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NJ Pioneers New Standard for Assisted-Living Facilities

Health Department partners with long-term care industry to set higher benchmark for quality.

Since 1993, New Jersey has licensed and regulated assisted living facilities whose senior citizen residents need help with many of the routines of daily life, such as mobility, housekeeping, and meals but who don’t generally need round-the-clock nursing care. Today about 17,000 elderly New Jerseyans live in 215 assisted-living facilities inspected by the state Department of Health and Senior Services for compliance with state regulations on health and safety, employee credentials, and staffing adequacy.

But Health Commissioner Mary O’Dowd said a state license merely tells the public that a facility meets minimum state standards. Now, in what she said is a first for the nation, New Jersey is partnering with the long-term care industry to promote new and higher quality standards that will single out facilities reaching for a higher bar than what is required to get and keep a state license.

Called “Advanced Standing,” this new benchmarking process is designed to elevate quality at assisted living facilities, O’Dowd said. When the four-year pilot launches in July, individuals considering moving to an assisted living facility, and their families, will be able to go the state Department of Health and Senior Services website and start to see facilities that have achieved Advanced Standing. Forty facilities have already expressed interest in participating, and it is expected that number will grow as the program gets underway.

The benchmarks that facilities must hit for Advanced Standing status are now being developed by a peer review panel, whose members include representatives of the state’s health department and the foundation of the Health Care Association of New Jersey, the trade association for nursing homes and assisted living facilities. The foundation will implement Advanced Standing. It will hire inspectors who will visit assisted living facilities and determine their eligibility. The peer review panel includes James McCracken, the New Jersey ombudsman for the Institutionalized Elderly, whose staff investigates complaints of abuse and neglect at long-term care facilities.

More than a year ago, the Health Care Association proposed creating Advanced Standing as a public private partnership with the state’s Health and Senior Services agency. O’Dowd commended the industry for taking a proactive push for higher quality standards. She unveiled the program Friday at a press conference at Brandywine Senior Living in Princeton Borough.

State Sen. Joseph F. Vitale (D-Middlesex), chairman of the Senate’s health committee, commended the efforts for Advanced Standing. While the health department’s oversight of assisted living and other healthcare facilities will remain critical, “pursuing the kind of quality they are talking about is admirable and necessary,” he said. “This is a population that we need to show this kind of respect for. These are senior citizens who have raised families, and served their country, and they deserve our respect and attention.”

O’Dowd praised Paul Langevin, president of the Health Care Association, for spearheading a quality standard that not all of his members, at least initially, are likely to meet. The association “represents those who will have this [Advanced Standing] designation and those who will not -- so not everybody is going to be especially happy with this program,” she said.

O’Dowd said her department will continue to oversee the assisted living industry, and facilities will need her department’s approval to be eligible to participation in the Advanced Standing review.

“There are going to be facilities that don’t have high enough standards even to get Department of Health permission to enroll in the program and be reviewed,” Langevin said. “There is going to be a certain subset, very small, that for whatever reason [the health department] will say ‘we’ll keep looking at them this year.’ That provides an incentive, the carrot to get better.”

Advanced Standings benchmarks will go beyond government health and safety licensing regulations, and furnish the sort of information consumers are looking for when they are trying to decide which assisted living facilities are engaged in a pursuit of excellence -- and which ones are merely complying with state law, experts said.

Under state license regulations “there is no requirement to do customer satisfaction surveys, to monitor employee turnover -- but those things are clear indicators of whether a facility is a high quality provider,” Langevin said. As the peer review panel establishes benchmarks for Advanced Standing, it will look to the quality benchmarks advocated by the National Center for Assisted Living. That group advocates facilities have both a residents’ council and a family council; a safety committee; tracking and reporting of incidents; mentoring of staff and exit interviews of those who leave; and a strategic plan and a mission statement that is communicated to the staff and the residents.

Advanced Standing is voluntary, O’Dowd said. “So that tells you that this provider has taken the effort and spent the money to invest in improving the standards of care they provide.” While her department will continue to oversee the Advanced Standing facilities, those that achieve Advanced Standing status won’t be inspected as often by her department, which now reviews the facilities annually.

The foundation of the Health Care Association will inspect facilities for Advanced Standing designation, “and we will audit their inspectors,” O’Dowd said. “The health department will come in unannounced and ensure that the inspection process is a valuable one and is a quality process.” The health department has a similar inspection relationship with the federal Centers for Medicare and Medicaid Services (CMS). O’Dowd said the state is designated by CMS to inspect nursing homes, and the department’s work is monitored by CMS inspectors. The Advanced Standing facilities “will be inspected more often but not necessarily by the state.”

Assisted living facilities that want to enroll in the Advanced Standing program will pay a fee, not yet determined to the foundation of the Health Care Association, which will hire staff to inspect Advanced Standing facilities. An assisted living facility does not have to be a member of the Health Care Association to sign up for Advanced Standing. All such facilities are eligible and those who enroll will still be required to pay health department fees: $1,500 for a license application or renewal; $15 per licensed bed annually, and a bi-annual inspection fee of $1,500.

Most residential long-term care is provided to seniors living in nursing homes. Langevin said New Jersey has about 40,000 nursing home residents, and for the majority of them, or about 29,000, the cost is paid either by Medicaid or Medicare.

But most of the 17,000 assisted living residents are not eligible for Medicaid or Medicare because they do not meet the federal government’s medical need standard for placement in a nursing home, Langevin said. About 14,000 of New Jersey’s assisted living residents are “private pay” consumers who are paying their own assisted living bills, which can range from $3,000 to $6,000 a month, depending on how much care the individual requires.

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