Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, September 7, 1993 TAG: 9309070044
SECTION: VIRGINIA PAGE: B1 EDITION: METRO
SOURCE: RICK LINDQUIST STAFF WRITER
DATELINE: BLACKSBURG LENGTH: Long
Stricter regulations under consideration for adult homes would make it harder for them to accept individuals who require intensive and costly supervision.
At the same time, tightened state Medicaid guidelines may block reimbursements for nursing-home care for some of these same individuals who are otherwise relatively healthy.
Officials from the Virginia Department of Social Services have been touring the state to gather comments from adult-home operators to help shape these new regulations. They were mandated by a major revision of adult-care statutes by the General Assembly, which still must come up with money next year to fund the changes.
Because they are not health-care facilities, adult homes don't qualify for Medicaid payments, though that rule could change.
Patients who cannot afford to pay to live in an adult home usually must get "auxiliary grants" through local social service agencies.
Even though grant amounts will go up under the new rules, some adult homes - especially smaller facilities without strong financial backing or corporate connections - may simply find they can't afford the staff or facilities to care for Alzheimer's patients, who sometimes wander or exhibit difficult behavior.
Under the proposals, adult homes won't be able to accept residents with certain medical conditions or for whom they cannot provide "appropriate care."
Determining who can claim these clients already has precipitated a battle between the nursing-home and adult-home industries.
"Trying to draw the line between nursing homes and adult homes is very difficult," said Katie Summers of the Alzheimer's Association in Fairfax, who belongs to both the Adult Levels of Care and Long Term Care task forces studying the proposed rules.
Virginia has more than 500 adult-care homes, with room for approximately 27,000 clients. As a result of the pending regulatory changes, Summers and others predict, more Alzheimer's patients will end up in adult homes than in nursing homes.
To help better define the line between nursing homes and adult homes, the proposed rules will require a formal assessment of prospective adult-home residents.
The regulations also will establish two levels of adult-home licensing and care - Level I for residential-living facilities and Level II for assisted-living facilities.
Level I would be for adults who are mobile but need minimal help with daily living, while Level II would be for adults needing at least a moderate level of help.
Deputy Secretary Bobby Vassar of the state Department of Health and Human Resources met recently with adult-home care providers at Warm Hearth Village, a Blacksburg retirement community that offers several levels of residential care. His visit was one of four stops around the state to gather information and opinions on the adult-care proposals.
He said the data gathered could be used eventually to develop state guidelines to provide "a continuum of care" to bridge the gap between adult homes and nursing homes.
Brenda Smithson, a registered nurse and director of Showalter Center, a residential-care and assisted-living facility that's part of Warm Hearth Village, was among the 30 or so who attended the meeting.
"There could be some people that could fall through the cracks," she said later.
Summers agrees. "There's always a possibility, and it's something I'm afraid will happen."
"It's difficult to place an Alzheimer's patient, anyway."
But Summers believes the new adult-home regulations are a step in the right direction.
"We've been making excuses for [the adult-home industry] for too long." She said the proposed rules were "necessary to bring the level of care up to where it should be" for Alzheimer's and dementia sufferers.
Some at the Blacksburg session brought with them tales of those already suffering from inappropriate care.
One adult-care provider from Southwest Virginia told of a client who was a hepatitis-B carrier who did not qualify for nursing-home admission until he developed a brain tumor. Now the man is qualified; but he has behavioral problems and has hurt another resident, so no one wants him.
Earlene Johnson, administrator of an adult residential center in Scott County, is mostly upbeat about the process.
"This will restructure the adult-home industry in a way it's never been restructured before," said Johnson, who represents the Virginia Association of Homes for Adults on a task force studying the new regulations.
Once the new rules are in place, people will not be able to enter an adult home without the necessary assessment - even those clients who pay their own way and don't receive public assistance.
"That's been a real sore spot, because private pays have traditionally been allowed to stay where they wanted to stay," she said.
But money remains an issue. The higher auxiliary grants for adult-home residents still are far behind the actual cost of keeping a client, Johnson said. An adult home's cost, she said, averages $800 to $900 per month per resident, while reimbursements are running $631 per month, plus a small stipend for personal items.
The proposed reimbursements are $714 for Level I and $790 for Level II care, but that still might not be enough, she said, to open the doors to certain Alzheimer's patients.
"The money's not there for us to do it," she said.
Johnson, who worked in nursing homes for 17 years, conceded it's also a "market-share issue" - a tug of war over clients - between nursing homes and adult homes.
The industries are not too far apart, she said, and she remains optimistic they'll be able to work together.
Smithson predicts that the increasing ability of adult homes to provide more services - such as assisted living and around-the-clock nurses - will keep some adults out of nursing homes. But she views nursing homes as an ally, not a competitor for a shrinking pot of money, because of their different roles.
Vassar, meanwhile, assured the adult-home care providers at the Blacksburg session that their voices would be heard in coming up with the final version of the rules, which won't go into effect until June.
He said that with the state facing a budget shortfall of at least $500 million, however, their implementation is another major issue for adult-home providers to face. The General Assembly authorized funding the regulations only to the extent that money is available.
Once the final regulations are published, the public will have a chance to comment during hearings this fall.
by CNB