Question of the Month: Government Regulation

Do you expect government regulation to increase for assisted living? What regulations are you planning for?

Work closely with regulators
By Tom Grape
Benchmark Senior Living
Assisted living has been overseen mostly by state regulators since its inception back in the 1980s. This approach has allowed for diverse approaches to how services are provided and how we are regulated.
Meanwhile, our residents move in with more complicated needs than they did 30 years ago.
An advantage of state oversight is that it allows assisted living providers to work proactively with regulators to meet residents’ needs while taking advantage of the variety of innovations available today. We should also continue enhancing quality improvement standards espoused by our national trade association, Argentum, so that federal regulation is unnecessary.

Regulations can bring value
By James Balda
President & CEO
I expect regulations at the state level to increase, mostly centered on issues related to resident safety. We are pleased to see a number of state senior living organizations actively focusing on these issues, which include enhanced employee screening and training, and emergency preparedness measures.
As we advocate for additional services to be made available to seniors in assisted living and memory care residences, we understand and embrace the increased regulatory oversight that comes with these services so our residents can receive what they need where they choose to live.

Laws in some areas are woefully inadequate
By Joel Goldman
Hanson Bridgett
Increased regulation of assisted living is inevitable as “acuity creep” continues. I expect to see a focus on specific staffing requirements/ratios as many states now require only “adequate staff to meet resident needs.”
I anticipate more regulation pertaining to emergency response/evacuation in light of recent natural disasters. I also anticipate regulation pertaining to new technologies as regulators try to balance resident privacy with safety and security considerations.
Finally, I hope that we will see thoughtful legislation or regulation pertaining to sexual activity among dementia residents, as current laws are woefully inadequate.

Most occurs at state level
By David Schless
Given that the current administration is focused on regulatory rollback, I don’t believe there is a direct threat of federal regulation for the assisted living industry at this time.
For operators who choose to participate in federal programs such as Medicaid and HUD housing subsidy programs, rules changes and general oversight are the norm and will continue. New expansions in Medicare Advantage plans may offer new assisted living benefits. For those who choose to pursue those benefits, they will also come with federal oversight.
Most regulation occurs at the state level. While there is much activity to increase regulatory requirements, the key areas of focus remain in the areas of staffing, medication management and dementia care.

Factor it into financial decisions
By Brian Beckwith
Formation Capital
Today’s assisted living is becoming more and more similar to yesterday’s skilled nursing. With shifting acuity and more of a focus on quality and outcomes, we expect the evolution of regulations to follow.
All 50 states have individual regulations for this industry, and we have already seen many of the state agencies implement various changes in the rules governing the operation of assisted living.
Our strategy is to expand the focus of our clinical advisory team, Formation Healthcare Group, to develop tools to help us thoroughly understand the regulations through a dynamic state regulatory database. We use this tool in our diligence and monitoring efforts, and focus our investments on areas where a more acute level of service and regulation can be improved or managed well.