Assisted-living reform is passed; rules aim to ensure quality of life

By Marsha King
Seattle Times staff reporter

	ALAN BERNER / THE SEATTLE TIMES Bill Amble has an assisted-living apartment at Foss Village in Seattle. Rules approved yesterday by the Legislature are intended to protect the quality of life for boarding-home residents such as Amble. On the wall is a portrait of him and his late wife, Shirley; they were married more than 42 years.
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State lawmakers yesterday passed a reform act that both pares back and strengthens state rules that govern the quality of life for thousands of older and disabled residents in boarding homes, often called assisted-living facilities.

The rules, first adopted last July, address everything from medication management, staff training, meals and infection control to resident rights and state inspection procedures.

The Legislature also repealed a disclosure law that prevented the state from automatically notifying the public about sanctions such as fines and closures imposed on deficient boarding homes.

Now, the state can issue news releases on problems in boarding homes, just as it routinely does concerning adult family homes and nursing homes. Those news releases can be found on the Department of Social and Health Services Web site at www.dshs.wa.gov.

"That's important to family members who are considering moving someone into that boarding home," said Steve Williams, a spokesman for DSHS.

What's assisted living? Assisted-living facilities are licensed as boarding homes in Washington, and care for seven or more residents. Residents typically live in a room or apartment where they receive meals and help with the daily tasks of life. Assisted-living centers can provide limited nursing services and care for dementia, mental-health problems or developmental disabilities. Adult family homes are homes in the community licensed to care for up to six residents. They provide meals, laundry, supervision, activities and help with daily personal needs such as bathing, dressing and taking medication. Some provide special care for residents with dementia, mental-health problems or developmental disabilities. Nursing homes provide skilled personal and health care for people who can't be cared for in other settings. That care can include dressing, bathing, feeding and using the bathroom, as well as administering medication. Most nursing homes provide rehabilitation care after an injury or hospital stay.

The measures await Gov. Gary Locke's signature.

The rules are aimed at creating more options and assuring safety for people seeking alternatives to nursing homes, said Denny McKee, a program manager for DSHS.

"There probably will be even more creative models as the boomers get older and try to figure out how to live their lives and have their long-term-care needs met," he said.

The rules and the reforms reflect a push across the country to improve equitable regulation of the assisted-living industry, which has emerged as a popular choice in long-term care over the past decade. About 1 million people nationwide live in such centers, and many need a higher level of care than before.

"There are still so many parts of the country where assisted living is very weakly regulated," said Kary Hyre, the state long-term-care ombudsman. "We have a good residents' rights law, a good set of rules about what care is supposed to be like and better enforcement."

In Washington, assisted-living facilities are licensed as boarding homes. They provide maid service, meals and activities. Most also offer help with daily tasks, such as bathing and dressing, and some provide limited nursing services.

The state licenses 525 boarding homes with about 24,600 beds. Not all are marketed as assisted living.

The reform measure approved yesterday reflects a compromise hammered out among the Department of Social and Health Services, the state long-term-care ombudsman and the provider industry.

"Do we love everything that's in there? No. Can we live with it? Yeah," said McKee, of the DSHS.

	ALAN BERNER / THE SEATTLE TIMES Assisted-living residents of Foss Village choose menu items two days in advance.

The reform bill followed nearly four years of collaborative work to revamp outdated regulations of boarding homes. That process turned contentious after the state published a set of rules last July that some providers immediately complained were too heavy-handed and expensive to implement.

A coalition of providers sued the state, seeking to overturn the rules. The lawsuit garnered financial backing from national assisted-living trade associations and is pending.

Meanwhile, providers also sought to short-circuit the state through this year's legislative process. Their initial bill called for extensive rule revisions that state officials and the long-term-care ombudsman refused to endorse.

The boarding-home industry wanted more flexibility in what services it provides in order to accommodate market demand, said Brendan Williams, executive director of the Washington Health Care Association.

The reform bill came about from "hours and hours of good-faith discussion" between the state and industry representatives, Williams said.

The result, he said, is legislation "that prevented the department from taking a cookie-cutter, one-size-fits-all approach in regulating boarding-home care."

The upshot is that even with the reform bill, most of the rules adopted last July still stand and are scheduled to go into effect in September.

	ALAN BERNER / THE SEATTLE TIMES Bill Amble keeps active by walking the courtyard of Foss Village several times a day. The assisted-living resident says his courtyard route covers precisely 393 feet.

They improve quality of care, reinforce residents' rights and ensure greater safety.

Basic services such as meals, activities, therapeutic diets and medication assistance are more clearly defined. Each resident must have a negotiated, highly structured service agreement that will be reviewed and updated. Residents can have intermittent nursing care that may postpone moving to a nursing home.

However, the bill makes these key revisions:

• If a boarding home chooses to offer assistance with basic daily tasks such as bathing, using the bathroom and eating, it won't have to provide more than standby help or occasional physical assistance. However, homes can offer higher levels of assistance for residents who want more care.

• Residents must receive a standardized disclosure statement clearly describing what care and services a boarding home offers. That's supposed to make it easier to compare services from one boarding home to another.

But there's debate about whether the disclosure is legally binding, because the reform bill says the disclosure form can't be considered a contract. Some fear boarding homes won't be required to deliver the services they say they will provide. Others note facilities are still required to enter into a binding service agreement with residents, in addition to the disclosure statement.

• Boarding homes must give 90 days' notice when there's a voluntary change in the level of care and services that would result in the discharge of a resident. Homes must give a 30-day notice when services change for reasons beyond the provider's control and result in a discharge.

• A pre-admission assessment of each resident — with information on eight factors, including medical history, diagnosis and personal-care needs — is required. A more detailed assessment must occur within 14 days of admission and annually thereafter.

• A boarding home can request a resident's family to develop a medication or treatment plan if a family member, rather than the facility, is going to administer medication. This limits a facility's liability for the actions of family members. Residents also have the right to receive services from other agencies, such as licensed home-health-care organizations or hospices.

Marsha King: 206-464-2232 or mking@seattletimes.com

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