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Proposals to reform ALFs hit resistance

As the governor’s task force to reform assisted living facilities nears its final chapter, the gulf between owners of the troubled homes and advocates for frail residents is still steeped in differences and distrust.

The Assisted Living Workgroup, whose members were appointed last year by Gov. Rick Scott, met for the second time Friday to debate dozens of recommendations to improve the lives of elders and disabled people in ALFs across the state.

But the group, which includes more than twice as many owners as elder advocates, rejected or tabled virtually every measure that ran afoul of the industry.

One proposal to help fix the system called for banning administrators who had lost a license previously due to egregious cases of abuse or death.

But state Rep. Matt Hudson, a Naples Republican, called the proposal “exceptionally onerous or harsh” on industry members. Another lawmaker on the panel, Hialeah Republican Sen. Rene Garcia, called the idea “way, way too onerous.”

“We are at the mercy of any staff member, whether we are in the building or not,” said Brian Robare, who owns the Villa at Carpenters ALF in Lakeland.

In the end, panel members agreed to table the discussion, and advocates for ALF residents said later they deferred a vote because they knew it would fail.

“I feel strongly that I have a duty to this group to look to the protection of individuals who are served in these licensed facilities,” said Martha Lenderman, a consultant on involuntary psychiatric commitment, discouraging members from tabling the vote.

The divide comes just a year after The Miami Herald exposed wretched conditions in ALFs — including dozens of deaths from abuse and neglect — prompting the shutdown of more than 13 facilities and the state’s harshest penalties against three dozen others.

Much of the meeting — the second of three since Scott resumed the task force from last year — was mired in disagreements between industry representatives and advocates over how much responsibility owners and administrators should bear for the safety of residents.

Charles Paulk of the Florida Life Care Residents’ Association, said administrators ultimately were responsible for conditions in their homes, whether they were on site or not.

“I found on my visits to these communities that administrators were often off-campus, and did not have a qualified person to replace them. An administrator should always be held responsible, and how he deals with an incident should modify the severity of what comes back to him as a result.”

Robare replied: “I never said administrators shouldn’t be held responsible. We’re responsible for everything that happens in our building. But there are some things, responsible or not, we cannot control.”

ALF owners — who outnumber consumer advocates 7-3 on the panel — said they were pained by the characterization that they put dollars over safety.

“Nobody here in the room wants bad providers in our profession,” said Steven P. Schrunk, who represents the Florida Health Care Association.

“We don’t want these characters, these repeat offenders, exploiting our elders or neglecting our elders or mistreating them in this profession, period.”

Still, a resident advocate with the Ombudsman Program in Broward, Laura Leite, said she often finds residents “positioned” in front of television sets doing nothing for hours when she visits facilities. “I consider this abuse,” she said.

The worst thing is that residents do not complain, Leite added. Fearful that administrators will discharge them onto the streets if they make waves, most residents refuse to discuss their concerns with ombudsmen, she said.

One of the few items approved by the group suggests creating an ALF “council” that will meet regularly to set policy.

Several items disliked by industry groups were either rejected or tabled, including a recommendation that new administrators be required to work with a “mentor” with a good record for two years before being given a license — a proposal the industry said would discourage people from entering the field; a recommendation that hospitals be held accountable when they discharge residents into homes where they aren’t safe, and a proposal that the group set ratios between staff and residents.

As they did last year, owners blamed many of their industry’s woes on social workers who oversee ALF residents with chronic mental illness.

During a heated discussion over qualifications for ALF administrators, the owner of a North Florida ALF, Michael Bay, reminded task force members that their suggestions were binding on no one — and changes to the industry could come only from lawmakers.