TALLAHASSEE -- Legislative leaders identified reform of Florida’s assisted-living facilities as one of their top goals this session, but once again lawmakers did not adopt measures to improve conditions in the 3,048 facilities around the state.
It is the third year the Legislature has not passed reforms proposed after a 2011 Miami Herald investigation that revealed the neglect, abuse and death of residents at some in ALFs.
The most recent Senate and House proposals fell apart in the final days when the House attached other health care related bills to the Senate’s ALF bill and they couldn’t resolve their differences.
“We still have the same antiquated, dangerous system that was in place when the Miami Herald wrote its series,” said Brian Lee, executive director of Families for Better Care. The state “has not fixed the abuse and neglect, and residents are still in trouble.”
Getting rid of the “bad apples” in the ALF industry and adding more oversight affects not only the elderly who live in facilities that can house a total of more than 80,000 residents, but also Florida’s economy and future generations, said Jack McRay, advocacy manager for AARP Florida.
“Florida seniors pay more in taxes than they get back in services,” McRay said. “It’s essential that they are able to remain and stay in Florida... We need to get it right.”
What happened this session “is a classic example of politics again trumping policy,” McRay said. “It became part of a healthcare ‘train’ that became a train wreck.”
The Senate unanimously passed SB 248 early in the session. The House passed its version, HB 573, at the end of April. While House Speaker Will Weatherford and Senate President Don Gaetz identified ALF reform as one of their session goals in their “Work Plan 2014” program, it failed to make any progress.
Gaetz blames the House, and the ALF industry, for the bill’s demise.
“It wasn’t the trains that killed the bill. It was the House that killed the bill,’’ he told the Herald/Times. “Speaker Weatherford gave me his commitment they would try to do this. The ALF industry lobbied very hard against reforms. They lost a lot of credibility. It’s a real shame.”
He said that when the House bill began to be “picked apart” in that chamber, he urged the Senate prime sponsor, Sen. Eleanoer Sobel, D-Hollywood, to start attaching it to several high priority House bills. In retaliation, the House attached language to the ALF bill that the Senate didn’t want -- language about surgery centers and visitation rights for grandparents.
“Healthcare is a complex issue, and we just weren’t able to get agreement between the two chambers,” Weatherford said after the session ended May 2.
Gaetz said he vowed to be Sobel’s first co-sponsor and will work to pass the bill next year.
"Frankly,’’ he said. “Those of us who support her efforts need a little bit more enthusiastic help.”
Sobel and House sponsor, Rep. Larry Ahern, R-Seminole, both vowed to renew their efforts next session.
"I’m very disappointed,” said Sobel, who also blamed “special interests” for the bill’s failure. “I believe we were very close and got further than we have in previous years,” she said.
Ahern said the important thing for next year “is to agree on something the first month of session and get this done early.”
Among the provisions, the ALF bill would have required facilities with one or more, rather than three or more, state-supported mental health residents obtain a limited mental health license; authorized ALF staff members, with increased training, to perform additional medication-related duties; and to assist with the self-administration of medication with increased training.
The most contentious issue was a new rating system for all licensed ALFs, similar to the system used for nursing homes. It would help consumers pick the best home for their loved ones. Family members often find themselves in a quandary when the hospital discharges a patient who cannot go home, McRay said.
“The consumer doesn’t know where to go or which ALFs are good and which are bad. A rating system has worked very well with nursing homes.”
The idea of a ratings system rankled the ALF industry. One industry group, the Florida Assisted Living Association (FALA), raised objections that people could post anonymous, possibly damaging comments on a website that would be managed by the state’s Agency for Health Care Administration.
The ratings system, along with a change in the fine structure that FALA said could affect smaller homes, were among the group’s key objections, said Shaddrick Haston, its CEO, but he contends that members were not trying to sabotage the bill.
“Actually, most of the bill had great things to help residents age in place,” said Haston, who is AHCA’s former head of licensing for assisted-living facilities. “The industry wanted an ALF bill this year.”
One concern of Lee's, director of Families for Better Care, was a change that would reduce monitoring visits for homes that met certain criteria. Even a home that has had a good reputation can falter, he said.
In the fall, he noted, the state fined the Royal Palm Retirement Centre, an ALF in Port Charlotte, $22,500 for several violations found during a visit. AHCA’s inspection report noted that among resident-care problems, the facility “failed to provide adequate nursing supervision in providing care for four insulin-dependent diabetic residents.”
AHCA, Lee said, “needs to put more boots on the ground in ALFs, not fewer.”
Herald/Times staff writer Mary Ellen Klas contributed to this report. Contact Rochelle Koff at [email protected]