Secretary of Health & Human Services Jane Hayward Details 23 Recommendations to Improve Assisted Living Oversight in Rhode Island

Governor Donald L. Carcieri today announced that he has accepted twenty-three detailed recommendations for reforming the quality and safety of assisted living facilities in Rhode Island. The recommendations were included in a report prepared by Secretary of the Executive Office of Health and Human Services (EOHHS) Jane Hayward after a four-month review of the state’s assisted living system. The Governor asked Hayward to conduct a thorough review of assisted living in June 2005, following the tragic death of a resident and assault on a staff person at the Beechwood Assisted Living residence in Central Falls.

While the report found that assisted living is often a safe and appropriate housing option, it also included twenty-three specific recommendations for improving safety at assisted living facilities, and for improving state oversight.

“Last year, I worked with the General Assembly and others to improve the safety of nursing home residents throughout Rhode Island,” Governor Carcieri said. “The tragic death of a resident at an assisted living facility in Central Falls pointed to the need to take a similar hard look at the safety of residents in assisted living facilities throughout our state. While this report demonstrates the quality and value of assisted living in Rhode Island, it also highlights a number of necessary improvements to ensure the safety of assisted living residents. Today, I have formally accepted the recommendations included in this report, and have instructed my cabinet to fully implement them in a timely manner.”

“Since I commissioned this report, we have already begun to enact some of the most immediate reforms,” Carcieri continued. “Other reforms will take a little more time. But one thing is clear: when fully implemented, these reforms will significantly improve the way Rhode Island regulates assisted living facilities and protects their residents.”

“I want to thank Jane Hayward, her staff, and the staff throughout a number of state departments and agencies that helped develop this important report,” Governor Carcieri concluded. “They have made a very important contribution to our efforts to protect some of Rhode Island’s most vulnerable citizens.”

The report found that, for the most part, the assisted living system is an appropriate and safe supportive housing option, particularly for the elderly, which represent the majority of the 3,500 Rhode Islanders living in this type of supportive housing setting. However, the second population of Rhode Islanders living in assisted living – adults under the age of 65 with a chronic and disabling physical and/or behavioral impairment – is not having its needs adequately met. One of the victims and the alleged assailant in the Beechwood incident fell into this category of resident. For this minority population, the review found a significant lack of housing options to meet their more complex needs compounded by the inefficient use of finances and resources by the state and exacerbated by the lack of appropriate care and service coordination.

“In reviewing the Beechwood incident in the context of the state’s role in our assisted living system, we found that as a whole, for those residents under 65, the system is fragmented and disjointed with very little interagency coordination and few measures to ensure proper resident placement, resident safety and appropriate care coordination,” said Hayward.

The report submitted by Hayward recommends adding a new level of licensure for the under-65 population, to ensure that minimum service and care needs are met and to ensure the qualifications of these particular providers. In addition, it recommends blending public funding sources in order to move some individuals into more appropriate supportive housing options that exist within the community already and generally expanding the market to increase housing options for the under-65 population.

The recommendations contained in the report include a number of regulatory changes relating to licensing, assisted living public financing, assessments and the coordination of resident care. All of the recommendations are intended to meet the following overarching goals:

Ensuring that, in the area of licensing, the state fully exercises its authority to promote safe and appropriate care in assisted living residences.

Improving resident screening and assessments to ensure that all assisted living residents are comprehensively evaluated to determine their specific care needs, identify and address and potential safety and health risks, and inform decisions about whether an assisted living residence is an appropriate services setting at admission and periodically thereafter;

Enhancing consumer information to provide prospective and current assisted living residents with information to make informed choices about their care;

Enhancing care coordination to assure that assisted living residences coordinate a range of services to meet each resident’s needs;

Strengthening the regulation and oversight of residences to protect the safety of residents and to assure access to quality care; and

Addressing financing concerns to make long-term policy changes which improve future options for assisted living services for more Rhode Islanders, including the lowest income frail elders and adults under-65 with disabilities.

Some of the recommendations are suggested for immediate implementation to ensure the safety of current assisted living residents including: excluding convicted felons on probation or parole who are subject to electronic monitoring from residing within assisted living residences; fully implementing and continuously monitoring recently developed Department of Corrections protocols strengthening oversight of and the exchange of information about individuals on probation or parole that are residing in assisted living; and, using the joint authority of the Department of Human Services and the Department of Elderly Affairs to establish a new, permanent certification process for licensed assisted living residences now admitting public pay (SSI) residents.

Other recommendations are categorized as “short-term” and would be expected to be implemented within a six-month period of time; while others, categorized as “long-term” would require greater effort and more time (twelve months) to implement.

Some of the short-term recommendations include: requiring licensed residences to use a standardized comprehensive screening instrument that covers cognitive, behavioral health and functional impairments both prior to admission and at six-month intervals; requiring assisted living residences to provide service coordination; and, amending state law to provide the State with the flexibility permitted under federal law to expand the supportive housing options covered under SSI-D.

Long-term recommendations include adopting a standardized, and easy to administer assessment tool with the capacity to be used across long-term care settings; leading an interagency effort focusing on adopting or developing payment options that are more responsive to the variable needs and service requirements of public pay residents and the licensed residences where they live, including modifications to the State-funded Supplemental Security Income enhanced payment for assisted living (SSI-D); and, convening an interdepartmental workgroup to develop a plan to ensure the State utilizes all of the available sources of funding for assisted living.

“The recommendations contained in my report to the Governor are intended to provide residents, staff, regulators and operators with the tools to make informed decisions, conduct appropriate assessments, coordinate care, provide more specific guidelines and enforce regulations which would certainly have a wide-ranging and positive impact on the status of the assisted living industry in Rhode Island,” concluded Hayward.

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