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