17 comments
Hello, my name is Marcus Omar Squires a resident of Petersburg, Virginia where many licensed assisted care facilities are located. One facility in Petersburg has many residents who do not know what rights they have, and are being abused, but they do not know what to do and are afraid of retaliation if they do speak up. Over the summer of 2020 the residents did not have AC, adequate food, or even lighting. When I reported this issue to the state, their response was that the state relies on the faith and good will of the building administrator.
I would propose an amendment to section 22VAC40-73-130. Reports of abuse, neglect, or exploitation.
C. A facility will lose their licence if found to retaliate against residents who report abuse, neglect, or exploitation.
D. Require a telephone in each facility to allow residents to report abuse, neglect, or exploitation.
E. Require tri-annually unannounced welfare checks to facilities with more than 15 residents where buildings are inspected and residents can report issues to an agent.
I believe that these two amendments would aid in keeping facilities up to par and allowing disenfranchised residents to maintain their quality of life in these facilities.
Hello, my name is Marcus Omar Squires a resident of Petersburg, Virginia where many licensed assisted care facilities are located. One facility in Petersburg has many residents who do not know what rights they have, and are being abused, but they do not know what to do and are afraid of retaliation if they do speak up. Over the summer of 2020 the residents did not have AC, adequate food, or even lighting. When I reported this issue to the state, their response was that the state relies on the faith and good will of the building administrator.
I would propose an amendment to section 22VAC40-73-130. Reports of abuse, neglect, or exploitation.
C. A facility will lose their license if found to retaliate against residents who report abuse, neglect, or exploitation.
D. Require a telephone in each facility to allow residents to report abuse, neglect, or exploitation.
E. Require tri-annually unannounced welfare checks to facilities with more than 15 residents where buildings are inspected and residents can report issues to an agent.
I believe that these amendments would aid in keeping facilities up to par and allowing disenfranchised residents to maintain their quality of life in these facilities.
I, too, would propose an amendment to section 22VAC40-73-130. Reports of abuse, neglect, or exploitation.
C. A facility will lose their license if found to retaliate against residents who report abuse, neglect, or exploitation.
D. Require a telephone in each facility to allow residents to report abuse, neglect, or exploitation.
E. Require tri-annually unannounced welfare checks to facilities with more than 15 residents where buildings are inspected, and residents can report issues to an agent.
I also believe that these amendments would aid in keeping facilities up to par and allowing disenfranchised residents to maintain their quality of life in these facilities as I agree that the conditions in Petersburg justify this.
The Gilmore administration put in law that the department of social services must take into consideration the cost impact their regulations will have on small business. Throughout their report they consistently put there will be no impact; but today we are clearly feeling the affect because 1) small business (aG) Auxiliary grant facility doors are increasingly closing 2) the auxiliary grant amount is way below market prices $53 a day per person. The cost of the ag is not sufficient to ensure compliance with DSS standards (jlarc 2006,p 33).
The following regulations have negatively impacted residential only licensed facilities and created our facilities to become pseudo nursing homes without any funding to match their mandates.
Even the department of social service define Assisted living Facilities as non-medical setting and as residential only facilities we should be exempt from the following regulations and requirement should be amended.
22VAC40-73-10. Definitions - "Resident" means any adult residing in an assisted living facility for the purpose of receiving maintenance or care. The definition of resident also includes adults residing in an assisted living facility who have independent living status.
• This is one example where the actual definition may cause conflict in the standards for residents with independent living status and the completion of ISPs. 22VAC40-73-450 states, “An individualized service plan is not required for those residents who are assessed as capable of maintaining themselves in an independent living status.” An example of potential conflict where ISPs are required to be updated with specific information for “residents” but are not needed for IL residents is found in 22VAC40-73-220 A 2 Private duty personnel.
22VAC40-73-70. Incident Reports - Each facility shall report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident.
• Over the years, we have received numerous concerns from ALFs about the varying interpretations of licensing inspectors on what is a “major incident.” The previous Standards were accompanied with Technical Assistance to clearly identify major incidents, which was helpful to ALFs.
ncident Reports - Each facility shall report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident.
• Over the years, we have received numerous concerns from ALFs about the varying interpretations of licensing inspectors on what is a “major incident.” The previous Standards were accompanied with Technical Assistance to clearly identify major incidents, which was helpful to ALFs.
22VAC40-73-380. Resident personal and social information. A. 5. Birthplace, if known;
• This information is not necessary for the protection of public health, safety, and welfare of the resident.
22VAC40-73-390. Resident agreement with facility. A. 4. F. The resident or his legal representative or responsible individual as stipulated in 22VAC40-73-550 H has reviewed and had explained to him the facility's policies and procedures for implementing § 63.2-1808 of the Code of Virginia;
• This is duplicative of 22VAC40-73-390.A.4.E and §63.2-1808.20.D and is unnecessary to be included in the Standards.
.
22VAC40-73-530. Freedom of movement. C. The facility shall provide freedom of movement for the residents to common areas and to their personal spaces.
• This requirement was restricted by the Commonwealth during the COVID-19 pandemic.
22VAC40-73-750. Resident Rooms. B. Bedrooms shall contain the following items...
• We have received comments from providers about licensing requiring vacant bedrooms to be furnished.
Maybe an appropriate amendment would be, “Occupied bedrooms shall contain the following items...”
22VAC40-73-940. Fire safety. Compliance with state regulations and local fire ordinances.
• During the COVID-19 pandemic, VDSS licensing inspectors did not conduct all licensing inspections in person, and neither did the fire officials. ALFs should not be cited for the refusal of government officials to visit the building during extenuating circumstances, such as the COVID-19 pandemic.
22VAC40-73-1130. Staffing
• A workforce shortage that existed prior to the COVID-19 pandemic has been exacerbated over the last couple of years. The requirement of, “for every additional 10 residents, or portion therof” continues to strain the ability of ALFs to care for residents by significantly limiting the number of available beds in an industry with limited number of available individuals willing and able to work. The requirement should be based on the actual needs of the residents instead of a count of individuals.
From: The Independent Home Owners
Periodic Review of 22VAC40-73, Standards for Licensed Assisted
Living Facilities
The Assisted Living Standards and Regulations listed below are
killing smart business owners. They are burdensome and present
unnecessary barriers and obstacles to compliance. At least 90% the
facilities receiving auxiliary grant funding provide residential living
level of care. The individuals residing in our homes tend to be
seriously mentally ill often with dual diagnoses or have intellectual
limitations sometimes both. Behavioral Health has abdicated their
responsibility to these individuals. Once our target population was
the elderly this is no longer the case. We have moved from a social
model to a medical model. Residential living is still operating at the
social model level and Assisted living at the medical care model.
However, there is minor difference in the standard requirements.
Assisted living care serves individuals with complex medical needs,
cognitive deficits, hospice, oxygen therapy, wound rare_ They
employ nurses, doctor's, therapists etc. One size does not fit all. All
levels of care are grouped together in a mixing bowl situation. There
should be separate standards for the various levels of care.
Currently, due to fall out from the recent pandemic we are still
operating in a crisis mode. The leniency afforded us during the state
of emergency is lifted but we are still experiencing challenges
attracting and retaining qualified workers which impacts staffing.
Unlike our private pay counterparts, we are not able to use staffing
agencies due to the prohibitive cost. Most owners are working shifts
due to the lack of staffing. In the central region alone, we have lost
approximately 768 beds.
p.2
2.
When the department meets with providers, publicly paid providers,
and minority small business owners are not included. We have been
excluded from the current mental health task force. Yet, that is the
population served by us not the private pay facilities. Instead, we
receive emails. We do not feel our input is valued. Decisions are
made based on the input from the facilities with lobbyist or large
corporations.
The Department no longer provides technical assistance to
licensee's. We want the departments interpretation not the licensing
inspectors. We want to be assured that everyone is receiving the
same response. The federal government requires the department
provide technical assistance to licensee's. This needs to be
reinstituted. Now the emphasis is strictly on enforcement, not
collaboration. Funding is low and enforcement is high with no
money. Governor Gilmore and _ Eric Canter stated that any
regulation promulgated should take into consideration the cost to
the provider by way of a Cost Impact Analysis Report. This no
longer is the case. The assisted living standards are considered to
be minimal, but the Department's expectations are not.
670.1.b Qualifications and supervision of staff administering
medications.
Be registered with the Virginia Board of Nursing as a medication
aide...
Behavioral Health staff working in group homes and other mental
health settings can administer medication with the 32-hour
medication administration course. ALF staff are serving the same
population at the residential level of care and required to take the
68-hour course and become registered with the Virginia Board of
Nursing. We recommend that if 80% of the population in a
residential facility has a diagnosed mental illness they should be
held to the same standard as behavioral health staff. This will not
impact the health, welfare, and safety of the residents.
p.3
3.
650.E Physician's or other prescriber's order.
The resident record shall contain the physician's or other
prescriber's signed written order or a dated notation of the
physician's or other prescriber's oral order. Orders shall be
organized chronologically in the resident's record.
Physician's orders are sent electronically to the pharmacy and are
attached to the resident's MAR's and sent to the facility monthly.
The date of the order is on the side of the MAR. The doctor and the
pharmacist manage these orders. Currently, we are asked that
orders generated by the pharmacy are signed monthly. The
prescription could not be filled if there was not an order. This is an
unnecessary regulation. But, if the monthly order isn't signed, we
get a violation.
1.40.D Administrator Qualification
For a facility licensed only for residential living care that does not
employ an administrator licensed by the Virginia Board of Long-
Term Care Administrators, the administrator shall:
2. ii. Have successfully completed a course of study approved by the
department that is specific to the administration of an assisted
living facility.
We are unaware of any available training for residential providers
specific to the administration of an assisted living facility. We
strongly recommend that the department provide this training free
of cost. Training has been offered periodically by outside vendors,
but the cost has been exorbitant. This presents a barrier and
hardship to potential applicants wanting to become licensed and
current providers seeking to fill vacancies. This standard is too
restrictive for facilities that are adult care residences providing
Board and Care.
4.
During these difficult times the department should allow facilities to
receive temporary variances to address staffing and other standards
that are difficult to comply.
4/18/2022
Linwood Russell, President
The Independent Home Owners
o: Virginia Department of Social Services, Licensing
From: The Independent Home Owners
Periodic Review of 22VAC40-73, Standards for Licensed Assisted
Living Facilities
The Assisted Living Standards and Regulations listed below are
killing smart business owners. They are burdensome and present
unnecessary barriers and obstacles to compliance. At least 90% the
facilities receiving auxiliary grant funding provide residential living
level of care. The individuals residing in our homes tend to be
seriously mentally ill often with dual diagnoses or have intellectual
limitations sometimes both. Behavioral Health has abdicated their
responsibility to these individuals. Once our target population was
the elderly this is no longer the case. We have moved from a social
model to a medical model. Residential living is still operating at the
social model level and Assisted living at the medical care model.
However, there is minor difference in the standard requirements.
Assisted living care serves individuals with complex medical needs,
cognitive deficits, hospice, oxygen therapy, wound rare_ They
employ nurses, doctor's, therapists etc. One size does not fit all. All
levels of care are grouped together in a mixing bowl situation. There
should be separate standards for the various levels of care.
Currently, due to fall out from the recent pandemic we are still
operating in a crisis mode. The leniency afforded us during the state
of emergency is lifted but we are still experiencing challenges
attracting and retaining qualified workers which impacts staffing.
Unlike our private pay counterparts, we are not able to use staffing
agencies due to the prohibitive cost. Most owners are working shifts
due to the lack of staffing. In the central region alone, we have lost
approximately 768 beds.
p.2
2.
When the department meets with providers, publicly paid providers,
and minority small business owners are not included. We have been
excluded from the current mental health task force. Yet, that is the
population served by us not the private pay facilities. Instead, we
receive emails. We do not feel our input is valued. Decisions are
made based on the input from the facilities with lobbyist or large
corporations.
The Department no longer provides technical assistance to
licensee's. We want the departments interpretation not the licensing
inspectors. We want to be assured that everyone is receiving the
same response. The federal government requires the department
provide technical assistance to licensee's. This needs to be
reinstituted. Now the emphasis is strictly on enforcement, not
collaboration. Funding is low and enforcement is high with no
money. Governor Gilmore and _ Eric Canter stated that any
regulation promulgated should take into consideration the cost to
the provider by way of a Cost Impact Analysis Report. This no
longer is the case. The assisted living standards are considered to
be minimal, but the Department's expectations are not.
670.1.b Qualifications and supervision of staff administering
medications.
Be registered with the Virginia Board of Nursing as a medication
aide...
Behavioral Health staff working in group homes and other mental
health settings can administer medication with the 32-hour
medication administration course. ALF staff are serving the same
population at the residential level of care and required to take the
68-hour course and become registered with the Virginia Board of
Nursing. We recommend that if 80% of the population in a
residential facility has a diagnosed mental illness they should be
held to the same standard as behavioral health staff. This will not
impact the health, welfare, and safety of the residents.
p.3
3.
650.E Physician's or other prescriber's order.
The resident record shall contain the physician's or other
prescriber's signed written order or a dated notation of the
physician's or other prescriber's oral order. Orders shall be
organized chronologically in the resident's record.
Physician's orders are sent electronically to the pharmacy and are
attached to the resident's MAR's and sent to the facility monthly.
The date of the order is on the side of the MAR. The doctor and the
pharmacist manage these orders. Currently, we are asked that
orders generated by the pharmacy are signed monthly. The
prescription could not be filled if there was not an order. This is an
unnecessary regulation. But, if the monthly order isn't signed, we
get a violation.
1.40.D Administrator Qualification
For a facility licensed only for residential living care that does not
employ an administrator licensed by the Virginia Board of Long-
Term Care Administrators, the administrator shall:
2. ii. Have successfully completed a course of study approved by the
department that is specific to the administration of an assisted
living facility.
We are unaware of any available training for residential providers
specific to the administration of an assisted living facility. We
strongly recommend that the department provide this training free
of cost. Training has been offered periodically by outside vendors,
but the cost has been exorbitant. This presents a barrier and
hardship to potential applicants wanting to become licensed and
current providers seeking to fill vacancies. This standard is too
restrictive for facilities that are adult care residences providing
Board and Care.
4.
During these difficult times the department should allow facilities to
receive temporary variances to address staffing and other standards
that are difficult to comply.
4/18/2022
Linwood Russell, President
The Independent Home Owners
o: Virginia Department of Social Services, Licensing
The regulatory requirement for an administrator be designated immediately upon the departure of a licensed administrator from a licensed facility is burdensome to providers/operators. The number of licensed administrators in the state of Virginia versus the numbers of licensed facilities is in a deficit. The training requirements, time to train and test is burdensome for interim administrators. Smaller companies find it difficult to appoint interim administrators and meet the burdensome regulations.
9. No assisted living facility shall operate under the supervision of an acting administrator pursuant to §§ 54.1-3103.1 and 63.2-1803 of the Code of Virginia more than two times during any two-year period unless authorized to do so by the department.
For nurse aide education, there are currently no waivers in place for clinical sites. Pursuant to 18VAC90-26-50(C)(3), Clinical training in clinical settings shall be at least 40 hours of providing direct client care. Five of the clinical hours may be in a setting other than a geriatric long-term care facility. Hours of observation shall not be included in the required 40 hours of skills training. 35 of the mandated 40 hours of live client clinical shall be performed in a Virginia Department of Health regulated long-term care facility.
The executive orders that permitted clinicals for the CNA program in ALF's expired last year (2021). Five hours may be performed outside of a LTC facility. Being that it isn’t a full 8 hr shift allowed, if doesn’t make sense to switch students clinical rotations for 5 hours. We can do clinicals for Medication Aide in ALF's just not CNA.
The new executive orders do not specifically permite training programs or allowing clinicals for students to be held in ALF's. The order appears to lessen employment restrictions; i.e. how many people a licensed EMT, Pharmacist, etc. may supervise.
We need to have regulations to allow for a variety of clinical training in different settings rather than limiting and restricting the workforce training.