Please reconsider ensuring that #5 ..."free of communicable disease," on the state form will not be needed to be circled by professionals if agencies have documented negative for tuberculosis--"O"mm.  Please accept the forms from official agencies, i.e.health departments, urgent care facilities, hospitals, and physicians' offices, when the forms are documented "negative" for tuberculosis and we can attach same to the state form.

The proposed new regulation 22VAC40-73-1010 (Applicability) removes the exception in 22VAC40-72-990 for facilities licensed for 10 or fewer and with no more than three residents with serious cognitive impairment. Thus, increasing the number of staff requirement  on duty. 

The removal of this exception is again eliminating small businesses/facilities by causing undue hardship and making it very difficult for them to be competitive with other bigger facilities.

Recognising that not all families likes the bigger facilities; some ALF's mission/vison is to provide care in a home environment, thereby having reduced number of residents in ech facility.

For example:  ALF  Y is licensed for maximum capacity of 4 or 5 residents of which one to two have serious cognitvie impairment as stated in Article 2. According to the propsed regulation, "there shall be at least two direct care staff members awake and on duty at all times in each building when residents are present". Having 2 staff at all times in a facility with 4 or 5 residents is not cost effective and posses undue hardship on the facility considering the fact that some of these resident will be AG residents. Even if these residents do qualify for some type of Waiver, monthly salary of one direct care staff with minimum wage of $7.5/hr alone is $1200.00. Based on the new proposed regulation, a total of 6 staff will be needed monthly (based on 8hrs shift), averaging about $7200.00 monthly on salaries alone (minus overtime).

I am hereby requesting that Part X , Article 2 be reconsidered and the Exception Clause be reinstated  back into the proposed regulation based on the type of licenses currently approved by VDSS for ALfs.

 

 

The Association of Minority Owned ALF’s is asking for a thirty days extension on the comment period. We are asking that the Department of Social Services do a small business impact study. If the department had truly done a study, they would have concluded that the regulation put in place in 2007 crippled small African-American ALF’s and that anymore regulations without funding would force our businesses to operate in non-compliance or create a business hardship that causes us to have to shut our doors. The JLarc2006. Study stated that the rate is well below market price and that the limited revenue of these facilities will continue to constrain their ability to comply with new regulations.

 

 

Virginia has seen a decrease in ALF’s bed still more beds are being lost because of regulations without monetary funding.

We lost an average of 853 beds. 8 facilities closed since May 2015 with several pending.We know that if DSS had truly done an impact study they would know the difficulties ALF’s were having complying with the shortage of medication aids and how they have become a force to reckon with because they will not work for small ALF’s who cannot Pay $14 to $20 dollars.The auxiliary grant facilities are receiving $43.00 a day to take care of resident members. Medication aides are coming in at no less than $13 an hour at 16 hours we are putting out  $208.00 a day.

We are now competing with Hospitals, Large Private Paid Facilities, The Jails and Prison who can pay $20 dollars for medication because they are less costly than nurses.

We are asking that an impact Study be done so that no more burdensome regulation need to be pushed onto residential-only Alf’s without the increases that were called for by JLARC  in 2006.

Key Recommendations/Findings That Have Not Been Fully Implemented

AG monthly rate should be increased (1988, 1991, 1998, 2000, 2000, 2006, 2007)

• AG rate increased and linked to services provided (based upon determined level of care or SMI diagnosis) (1988, 1991, 1998, 2000)
• The personal allowance for AG recipients should be increased/evaluated (1991,1998)

 

We are asking that because we are a social model that any medical regulations should be required to be paid by DMAS and not to come out of the business owner pockets such as the regulations for healthcare oversites, dieticians, and Uai training and ISP training. We are not against regulations we are against creating regulations with out monetary resources to back up their endeavors.

We are asking that for residential only be exempt from increase in training and that for direct care it is to remain the same.

We are asking that residential-only facilities  med tech take the 68-hour training and annual four-hour training without having to be state license so that we are not competing with the larger organizations.

We are aware that Virginia assisted living facilities are having difficulty supplying a need to the low-income disabled individuals because in 2016 and 2017 Department of Human Resources made an amendment (line item K 304… in the budget for $250,000 a year to ensure that Birmingham Green Assisted Living facility can continued to provide residential services to low-income disabled individuals (Senate bill 30).

We are asking that the General Assembly please make an amendment so that all auxiliary grant facilities receive an increase so that we ALL may have the opportunity to provide continuous services to our low-income disabled and not just a select few.

 

 

.

Adds that when there is a new facility licensee, there shall be no more than 2 residents residing in a bedroom. This standard will dramatically impact homeowners when they are ready to sell their property.And present a hardship to the seller. Statewide building code issues permits and C.O.'s. This is in the law. How can VaDSS change the capacity of your facility.We would like to have this standard revisited. And the State should compensate all facilities that reduces their C.O.'s upon sale of their business by the DSS.

Please allow more than one administrator.  As in "Lovng vs Virginia" case, what harm could it cause for the state of Virginia? Having two or more administrators would be exceeding, just has having 2 or more med aides, PCAs, etc.  150.B--If an admininstrator of record dies, the ALF would immediately have a new qualified administrator, not an acting administrator.  150.B.6--there would not be a limit of 150 operating days.  An acting administrator would not be needed.  160-the administrator would have the necessary trainings.  170--B--there would be more than one administrator at shared facilities, if applicable.  40 hours on-site with an administrator of record, administrator and/or assistant administrator in the same facilitywould maintain the fluidity and consistency of services provided.

The VADSS should establish a dual system for informing providers about regulation changes nit just emails. A lot of providers stated they did not receive notification of the proposed regulatory changes via email. This may be a reason for the low response to the proposed regulatory changes during the public comment period.

Please allow for more than one administrator.  One administrator cannot harm a facility;it can only enhance or exceed. An administrator will be in place for visitors, licensing, and other agencies--fire, health, case managers, ancillary staff, etc.  Both will be qualified, therefore, they will be able to take vacations separately, attend trainings at different times, eat lunch at different times, alternate times being out of the building, and be accessible to staff.  Administrators have passed the state exam, have paid their annual dues of $350, and have maintained their qualifications.  Why would the state not allow these qualified staff to maintain their qualifications?  If they are not an administrator at an ALF, they will not be able to keep their license.

Please allow more than one administrator in an assisted living facility. This allows for more than adaquate coverage, more than adaquate support for vacations, emergencies, and provided services. 

Our assisted living facilities would greatly benefit from the trained coverage, expertise and support by having more than one administrator in a facility. 

As stated, one of the reasons for the revision of the regulations is to provide greater protection for residents in care and reflect current standards of care. 

The number of residents in a room has not been proven to affect the protection or the care being offered.  Apparently, the size of the room met the regulations (at time of request) to be approved for the number of residents permitted in the room.

A test for the accuracy of this statement can be proven by the number of violations that have been cited as a result of having more than two residents per room. 

However, this new regulation would negatively affect the selling price of some smaller facilities.   

So, why are we revising a regulation that has not presented any problems?

Coordinated Services Management, Inc. represents several non-profit owners who have assisted living memory care units.  Providing the highest level of care, comfort and safety is the primary mission for each of these owners.  This requirement places an undue burden on assisted living facilities by requiring additional staff requirements, even when the assisted living facility has determined that the facility is adequately staffed to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments (UAI) and individualized service plans (ISP).  If there are additional direct care staff in the building and the community has determined that there is adequate staff readily available to assist with emergencies in the special care unit, then this requirement of additional staff is unnecessary.  At night, in particular, a majority of residents are asleep in their beds.  This requirement presupposes that more staff will result in a higher level of care when the UAI and ISP should drive the required staffing levels based on overall resident acuity.  The average cost to add one staff member to one facility to meet this requirement is approximately $43,680 annually.  This will result in an increased rent of approximately $2,080 per year per resident.  This requirement should be reconsidered so that any staffing requirements are driven by resident care needs as determined by the UAI and ISP.

Mennowood Retirement Community is a Christian, not-for-profit assisted living community offering independent living, assisted living, and memory care in Newport News.  Love, service, and compassion for our residents is our calling and our mission.

We firmly beleive that his requirement places an excessive burden on assisted living communities when the community has determined that the facility is adequately staffed to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident needs as assessed in the UAI and carried out in the ISP.  If there are additional direct care staff in the building and the community has determined that there is adequate staff readily available to assist with emergencies in the special care unit, then this requirement of additional staff is unnecessary.  On the third shift (11p-7a) a majority of residents are asleep and require minimal care beyond monitoring.  

This requirement assumes that more staff will result in a higher level of care.  In truth, the UAI and ISP should drive the required staffing levels based on overall resident acuity. 

Lastly the cost of addional caregivers cannot be ignored. The average cost to add one staff member to one facility to meet this requirement is approximately $43,680 annually.  This will result in an increased rent of approximately $2,080 per year per resident. 

In sum, we offer that this requirement should be reconsidered so that any staffing requirements are driven by resident care needs.

Thank you.

Good morning. 

It is diffricult to meet the needs of the low income residents and continue to give quality service as required so I'm asking that the  facility's who have more than 2 residents per room to be given the opportunity to remain as is and to allow all AG facility's to have up to 3 per room once they meet a certain room size qualification. This will help with cost and quality of service. The needs of my residents are important to me and their happiness is EVERYTHING!!! Please reconsider the policy's and processures for AG facility's. 

Thanks

Garretha Williams-Atkinson

We appreciate the opportunity to comment on the comprehensive revisions to the Standards for Licensed Assisted Living Facilities.  We commend the Department’s efforts in crafting revisions that strengthen protections for residents with particular attention to the special needs of persons with cognitive impairments. We appreciate the commitment to consistently incorporate more person-centered care principles throughout the Standards.  We believe these revisions will help ensure that the increasingly complex needs of residents in assisted living facilities will be effectively met.  Thank you.

After reviewing the proposed changes to the Standards for Licensed Assisted Living Facilities, we appreciate the diligence of the Virginia Department of Social Services (VDSS) staff in considering the intent and impact of the numerous changes made to the Standards. We understand the reasoning behind many of the changes; however, we cannot fully support every change that has been proposed. The primary reason for objecting to several of the proposed changes is the financial situation of the assisted living industry in Virginia with the lack of a Medicaid waiver for general assisted living services and the severely underfunded Auxiliary Grant (AG) program.

Some of the proposed changes have a very high probability of resulting in the closure of smaller assisted living communities as well as a closure for those assisted living communities that serve a larger population of residents receiving the AG rate due to the inability to afford the required changes. With the closure of even one assisted living community, there is a significant burden placed on the general community in finding new housing for residents, new employment for staff, new customers for business suppliers, and new business operators for the physical location of the closing assisted living community. Below are two examples of proposed changes that are very concerning to the continued operations of these communities, as well as potential replacement language to be considered.

22VAC40-73-1020. Staffing.

Exception: The requirements of subsections A and B of this section do not apply when facilities are licensed for 10 or fewer residents if no more than three of the residents have serious cognitive impairments. Each prospective resident or his legal representative shall be notified of this exception prior to admission.

We do not support the removal of this proposed language. Assisted living communities licensed for 10 or fewer residents with three or less residents who have a serious cognitive impairment will most likely be financially unable to comply with the removal of this exception due to the cost of adding an additional staff member. With the language in the other areas of the proposed regulations, larger providers are required to have at least 2 staff members awake and on duty for 20 residents with the possibility of the all of those 20 residents having a serious cognitive impairment resulting in a 1:10 ratio. The elimination of this exception would penalize the smaller providers by requiring a possible 1:5 ratio even during the evening hours when most, if not all, of the residents would be asleep. Two possible options for replacement language are listed below, of which one is to not strike the exception as it was previously published:

1. Exception: The requirements of subsections A and B of this section do not apply when facilities are licensed for 10 or fewer residents if no more than three of the residents have serious cognitive impairments. Each prospective resident or his legal representative shall be notified of this exception prior to admission.
2. Exception: The requirements of subsections A and B of this section do not apply when facilities are licensed for 10 or fewer residents if no more than three of the residents have serious cognitive impairments. Instead, each of these facilities would be required to have at least one direct care staff member awake and on duty at all times in each building who shall be responsible for the care and supervision of the residents. Each prospective resident or his legal representative shall be notified of this exception prior to admission.
3. Exception: The requirements of subsections A and B of this section do not apply when facilities are licensed for 10 or fewer residents if no more than three of the residents have serious cognitive impairments. Instead, each of these facilities would be required to have at least one direct care staff member awake and on duty during times when the majority of the residents are sleeping in each building who shall be responsible for the care and supervision of the residents. Each prospective resident or his legal representative shall be notified of this exception prior to admission.

22VAC40-73-1130. Staffing.

1. When 20 or fewer residents are present, at least two direct care staff members shall be awake and on duty at all times in each special care unit who shall be responsible for the care and supervision of the residents, except as noted in subsection B of this section. For every additional 10 residents, or portion thereof, at least one more direct care staff member shall be awake and on duty in the unit.
2. Only one direct care staff member has to be awake and on duty in the unit if sufficient to meet the needs of the residents, if (i) there are no more than five residents present in the unit and (ii) there are at least two other direct care staff members in the building, one of whom is readily available to assist with emergencies in the special care unity, provided that supervision necessary to ensure the health, safety, and welfare of the residents throughout the building is not compromised.

We do not support the inclusion of the words, “or portion thereof” as this could result in significant financial burdens on assisted living providers and could result in a staff to resident ratio of 1:7 should the assisted living community have 21 residents. This requirement may also result in providers refusing to accept emergency placements should they presently have an increment of residents similar to 20 or 30, where the addition of one resident would result in the requirement of one additional staff member for all shifts.

We do not support the inclusion of the words, “or portion thereof” especially for the time periods when the majority of residents are sleeping.

We recommend that language be added to allow for a staff member to take breaks, such as 15 minutes or 30 minutes, without having to bring on an additional staff member should the staff who is taking a break remain in the building and able to be called back to duty, and to have that on-site availability to be sufficient in meeting the staffing requirement. 

22VAC40-73-1130 – Adds a requirement that when there are 20 or fewer residents present in a special care unit, there must be at least two direct care staff members awake and on duty in the unit, and for every additional 10 residents, or portion thereof, there must be at least one more direct care staff member awake and on duty in the unit, rather than two direct care staff in each unit.

This requirement places an undue burden on assisted living facilities by requiring additional staff, even when the assisted living facility has determined that the facility is adequately staffed to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments (UAI) and individualized service plans (ISP).  If there are additional direct care staff in the building and the community has determined that there is adequate staff readily available to assist with emergencies in the special care unit, then this requirement of additional staff is unnecessary.  At night, in particular, a majority of residents are asleep in their beds.  This requirement presupposes that more staff will result in a higher level of care when the UAI and ISP should drive the required staffing levels based on overall resident acuity.  The average cost to add one staff member to one facility to meet this requirement is approximately $43,680 annually.  This will result in an increased rent of approximately $2,080 per year per resident.  We have three (3) memory care units, housing 21 residents on each unit, so those staffing numbers would have to triple. The current staffing pattern is more than sufficient to meet the care needs of the residents in our memory care units.  We also have additonal assisted living staff for a unit outside of the memory care areas, who would be available to assist if needed. This requirement should be reconsidered so that any staffing requirements are driven by resident care needs.

Facility should have ability to have more than one administrator. Every other position allows part time employment to compose proposed staff ratio . Administrators should also have the flexibilty of having more than one administrator. Administrators have to attend trainings and complete other task off site, and having more than one administrator would benefit facilities.

I ask that VDSS reconsider reducing the standards that require facilities that have received a Certificate of Occupancy to not have more than 2 person in a room in the event of a sale or new owner. This would affect a large and profitable margin of re-sale value. If rooms and space allow per regulations this should not cap facility to only 2 persons. Please reconsider

Facilites should have ability to have more than one administrator.     

Facility shouldn't be cap on only two people per room. Especially if facility's rooms are within requird footage of standards.