid stigma related to healthcare consumers and social assistance clients. A report from the group is expected by May 1.
In addition to assisted living communities, OSHA’s initial framework would apply to a wide range of healthcare and aging services settings, including life plan communities, nursing homes and home health agencies. Hospitals also would be affected.
Varied approaches warranted in varied settings
LeadingAge, which is representing aging services providers on the panel, submitted comments last week calling the potential rule a “complicated issue” and asking OSHA to provide flexibility and avoid a “one-size-fits-all” approach to a standard.
“These distinctions are especially important when considering that aging services are provided to individuals in their homes,” LeadingAge Vice President of Legal Affairs Jonathan Lips wrote. “This is true for community-based providers — such as home health agencies — and for providers offering living spaces in congregate settings, such as nursing homes, assisted living facilities and continuing care retirement communities — all of which make it their mission to create, maintain and foster a supportive home-like environment for those they serve.”
Using assisted living as an example of diversity across provider types, Lips said that assisted living providers can vary greatly in size, and levels of care and service might be different depending on state licensing requirements.
LeadingAge also urged OSHA to avoid duplicating existing requirements that employers already meet under federal certification or state licensing requirements, state Medicaid payment conditions or standards applied by accrediting organizations.
“Even when two standards are conceptually aligned, differences in content, process or other factors can create significant operational complexity,” Lips wrote. Existing licensing and certification requirements that address certain aspects of OSHA’s working framework on the workplace violence standard include emergency preparedness and person-centered care planning and service delivery, among others, he added.
Narrowing the scope of focus
The American Health Care Association / National Center for Assisted Living also submitted comments that similarly call on OSHA to reduce prescriptive requirements that could detract from the homelike environment offered in long-term care settings. Additionally, the agency should recognize that providers already are taking actions that meet the intent and purpose of the standard, the groups said.
AHCA / NCAL Vice President of Quality and Programs Courtney Bishoni and NCAL Director of Policy & Regulatory Affairs Jill Schewe said that the scope of the standard should be narrowed to focus only on actual acts of violence resulting in injury to those employees with direct contact to potentially violence individuals.
“Including threats of violence that do not result in harm or injury is burdensome and counterproductive, and could create unintended consequences in settings that care for individuals with dementia or other behavioral health challenges,” AHCA / NCAL wrote. “A person-centered approach to care often includes evaluating these statements to determine the level of risk and ability for the individuals to carry out the threat.”
LeadingAge also said it will be important to define certain terms if OSHA proceeds to rulemaking, including the definition of residential care facilities as relates to life plan / continuing care retirement communities.
“While these settings offer assisted living and/or nursing facility levels of care, a fundamental aspect of these settings is the provision of housing and related amenities for independently living adults, and it would be important for the definition to clarify that the proposed requirements would not necessarily apply to all areas within these settings,” Lips wrote.
AHCA / NCAL suggested that OSHA provide resources and education to help providers develop effective workplace violence approaches for their varied settings.
