Assisted living: a license for flexibility

By Chelsea Wallis
Nov. 14, 2011 – Waterloo-Cedar Falls Courier

(Photo: Chelsea Wallis/MNS)

WASHINGTON — The Dubuque Retirement Community decided it was no longer an assisted living facility under the state definition on Oct. 1, 2009. It voluntarily decertified and has since operated as a residence with home health options, which does not require a license.

It became an uncomfortable anomaly for Iowa state oversight services and other assisted living providers, and it wasn’t the last.

The Iowa Department of Inspections and Appeals, which certifies assisted living programs, keeps a broad definition to encompass what has become a fast-growing business since the 1990s. The facilities often are privately paid for, and services are consumer-driven.

But the push of government oversight and the pull of individualized care are not yet resolved.

Today, Assisted Living Concepts Inc., which operates the Dubuque facility, owns four other businesses that were once certified assisted living facilities in Iowa, but has since decided not to renew the certificates. Assisted Living does own two facilities that are certified.

Assisted Living did not return requests for comment. The company website states its philosophy: “To enhance our residents’ quality of life by creating a home-like setting that fosters independence, dignity and choice.”

At the time the company voluntarily decertified its Dubuque facility, it had eight fines between February 2008 and July 2009 as a result of state monitoring and complaint tracking. In August 2009, a state report revealed 17 instances of incorrectly reported medication doses or treatments over a nine-day period.

Assisted Living now operates rentals that offer independently certified home health services.

“I have a problem when a business starts out as one thing and becomes another just to circumvent the survey and inspection process,” said Kris Hansen, CEO of the nonprofit assisted living provider Western Home Communities in Cedar Falls. “Housing plus services is not an assisted living facility.”

The Department of Inspections and Appeals doesn’t know why Assisted Living decided to decertify, spokeswoman Ann Martin said. Resident complaints must now be taken up with the company unless there is a serious medical violation that could prompt state investigations.

“I don’t think it’s a trend,” Martin said, but it was a minor worry for a time. “Most facilities in this state want to do things right,” she said. “They believe in this process.”

“I think the state is doing a great job handling assisted living,” said Hansen.

There is still room for debate on the state definition.

When it comes to long-term care, Martin believes more oversight creates a safer environment. Assisted living “is a model that can’t retain the frailest of the frail,” she said, “and we watch for that.”

But Hansen doesn’t know if the line between assisted living and nursing homes is necessary, depending on the quality of the facilities. “If that assisted living program is well staffed and the resident wants to stay in that home,” he said, “it’s tough to force them to leave.”

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