Having now experienced care for my Loved One in two Memory Care facilities in Charlottesville, I have deep concerns regarding the oversight and transparency that the facilities exercise when caring for this most vulnerable population.

Not all "dementia" patients are the same and some have fluctuating needs. I feel that direct training requirements and education ( not just the current on-line requirement) are imperative to provide an adequate level of care. In addition, there needs to be clearer guidelines for meeting resident care requirements and general supervision. I have seen the current plan of just securing the living space and letting residents roam and interact unsupervised, end badly.

The facility should not be able to change prescribed medications without family consent, even if it is an over-the-counter medication, and all medications should be given as prescribed on the schedule prescribed. Allowing the facilities "two hour windows" is not in the best interest of the resident.

And finally, the family needs to be informed in writing of any "incidents" occurring at the facility and given copies of any reports submitted to any agency that concerns their Loved One. All records of the resident are the property of the resident and should be assessable by the Residents' POA.

I am writing to provide a comment on the action “Amend Standards for Licensed Assisted Living Facilities” [22 VAC 40-73] with comment period ending August 16, 2023 at 11:59pm (ET). As indicated in the Notice of Intended Regulatory Action (NOIRA) Agency Background Document, my comment addresses “(iii) the potential impacts of the regulation” and issues related to “regulatory reduction, pursuant to Executive Order 19” (page 4).

My grandmother was in a Memory Care Special Unit in Charlottesville, VA, and I visited her a lot. In my observation in visiting multiple times per week over the course of twelve months, I noted a persistent lack of programming and activities. I confirmed this with other residents, family members, and staff. Memory Care residents are supposed to receive a minimum of 2 hours each day of engagement activities and stimulation, and that was clearly not happening, sometimes for months at a time. Activities on the weekend for the residents was a very rare occurrence.

I strongly feel that there needs to be better regulations and accountability to ensure the Memory Care residents are receiving the proper stimulation and engagement through programming. I am concerned that the following action as written in Executive Order 19 — “[The Office of Regulatory Management should include] The oversight and implementation of a 25% reduction in regulatory requirements” — will further deteriorate the already abysmal state of programming in Memory Care Special Units across the Commonwealth. I am also concerned to read the emphasis of EO 19 in the final bullet of the “Amend Standards…” action: “Remove unnecessary and burdensome requirements congruent with regulation reduction per Executive Order 19” (page 4). It is my plea that ALF regulations are improved and enforced, not stripped in the name of streamlining bureaucracy at the expense of the care of our Virginia’s elders.

I observed twelve months of a dementia/cognitively impaired population, on average 25 residents at any given time, who were isolated, relegated to their rooms, bored, depressed, ignored, not engaged, and had nothing to do while closed off in their rooms. Or left to languish unattended and disregarded in a common area. This is not fair, appropriate, or humane for these once thriving contributors to our community. This utter lack of engagement is detrimental to their already fragile health, because it expedites cognitive decline and leads to agitation and depression / hopelessness, and other harmful conditions and situations. Further, I do not consider parking Memory Care residents in front of a TV all week as an appropriate form of engagement and programming (and I do mean parked — some residents are wheelchair bound and unable to move freely). I have observed residents getting upset by what’s on television. Television is a relaxing activity for some, but cannot be the only “activity” available for weeks at a time.

I also believe Memory Care employee training needs to be greatly improved and regulated. Sadly, I observed many employees who knew nothing about dementia and similar cognitive conditions, and didn’t know how to properly interact with residents. I observed verbal and psychological abuse, yelling, scolding on the part of Memory Care employees. While residents with dementia or other cognitive conditions may not interact and engage with people in the same way as those who do not have these conditions, they are just as negatively affected by abusive behavior. Memory Care Special Units need requirements for management and oversight from the ALF. It is too easy for these residents to get overlooked, neglected and abused, and because of their medical condition(s), they are unable to advocate for themselves.

Please take into account the above comment when updating language in this action, particularly as these comments pertain to:

• Clarify requirements for reporting abuse, neglect or exploitation;
• Clarify licensure requirements for acting administrators;
• Clarify direct care staff training requirements when residents have serious cognitive impairments;
• Clarify requirements for meeting resident care and general supervision needs;
• Clarify that direct care staff must be available when residents may need assistance in the dining room (page 3 of action).

Sincerely,

Addison Patrick

Charlottesville, VA

I encourage everyone to participate in this process. It is great to see that DSS is focusing on clarifying areas such as dining and staff training requirements for Memory Care and major neurocognitive disorders. I would like to see further improvements in the area of Programming, Engagement and Activities which is critical to those with cognitive issues. This population needs Engagement Activities and stimulation in order to mitigate cognitive decline and to enhance their quality of life for their impaired diagnosis. 

Richmond, Virginia

I have experience across multiple Memory Cares in Virginia, and the regulations and standards are not where they need to be for Virginia Residents with varying levels of major neurocognitive disorders. In many cases they are simply locked-up, as if in a containment pen, and are not treated very well, even the most basic needs not met.  (i.e. lack of:  basic hygiene, access to food & water, clean clothes, daily oral care, toileting, clean briefs.)  It is unclear sometimes when the residents last had access to fresh air.

It is shameful to see how some of the residents of Virginia are being treated. These facilities are very expensive.

Staffing minimums are a big problem. Must be increased. The facility operates with bare minimum staff, on purpose, to increase profit and executive bonuses. And are not meeting the needs of the Memory Care residents. It is harmful and dangerous. This is not fair to the staff, and unconscionable for the residents.

Also better process to lodge complaints. No one is speaking up because it is not safe to do so. Hostile environment.

Virginia must improve these standards.

Any assisted living facility that puts profitability over care, does not belong in Virginia.

DWS

Alexandria, Va

Despite the fact that Covid has been with us for 3.5 years, I have observed Memory Care facilities during outbreaks behave as if it were the first time it happened. No one had any idea what to do or what’s going on — and there were no communications about what’s going on. ( The facility had no plan. )

There should be protocols laid out in advance for Memory Care Facilities, and POAs should be informed in advance what these plans and protocols are before any potential outbreak.  It is shocking that facility managers and corporate leaders don’t have a plan at this late stage in the situation. There should be Standard Operating Procedures, and families should be provided the Standard Operating Procedures for a covid outbreak.

This is of special importance in a Memory Care Unit, where the Activities team needs to know how to pivot what they do, in order to compensate for a cognitively-impaired group of residents, being isolated in their room for 10 days of quarantine. The Memory Care Facility and their Activities manager and employees need to have a plan for what they’re going to do in this case to engage the Memory Care residents in the quarantine.

Memory Care Facilities should also have proper plans, knowledge and training for in-room meal service for Memory Care during a quarantine. They need to be aware and trained in what’s appropriate and what is not appropriate when food is served in the resident apartment.

All of these Standard Operating Procedures need to mapped out in advance, with transparency for residents and families upfront.

The staffing requirement for Memory Care needs to be higher. The requirement of one staff member for every (10) residents is not enough to meet the needs of Memory Care residents.