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ALFA's take on the assisted living workgroup--and beyond. (Assisted Living Review).

In August 2001, the U.S. Senate Special Committee on Aging ( charged assisted living stakeholders with the development of guidelines for improving quality of assisted living care. These stakeholders--comprising almost 50 groups representing assisted living providers, aging-advocacy and healthcare-related organizations, regulators, and other interested parties--formed the Assisted Living Workgroup (ALW, in response. ALFA has been actively engaged in the ALW from the beginning and felt that this organization offered a historic opportunity to develop progressive, customer-centered recommendations for assisted living. Having recently completed its sessions, the ALW will present its recommendations at a committee hearing later this month.

While ALFA has helped to develop and will continue to support certain recommendations, we came to the conclusion early on that we have a fundamental difference of principle from the ALW's overall approach. In our view, the ALW recommendations, taken as a whole, give insufficient attention to the principles of consumer choice and state flexibility.

The challenges confronting the ALW continue, as evidenced by recent events. Despite almost 18 months of intense discussion, an assisted living definition proposed by the ALW failed to receive the needed votes for final approval during an ALW meeting in February. This uniform definition of assisted living was among the chief priorities given to the ALW by the Senate Special Committee. As of this writing, it appears that there will be no single, uniform definition that all ALW members can agree upon.

Beyond this, although the average assisted living provider may not believe that a report issued by some government-sanctioned group could impact his operations or business, that couldn't be further from the truth. In all likelihood, the ALW report will be widely disseminated to state and federal policymakers and legislators, as well as through the groups represented on the ALW. This report will be touted by some organizations as a national consensus on how states should regulate assisted living.

Imagine, however, trying to run an assisted living residence when you are required to contract with an outside operations consultant and consultant pharmacist. Or be required to have a resident council, even if you have an all-Alzheimer's residence. These are just some of the more than 100 recommendations coming from the ALW. Admittedly, some of these recommendations do fall within the ALW's original mandate, e.g., consumer disclosure and life-safety issues-- attention to which ALFA supports and believes that it's common sense for providers to do so, as well.

That's why ALFA thinks it is important that another vision of assisted living be presented to public officials--one that puts the consumer's perspective directly into the definition of quality. This vision further recognizes that states have the flexibility to decide how best to meet the spirit of appropriate recommendations without being tied to specific ALW-prescribed processes.

ALFA supports a regulatory structure that is state-based. This ensures that assisted living in California, for example, reflects the unique nature of assisted living in that state. A national regulatory scenario, as proposed by the ALW, makes assisted living in California the same as assisted living in Ohio. This removes flexibility and customer choice, the very elements that have helped assisted living to thrive.

ALFA continues to work within the ALW framework to espouse our regulatory approach. Simply put, in most cases, regulations should be based on how satisfied customers (the resident and his or her family) are with assisted living, rather than opting for regulations that mandate a specific process or method.

Customer-satisfaction-based regulations are already advancing in more than 10 states (see sidebar, "Wisconsin's Approach to Customer-Centered Regulations"). ALFA strongly believes that this is the best way to go for both the customer and the assisted living provider. ALFA will tirelessly carry this message to the ALW and to the Senate Special Committee.

In preparation for the final ALW report, ALFA is developing specific positions that we hope will help carry deliberations beyond April. We see an opportunity to ensure quality of care while still focusing on the customer. Fighting regulation is not our mission. Providing for appropriate regulation is our ultimate goal. We are, after all, already regulated in all 50 states. The issue is not whether we should be regulated, but how. And the how will determine the very survival of assisted living and its continued ability to focus on customer needs and preferences.

RELATED ARTICLE: Wisconsin's Approach to Customer-Centered Regulations

A primary concern for state government is how to balance the sometimes-conflicting goals of maximizing consumer independence, choice, and control with the state's responsibility for keeping residents safe from abuse and poor care, while in the process improving the quality of care. Some states have achieved that balance by making significant changes to licensing requirements so that they are more person-centered and outcome-based than typical regulations, without compromising the safeguards designed to protect people.

Family Care ( Wisconsin's redesigned system of long-term care for elderly individuals and individuals with physical or developmental disabilities. The Wisconsin Department of Health and Family Services (DHFS) recently undertook a multiyear initiative to measure and ensure quality in the Family Care program. In the final report of its 2001 assessment, DHFS made the following observation:

Traditional methods of monitoring quality focus on compliance with standard procedures and organizational processes, and emphasize documentation and compliance with regulations. These traditional systems typically depend upon the judgment of professional inspectors. The result is the identification of deficiencies leading to required plans of corrections, and administrative sanctions that may involve threats of loss of funds or fines. In contrast, a focus on assessing consumer outcomes will better enable providers to know and understand their clients as people with goals similar to their own and will provide incentive to adapt services more creatively to the needs of each unique individual. No longer will it be acceptable to provide services that do no more than meet minimum licensure standards; providers will be expected to support the achievement of desired results for the individuals. Knowledge about outcomes enables consumers and their families to reject services that are ineffective, and allows policy m akers to redirect resources to programs that do a better job of improving the health and well-being of their consumers.

Paul R. Willging, PhD, is president/CEO of the Assisted Living Federation of America. For further information, phone (703) 691-8100 or e-mail or visit www.alfa.rog. To comment on this article, send e-mail to
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Author:Willging, Paul R.
Publication:Nursing Homes
Geographic Code:1USA
Date:Apr 1, 2003
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