Florida lawmakers support tougher oversight of assisted-living facilities

Just months after Florida lawmakers tried to strip away crucial protections for residents of assisted-living facilities, legislators are now radically reversing course in what could lead to the biggest changes in state law in a generation.

After months of devastating reports of elders dying at the hands of caretakers, lawmakers are considering changes to ramp up fines, increase credentials of people running ALFs and give more power to the state to shut down dangerous facilities.

“If you see abuse and you don’t report it, you lose your license, you’re out of business,” said Sen. Don Gaetz R-Destin.

A meeting of the Senate’s Health Regulation and Children, Families and Elder Affairs committees on Thursday was the first legislative event to address serious breakdowns in the state’s oversight system that allowed dozens of troubled ALFs to stay open, despite a rising number of abuse and neglect cases across the state.

The hearing was held just months after some of the same lawmakers pushed 23 bills in the past session calling for removing key regulations — including portions of the residents’ bill of rights.

Most of those bills died days after a Miami Herald series was published in May revealing that while residents were dying of abuse and neglect almost once a month, most of the homes were allowed to keep their doors open.

By the close of Thursday’s meeting, senators were calling for tougher sanctions.

“There’s a time when you lean toward more regulation, and that’s when you have problems that affect people’s lives and health,” said Gaetz.

At one point, Randolph Gray, a resident of Madison County, appeared before the panel, recounting how his father died after a caregiver ignored dietary instructions at a nursing home, and his mother died after choking on her failed feeding tube at her nursing home. His mother cried for help but no one came, Gray said.

“I’m compelled to be here today to speak because my parents can never be brought back. We can do more to save those parents who are still here,” said Gray, who asked that video monitors be placed in all ALF rooms.

Several lawmakers said part of the problem is that oversight of ALFs — now the primary residences of more than 80,000 people across the state — is scattered among four primary agencies — the Agency for Health Care Administration and the departments of Health, Elder Affairs and Children & Families.

“I think that’s why we’ve gotten so many of the troubles that we’ve gotten,” said Sen. Rene Garcia, R-Miami, chairman of the Health Regulation Committee, who pushed legislation earlier this year that would have done away with key regulations.

Senators favored tasking AHCA with overseeing a database that would keep tabs on all complaints, record violations and responses — even those going to the Department of Children & Families. The agency is already in charge of licensing and inspections — and imposing punishment.

Increased responsibility creates a need for more money: AHCA’s budget for inspections has been underfunded for years. In the 2009-10 fiscal year, it faced a $4.3 million shortfall.

Some senators said they favor higher penalties — and an escalating scale of fines for repeat offenders — to bring in more money to pay for inspections. They opposed raising licensing fees across the board, saying it would hurt providers with clean records.

“I don’t think the way to do it is on the backs of the people who are having a low reimbursement,” said Sen. Nan Rich, D-Weston

In another shift from the Legislature’s recent preference for deregulation, senators balked at a proposal to privatize the state’s inspection program to cut costs.

The Herald found that AHCA had been dropping inspections by 33 percent over the past five years, even as the number of abuse and neglect cases was rising.

“I think that is definitely the wrong road to go down,” said Sen. Audrey Gibson, D-Jacksonville. “There’s enough trouble in the way things are going now to add that to the mix.”

Rich said she and Sen. Ronda Storms, R-Brandon, chair of the Children, Families and Elder Affairs Committee, want an online rating system in their committee bill so consumers can get quick reads of facilities in their area — much like a star system.

She also wants to raise the level of experience and education required to become an ALF administrator. The requirements are now among the lowest in the nation: 26 hours of training and a high school diploma.

While some senators said AHCA should take the lead in oversight, the agency is the sole regulator under state law — and has been since the 1990s. Over the past five years, The Herald found AHCA failed to impose sanctions in dozens of cases while allowing repeat violators to stay in business. For instance, it could have pushed to shut down 70 homes in 2008 and 2009, but closed just seven.

“That’s why we’re in the position we’re in,” said Brian Lee, past director of the state Elder Affairs ombudsman program, after the meeting. “All the other agencies have always deferred to AHCA.”

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