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