PA's Act No. 56 on Assisted Living Facilities

On July 25, 2007, Governor Rendell signed Senate Bill 704, P.N. 1272, as Act No. 56 of 2007. Act 56 addresses, for the first time in the Commonwealth, a statutory & regulatory framework governing operations of assisted living facilities.

SB 704 was transmitted by the Legislature to the Governor on July 15th, and was signed by him into law as Act No. 56 of 2007 ten days later. The Act will take effect in ninety days.

I discussed this legislation previously in my posting "PA's "Assisted Living Facility" Bill (likely, Law)" (07/16/07).

The Governor's Office issued a Press Release dated July 25, 2007, entitled "Governor Rendell Says Older Adults and Persons with Disabilities Will Benefit from Historic Assisted-Living Legislation":

Governor Edward G. Rendell said today that Pennsylvania has broken a decade-long deadlock by enacting assisted-living legislation that will allow Pennsylvanians to maintain their independence and continue to exercise personal choice while receiving the support they need.

“Until today, Pennsylvania was one of only a few states that did not have separate licensing standards for assisted-living residences,” said Governor Rendell. “Now, Pennsylvanians will enjoy a wider range of options when it comes to choosing services for their long-term living needs. The legislation I’m signing today creates standards that will protect the health and welfare of Pennsylvanians living in assisted-living residences.”

Pennsylvanians who do not need a higher level of care -- such as the care provided by a nursing home -- will now be able to confidently choose a less restrictive, licensed, assisted-living residence that meets state standards. Senate Bill 704 also creates a “special care” designation so that consumers can easily identify facilities that are certified to provide Alzheimer’s and dementia care. * * *

“I applaud Rep. Phyllis Mundy and Sen. Pat Vance for working with us in a bipartisan way to break a decade-long impasse by enacting this legislation. Many individuals came together and worked tirelessly to make this important legislation a reality,” the Governor said.

The Department of Public Welfare will have oversight of assisted-living residences and is creating a new unit responsible for licensing and inspections. Every residence must undergo at least one unannounced site inspection each year.

The department will apply for a new waiver from the federal government to support Medicaid recipients who wish to live in assisted-living residences. The waiver will provide funding for necessary personal assistance and support for people who are Medicaid-eligible in assisted-living residences. By creating a new funding source, DPW will ensure that the development of assisted-living residences will not hamper the continued growth in home and community based waivers and services. * * *

This is the third significant legislation signed into law in July, 2007 to address long-term health care in Pennsylvania.

The first was Act 40 of 2007, signed on July 17, 2007, dealing with long-term care insurance under the federal Medicaid Program. See: PA EE&F Law Blog posting "PA's Act 40 of 2007 on Long Term Care Insurance" (07/19/07).

The second was the package of Acts 46, 47, 48, 49 & 50, signed on July 20, 2007, relating to certain health care professionals. See: PA EE&F Law Blog posting "Assistants to be Elevated in PA Healthcare" (07/17/07).

The third, Act 56, signed on July 25th, will regulate assisted living facilities.

“This bill is crucial to meeting our goal of better balancing the long-term living system,” said Governor Rendell.

“Assisted living provides individuals who need personal assistance and health care services a much needed option to live independently with privacy and dignity – values that are important to every Pennsylvanian.”

The Philadelphia Inquirer had reported about the legislation on July 20, 2007, in an article by Nancy Phillips entitled "Assisted-living rules in the works". The article noted that "Pennsylvania is poised to place tough new regulations on assisted-living facilities, defining for the first time what services they must provide and imposing penalties for homes that are not properly licensed."

Until now, the same set of rules applied to all homes for the elderly and disabled - from small personal-care homes to larger facilities that provide more intensive supervision and care.

The new law requires assisted-living facilities to be licensed by the state, to meet new standards of staff training, and to undergo unannounced inspections at least once a year.

"It's quality assurance," said State Rep. Katherine M. Watson (R., Bucks), who helped draft the bill. "A lot of these facilities are really nice, and they do a great job, but there are exceptions."

As The Inquirer reported earlier this year, at least 55 residents of assisted-living facilities have died since 2000 under circumstances that raised questions about the quality of their care. Uncounted others were beaten or neglected. At least five were raped.

State regulation of such facilities had been so lax that many troubled homes continued to operate without penalty, and in some cases, problems went unchecked and residents suffered injuries or even death.

Advocates for the elderly called it one of the state's worst failures.

The new rules are designed to correct that, said State Sen. Pat Vance (R., Cumberland), the bill's prime sponsor. Vance, a registered nurse, spent nearly a decade advocating stricter regulation of assisted-living facilities.

By defining the level of care that such homes must provide, she said, the state is creating a sound alternative to nursing homes. Assisted living is designed for people who need help with bathing, dressing, and other personal care, but do not have extensive medical needs. * * *

The article noted, however, that regulations implementing the new law likely will become the subject of contentious debate.

* * * Although the bill mandates new rules for assisted-living homes, some of the specifics have yet to be determined. * * *

One state official said drafting those regulations could well be a contentious process.

"I know that there's going to be a lot of debate," said Mike Hall, deputy secretary for the state's Office of Long Term Living. "There's a pretty wide spectrum of opinion" on the topic. * * *

Update: 07/27/07:

For a Press Release issued by the Pennsylvania House on July 25, 2007, see: "Mundy: Assisted living bill signed into law".

* * * Assisted living residences provide housing, personal care services and access to supplemental health care in a home-like environment that respects the individual’s privacy, dignity and self-direction. Although many personal care homes – meant for people with fewer care needs – refer to themselves as assisted living residences, until this legislation was passed, Pennsylvania did not have a licensing statute in place.

The final version of the bill was a collaborative effort among the bill’s prime sponsor, Sen. Pat Vance, R-Cumberland/York, and [Rep. Phyllis] Mundy, who introduced an assisted living bill in the House (H.B. 1583); the Rendell administration; and various stakeholders, including AARP Pennsylvania and the Alzheimer’s Association. [Links added.]

Update: 07/30/07:

The Observer-Reporter (Washington Co., PA) posted an Associated Press article, dated July 26, 2007, about Act 56, entitled "Gov. Rendell signs assisted living bill".

The article offers quotes from people involved in its adoption or its future implementation.

"The big winners in the legislation are indeed the consumers of assisted living," said Sen. Patricia H. Vance, R-Cumberland, the bill's sponsor.

Assisted living residences will be licensed to provide basic health-care services, such as administering intravenous medications or treating bed sores, said Dr. Stuart Shapiro, head of the Pennsylvania Health Care Association, which represents long-term care providers. * * *

The law sets strict standards for assisted living centers. For example, it requires single living units - unless two residents voluntarily share a room - with private bathrooms, kitchen areas and minimum space requirements to be determined by the Department of Public Welfare. Also, health-care services must be packaged and sold separate from the residential agreement.

The idea is to create a type of facility that is distinct from personal-care homes or nursing homes. "This is about more than providing health-care services in personal-care homes," said Mike Hall, deputy secretary of the Office of Long-term Living, which is operated jointly by the departments of Public Welfare and Aging.

The Public Welfare Department, which will regulate the assisted living residences, plans to seek a waiver from the federal government so eligible residents can be covered by Medicaid.

The first assisted living licenses may not be issued for two years - after the department's regulations are written and approved, Hall said. * * *

See also: "Vance's Assisted Living Legislation Becomes Law", posted July 27, 2007, by the Republican State Committee of Pennsylvania.

Sen. Pat Vance's (R-Cumberland/York) legislation defining and licensing assisted living facilities has become law after the Governor signed the bill today.

"This new law will allow Pennsylvanians to make educated decisions about their own care or the care of a loved one and better understand the limitations of a specific facility," Vance said.

"Currently, there is some confusion about what kind of care different personal care homes provide. By creating a specific assisted living licensure process, it will be easier to identify the differences between facilities." * * *

Update: 07/22/08:

For further developments, see PA EE&F Law Blog posting "New PALCA for Assisted Living Standards" (07/22/08).