Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, January 11, 1994 TAG: 9401110020
SECTION: VIRGINIA PAGE: C-4 EDITION: METRO
SOURCE: RICK LINDQUIST STAFF WRITER
DATELINE: LENGTH: Long
But adult-home operators say the new rules are too idealistic, and they worry that the tighter care and training standards will increase costs and paperwork.
"Everyone is going to have to purchase first-class care whether they can afford to do that or not," said JoElla John, a Troutville adult-home operator who nevertheless thinks the new standards are long overdue.
John, who runs Cave Creek Homes for Adults, has been a representative of the Virginia Adult Homes Association on a task force that helped write the new rules. The association represents mostly smaller adult homes.
The public gets its first crack at the proposals today in Richmond as the Department of Social Services begins a series of hearings on the regulations, mandated by a major revision of adult-care statutes by the General Assembly. A hearing is set for Friday from 1 p.m. to 4 p.m. in Roanoke City Council chambers.
Among other provisions, the new regulations define two primary care levels - based on how well residents can care for themselves - that adult homes may be licensed to offer. They also lay down new staff training requirements and specific regulations for residents with Alzheimer's disease or dementia, which some advocates feel should fall under a third care level still under study.
While most of those affected by the proposals say they are a step in the right direction, they also use words like "burdensome" and "cumbersome" to describe the paperwork and the complicated staffing formula the rules call for.
"I don't think the state realizes how much work this is going to be," said Tony Kelly of Roanoke's Lakeview Home for Adults.
Kelly said the proposed regulations are trying to make adult homes "more like nursing homes than they care to be."
Beverly Soble of the Virginia Health Care Association agrees. She thinks the new regulations blur the distinction between the social setting of an adult home and the medical setting of a nursing home. "This [the adult home] is a residential setting, not institutional," she said.
Soble said the proposed staffing requirements are too rigid and won't enhance resident care.
The regulations also will cost more and pose a bigger hardship for smaller homes in rural settings, operators predict. "Whatever it costs me to come up to the new standard will be passed on to the clients," John said.
Especially hard hit will be adult homes that take in residents who rely on taxpayer support through social service auxiliary grants.
Reimbursements for auxiliary grant residents have remained at $631 a month for more than two years. The proposed reimbursements are $714 for Level I - residents needing minimal help with daily activities - and $790 for Level II - those needing moderate to intensive help.
Under a proposal awaiting approval from the Health Care Financing Administration and the General Assembly, Medicaid would provide another $90 to $180 a month for Level II. Most, if not all, Alzheimer's and dementia clients fall into that category.
"The real battle is over money right now," said Katie Summers of the Alzheimer's Association in Fairfax. She called the additional Level II money "a great step for Medicaid to take."
Her organization is "prepared to fight" any attempts to alter or delete the dementia regulations, she said.
However, the Virginia Adult Homes Association would prefer a new Level III for Alzheimer's and dementia clients and a bigger reimbursement to go along with it, John said. "I'm just embarrassed that the state didn't fund it," she said.
John said she hopes the General Assembly "will be shamed into passing Level III" so there will be a smooth transition between adult homes and nursing homes.
Joe Teefey, deputy director of the Department of Medical Assistance Services, said the money will "bridge the gap" between nursing home and adult homes for Level II and borderline situations.
"It's a heck of a lot more money than they were getting," he said.
However, even if it's approved, the new Medicaid supplement won't go into effect until next year. Homes that take in public-pay clients would have to make do until then.
Bre Smithson, who directs the Showalter Center, an adult home in Blacksburg, said she hopes the proposed Medicaid supplement doesn't show up with more regulatory strings attached.
Home operators say reimbursements - even with the Medicaid supplements - already are far behind the cost of providing care. "They aren't even catching up with the cost of living," said John, whose own facility "cannot afford to keep public-pay clients." She said about half of Virginia's adult homes keep only private-pay clients.
Some operators predict that private-pay residents will be tapped to make up the difference between what homes get for each auxiliary grant resident and what it actually costs.
The regulations are to take effect June 1, but have been funded only for that month. The General Assembly will have to re-fund them for the new fiscal year, which begins July 1.
Meeting the new regulations also will mean additional personnel, some home owners predict.
Norma McCroskey, director of long-term care for the League of Older Americans' Roanoke office, said the organization favors the two levels of care in the regulations.
The group plans to file written comments by the Feb. 11 deadline, she said.
Memo: ***CORRECTION***