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Home care overhaul is coming Assisted-living site monitoring to change


Moving to protect the state's burgeoning elderly population, Maryland officials are about to overhaul the way they monitor thousands of assisted-living homes, the fastest growing type of long-term care.

The plan, unveiled last week, is intended to sew up gaping loopholes and replace a patchwork of contradictory regulations that the state has used up to now.

"In some places we've gone in and found very, very ill people, and we've had to intervene or move them to a hospital," said Carol Benner, director of licensing and certification for the state Department of Health and Mental Hygiene.

"It will still happen, but with these regs it will happen less often."

The proposed rules would affect places such as MontClaire Manor, a tidy brick ranch house in a subdivision in southern Howard County that is home to 92-year-old Concetta Diemidio and six other elderly women.

Diemidio does not need nursing care. She gets around fine with help from her cane, entertains visitors with the simple Italian love songs she learned as a child, and still fondly describes her mother's stew recipes. She moved to MontClaire Manor in 1991 after her family realized she could no longer manage her own cooking or bill-paying.

With a small staff handling their day-to-day needs, the housemates share stories and baby pictures of great-grandchildren, enjoy cookouts on the deck and the bounty of the backyard vegetable garden.

The freedom and unregimented style at such homes -- and their cost, about $1,200 a month, less than half that of nursing homes -- explains much of their appeal. In the past few years, about 8,000 seniors in Maryland have opted for such arrangements, at least doubling the state's number of assisted-living homes to about 5,000.

By 2005, the senior population in Maryland is expected to increase by 120,000, to 890,000, and the number of homes could double again.

The rapid growth of assisted-living homes outpaced the state's ability to monitor them sufficiently, health officials say. Further complicating the state's oversight was the variety of homes in operation.

Some, like MontClaire, help seniors with basic, day-to-day tasks. But an assisted-living home might also care for someone temporarily in a wheelchair, give round-the-clock oversight to residents with Alzheimer's disease or provide more complex medical care requiring a nurse. A home can serve one resident or several hundred, poor or affluent.

Under existing regulations, homes could apply to the Department of Health and Mental Hygiene, the Office on Aging or the Department of Human Resources. But those agencies often contradict each other on details from minimum room size to pantry requirements.

The new plan would shift responsibility for regulatory oversight to a single agency -- the health department -- which would also become a clearinghouse of information for consumers and homes.

Monitoring duties would still be shared with the other two agencies.

"One of the things you don't do is stay back where you were stuck," said the state secretary of health, Dr. Martin P. Wasserman. "We had to let go and rebuild."

The proposed regulations aim to prevent the opening of homes such as the former Lin & Lyn Shelter Home, a Baltimore facility shut down by the state in 1993. As a small home that cared for only five residents, it was permitted by existing law to obtain a permit without an inspection.

Four months after its opening, state health officials received complaints and discovered that three teen-agers had been left in charge. The home had no telephone.

The residents -- including a double amputee in a wheelchair -- reported being locked inside the house unattended for long periods. On one visit, breakfast was served at 1 p.m. and consisted of an egg. Lunch, served at 3 p.m., was spaghetti with meat sauce and a cinnamon roll.

Still being fine-tuned, the proposed rules were initiated by a governor's task force and a directive last year from the General Assembly. New regulations must be in place by October. A final draft, which is not due until June, must be approved by Wasserman and a legislative review committee.

Key requirements include:

A written agreement between the resident and home outlining costs and services to be received.

Detailed "Resident Rights" on such issues as privacy, confidentiality and visits.

Training for anyone who administers or helps administer medication.

Frequent re-evaluations to determine whether a resident's condition has changed sufficiently to require more care.

The plan calls for regular inspections and sets minimum standards for beds, furniture, bathrooms, telephone service and access to writing and mailing materials.

Patients needing certain levels of medical assistance -- including those requiring a ventilator or intravenous therapies -- would be ineligible for admission.

An emergency plan for transferring patients is also among the requirements, aimed at preventing chaos such as that accompanying the failure of Pimlico Elder Care in 1989.

When the Baltimore home's owner abruptly announced that financial problems were forcing him to close, health department workers scrambled to find new lodging for the home's 43 residents.

Scores of health officials and home operators have gone through more than a dozen drafts of the plan since last fall. Now comes a summer of public feedback and final tinkering.

While home managers agree that the regulations create many common-sense improvements that would better protect residents, some worry about the increased costs and whether smaller homes can survive them.

One provision would require a nurse to visit every 45 days to reassess homes where caregivers administer medication. That alone would cost at least $300 per visit, said Claire Nolan, who runs MontClaire Manor. All her residents live on limited incomes, and Nolan recoils at the idea of increasing their rates.

"I don't know where we'll find the money; I might have to lay off one person," said Nolan, who employs two helpers. "And where are these women going to go if they phase out homes like ours?"

Isabella Firth, president of the Maryland Association of Non-profit Homes for the Aging, shares those worries. But she and others say it's difficult to assess the extra cost to the homes or the state.

"It's a concern I've had all through this process -- how will the state balance the need to protect consumers with how much it will ultimately cost the state?" she said.

Benner, of the state health department, said the committees drafting the regulations pointedly ignored nursing home regulations.

"If we were to impose a lot of those similar regulations in assisted living, we would close people out," Benner said. "We require an evacuation plan and drills, but we're not saying you have to have heavy-duty sprinklers or 8-foot-wide corridors.

"There are going to be some people who are scared," Benner said of the proposed regulations. "There will always be a tension between the folks who are to be regulated and the regulators. But in general, I don't think there's going to be a huge problem."

Pub Date: 4/20/97

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