Tuesday, July 22, 2008

New PALCA for Assisted Living Standards

On July 7, 2008, a coalition organized in 2008 -- the Pennsylvania Assisted Living Consumer Alliance -- issued a press release, entitled "New Coalition Presses for Quality Standards", announcing that its membership "is pushing for quality standards in Pennsylvania state regulations covering assisted living facilities."

According to its website, PALCA is "a collaboration of consumers, family members, and local and statewide organizations that have united to advocate for safety, freedom of choice and high legal standards for residents in assisted living facilities in the state."

In January 2008, the Pennsylvania Health Law Project announced the formation of PALCA with the generous support of The Pew Charitable Trusts. [Links added.]

PALCA is working to ensure that the consumer voice is heard and considered in the development of assisted living licensure requirements for Pennsylvania.

PALCA is advocating for the establishment of standards that define and regulate assisted living facilities – in particular those relating to questions of residents’ rights, staff qualifications, training and resident ration requirements, physical site design, fire and safety codes, aging in place considerations, consumer choice, control, autonomy and an enforcement system.

Additionally, at present, there are no national standards or consistent definition or regulation for assisted living, nor any clear best practice standards. * * *

PALCA now seeks input towards new licensing rules in Pennsylvania consistent with its mission of protecting elderly and disabled residents. Its website notes that "about 50,000 people in Pennsylvania currently live in facilities that may call themselves assisted living facilities."

PALCA lists and describes its statewide and local "Participating Organizations" on its website; and the list is impressive and broad-based:
The press release noted the need for regulatory guidance in Pennsylvania following the enactment of a new assisted living law last year.

The Pennsylvania General Assembly last year passed a bill to license the fast-growing assisted living industry. The regulations are expected to be released this month, and the public will have a chance to comment on them before they are finalized. Until now, state regulations have lumped assisted living facilities together with a wide range of homes for the elderly and disabled.

“The passage of Act 56 was a great first step for consumers,” said [Alissa] Halperin, [Senior Attorney and Deputy Director of Policy Advocacy at the Pennsylvania Health Law Project,] “but now we need to make sure that the law isn’t window dressing. We need regulations that will protect the residents’ rights to access their own doctors and caregivers, to have adequate living space and to be served by appropriately trained staff.”

Assisted living has emerged in the past generation to house people who are not so sick that they require a nursing home. But they generally need more help with bathing, dressing, medication management and other basic care needs than may be provided in personal care homes.

Assisted living has been a marketplace phenomenon for consumers who want independence, privacy, and choice, but who also want the ability to "age in place" -- meaning they will not have to move when their care needs increase. In the past, however, state regulations have been so minimal and enforcement has been so lax that numerous reports of bad outcomes and, even, tragic results for residents have been published.* * *

[Diane Menio of the Center for Advocacy for the Rights and Interests of the Elderly said:] “Thus far, the quality of care has varied immensely from facility to facility, with the differences depending far more on the intent of the facility owner than on meaningful standards for ensuring good care. We need solid requirements coupled with meaningful enforcement to ensure that quality care is available.” * * *

For background about Act 56 of 2007, and the environment of its enactment, see: PA EE&F Law Blog posts, "PA's Act No. 56 on Assisted Living Facilities" (07/26/07), and "PA's "Assisted Living Facility" Bill (likely, Law)" (07/16/07).

I applaud the formation of PALCA and encourage its work on behalf of consumers.

I offer one suggestion for its organizers: Invite participation by medical and psychology organizations, like the Pennsylvania Medical Society, the Pennsylvania Psychiatric Association, the Pennsylvania Psychological Association, the Pennsylvania Chapter of the American Psychiatric Nurses Association, and other membership organizations of medical personnel or mental health service providers.

As a new paradigm develops for "at home aging", providers of medical and mental health services need to examine their delivery practices and systems to be available and effective in an assisted living, or even a personal care home, setting. Why not offer these other affected membership organizations an opportunity to brainstorm their future too?

“Your paradigm is so intrinsic to your mental process that you are hardly aware of its existence,
until you try to communicate with someone with a different paradigm.”

-- Donella Meadows
American organic farmer, journalist, and systems analyst
(1941- 2001)

quoted at ThinkExist