The Virginia Assisted Living Association (VALA) represents licensed assisted living communities from throughout Virginia of varying organizational structures and resident capacities. We thank the Board of Long-Term Care Administrators (Board) for considering areas of improvement to the current regulations that will eliminate some of the barriers in the recruitment, licensure, and retention of licensed assisted living facility administrators.

In consultation with many assisted living providers throughout the Commonwealth, Virginia’s regulations for licensure as an Assisted Living Facility Administrator are amongst the strictest in the nation and present a significant barrier to entry. According to the Virginia Health Care Workforce Data Center report Virginia’s Assisted Living Facility Administrator Workforce: 2022, it is expected that half of the currently licensed workforce will be retired within 20 years. This is alarming and does not include the licensed administrators that have left the industry within the last few years due to burn-out. With an industry that provides for the care and support of Virginia’s aging population that will exponentially increase in the next 20 years, it is imperative that Virginia streamline the licensure process for administrators.

The two biggest barriers to licensure as an assisted living facility administrator in Virginia are the significant number of hours required for an AIT program and the requirement of applicants to pass a national test that sometimes conflicts with Virginia’s regulations. We welcome the review to reduce these burdensome regulations pursuant to Executive Order 19.

Listed below are some recommendations for improvements and regulations of concern:

• 18VAC95-30-10. Definitions. B. “ALF AIT” means a person enrolled in an administrator-in-training program in a licensed assisted living facility.
• 18VAC95-30-170 establishes requirements of training facilities.
• 18VAC95-30-30. Accuracy of Information.
• Recommend allowance for electronic notification.
• 18VAC95-30-60. Renewal Requirements. B. The renewal form and fee shall be received no later than the expiration date. Postmarks shall not be considered.
• 18VAC95-30-60-A provides an expiration date.
• 18VAC95-30-70. Continuing education requirements. C. 2. d. Signature of an authorized representative of the approved sponsor.
• Many online training courses do not provide a “signature”. This requirement is outdated for the current CEU training platforms available.
• 18VAC95-30-80. Late Renewal.           
  A. A person who fails to renew his license or preceptor registration by the expiration date shall may, within one year of the initial expiration date:

1. Submit the renewal notice or request renewal by mail to the board;

B. The documents required in subsection A of this section shall be received in the board office within one year of the initial expiration date. Postmarks shall not be considered.

• 18VAC95-30-100. Education and training requirements for initial licensure
• Recommend reducing the number of AIT hours, as the current requirements are cumbersome, costly, and time consuming.
• The current number of required hours prevent significant barriers to entry in multiple capacities including in acquiring a preceptor to commit to the specified number of hours.
• With the shortage of preceptors and the limitations of available ALFs to host AIT trainings, VALA recommends the creation of a training program that could be administered by stakeholder associations, educational institutions, and/or Virginia agencies to provide core training to ALFA applicants in Virginia with a specified number of hours required within an assisted living facility. Virginia could offer workforce training grants to ALFs to serve as training hosts for applicants in the training program.
• 18VAC95-30-110. Examination requirements for initial licensure.
• Requiring applicants to pass a national examination that sometimes conflicts with Virginia regulations is a barrier to passage. The AIT program is to teach applicants how to be a qualified administrator, which would need to understand and practice based on the applicable regulations. The AIT program should be able to focus on the same regulations and practices instead of having to supplement teaching applicable skills and requirements to be able to pass a national examination that often is focus on nursing home requirements and practices. This could be a contributing factor to the significantly low pass rates of 49.5% experienced by Virginia’s ALFA applicants compared to the national average of 63.8%. The AIT programs should be able to 100% focus on applicable regulations and procedures for serving as an administrator of an assisted living facility in Virginia. As is often stated in education, teaching to the test does not adequately prepare the students for success in the future.
• Recommend creating an examination based on Virginia regulations. Another option would be to allow the applicant to choose whether to pass a Virginia-based examination or the NAB examination.
• 18VAC95-30-120. Qualification for licensure by endorsement or credentials.
• We encourage Virginia to follow the lead of South Dakota in welcoming most of the licenses and credentials issued by other states by expanding the acceptance of licensure as an administrator of an assisted living facility or similarly named senior living facility.
• 18VAC95-30-130. Application package. B. 4.  
  An attestation that he has read and understands and will remain current with the applicable Virginia laws and the regulations relating to assisted living facilities; and
• To serve as an administrator, the individual is required to abide by applicable laws and regulations.
• 18VAC95-30-150. Required hours of training. A.
• The requirement for an acting administrator to complete the training in 150 days can be difficult to meet with an AIT needing 640 hours (at no more than 40 hours/week) = 16 weeks = 112 days. This timeline does not include the timeframe experienced by mailing systems, state processing times, nor timelines for scheduling available testing dates.
• 18VAC95-30-170. Training facilities. B.           

1. An assisted living facility with a provisional license as determined by the Department of Social Services in which the AIT program is a new ALF AIT program unless the preceptor has been a licensed administrator for at least # years;
2. An assisted living facility with a conditional license as determined by the Department of Social Services in which the AIT applicant is the owner of the facility unless the preceptor has been a licensed administrator for at least # years;
3. A facility that is licensed as residential only and does not require an administrator licensed by the Board of Long-Term Care Administrators; or
4. An assisted living facility with a licensed resident capacity of fewer than 20 residents.

• Sometimes, the best training occurs when correcting previous mistakes. ALFs that are on the pathway to achieving compliance should not be excluded from teaching applicants.
• This requirement puts an even greater barrier on qualified training opportunities and discriminates against smaller providers. Due to workforce shortages, many facilities must train new talent, and this requirement prevents many ALFs from achieving compliance through training resulting in them potentially operating without an administrator for extended periods of time awaiting qualified applicants that may not exist in the area.

• 18VAC95-30-180. Preceptors.
• The limitation of no more than 2 trainees at one time creates a barrier to entry by new applicants seeking a licensed preceptor. Many applicants utilize the voluntary preceptor listing to contact preceptors, but they are often denied preceptorship due to the preceptor already maxed at 2 trainees.
• Expanding the pool of preceptors is crucial to maintaining a supply of licensed administrators, as unfortunately, some interested applicants have been quoted a rate of more than $10,000 to have a preceptor. 
• 18VAC95-30-200. Interruption or termination of program.

If the program is interrupted because the registered preceptor is unable to serve, the trainee shall notify the board within 10 working days and shall obtain a new preceptor who is registered with the board within 60 days.

• Due to the significant shortage of preceptors, the AIT may not be able to successfully secure a new preceptor within 60 days.

Being able to welcome staff members from a variety of backgrounds, professions, and industries helps to provide continuity of care for Virginia’s seniors. Improving Virginia’s administrator-in-training program by reducing barriers to entry will eliminate the unintentional discrimination of AIT candidates based on income status, employment at small businesses, or employment in rural areas.

Virginia’s long-term care communities need more opportunities to recruit, to train, and to license administrators. With these considerations in mind, we thank the Board of Long-Term Care Administrators for considering these recommendations and concerns of the Regulations Governing the Practice of Assisted Living Facility Administrators.  Please let us know if you have any questions regarding these comments.