After trying for four years to improve conditions at the state’s assisted living facilities, the Florida Senate on Wednesday sent to the governor a proposal to improve enforcement and oversight at the homes that serve more than 86,000 senior residents.
“With this bill we hope that all our facilities will be right and safe,’’ said Sen. Eleanor Sobel, D-Hollywood, who has authored legislation since 2011, after a Miami Herald investigation revealed neglect, abuse and death of residents at some ALFs and the state’s regulatory failures.
But critics warned that while HB 1001/SB 382 increases some oversight at the 3,027 ALFs in Florida, the measure also reduces the number of monitoring visits for homes with good reputations, leaving seniors vulnerable when homes falter.
“I don’t want to take anything away from Sen. Sobel’s remarkable accomplishment, who championed safer conditions for residents for four long years, but there are parts of this legislation that will only shrink oversight of those assisted living facilities who care for the most vulnerable ALF residents,’’ said Brian Lee, director of Families for Better Care, an advocacy group.
Under the current law, the state is only required to inspect homes every two years, but the new law subjects them to more frequent inspections if they are found with a major violation. Homes with a good track record, however, will see inspectors only every two years.
The bill clarifies when the Agency for Health Care Administration must revoke a license on a problem ALF, imposes new penalties on homes by charging them $500 for every time they fail to provide background screening of staff, and allows regulators to double fines on homes that fail to correct a serious violation within six months. It also requires increased financial and regulatory disclosure about the homes on the AHCA website.
“It moves us into the 21st century where we have been lacking as a state,’’ said Rep. Larry Ahern, R-Seminole, the House sponsor. “But the only lack in oversight would be at good ALFs. We need to focus on the bad apples because the good ones will take care of themselves — for the most part.”
The Herald’s four-part series, “Neglected to Death,” detailed abuses occurring in ALFs and revealed that the state’s agencies, and in particular the AHCA, which licenses the facilities, failed to enforce existing laws designed to protect ALF residents.
In the wake of the report, Gov. Rick Scott vetoed HB 4045, which reduced regulatory requirements on ALFs, and then formed a task force to examine the regulations and oversight of the industry.
Sobel and Ahern said the bill took so many years to pass because of the diversity of the industry, which includes homes that serve a small number of residents to those that serve hundreds.
The bill imposes a new requirement that homes that serve one or more, rather than three or more, state-supported mental health residents to obtain a specialty mental health license. It clarifies who is responsible for their care and coordination through the local managing entity. And it allows authorized ALF staff members, such as those with nursing training, to perform additional medication-related duties.
Legislators removed two of the most contentious issues sought by Sobel in previous years: a new rating system for all licensed ALFs, similar to the system used for nursing homes, and a change in the way penalties are imposed. Both proposals were strongly opposed by the industry.
The goal of the rating plan was to help consumers pick the best home for their loved ones, but industry operators said that negative comments could unfairly damage their reputations.
Lee, of Families for Better Care, noted that residents who live in these specialty licensed ALFs require multiple services to manage their care and cutting back oversight “would escalate their potential for harm.”
“If the Miami Herald’s investigative series taught us anything, it’s that ALFs need more oversight, not less,” Lee said.
Ahern said the goal of the legislation was to “find a balance” between agency oversight, business interests and patient care.
“We want to focus on the ones that are a detriment to our seniors and either nudge them back to the business model that says these are the standards or maybe they should find something else to do,’’ Ahern said.
Mary Ellen Klas can be reached at meklas@MiamiHerald.com and @MaryEllenKlas on Twitter.