By Howard Fischer
Capitol Media Services
PHOENIX -- Gov. Katie Hobbs signed sweeping legislation Monday designed to give state health officials more authority to monitor, fine -- and put out of business -- assisted living facilities that endanger patients.
The measure specifically requires the Department of Health Services to establish minimum training standards for those who work with residents with "memory care'' issues. But as HB 2764 developed during the session, it now encompasses the entire long-term care industry, with changes that the governor said will make a significant difference in ensuring that residents not only get the care they need but that facilities that fall short will face substantial penalties.
That, Hobbs said, doesn't exist now.
"There is a dire need for real repercussions,'' the governor said.
"Right now, the maximum penalty for a violation is a $500 fine,'' she said.
HB 2764, crafted by Rep. Tim Dunn, R-Yuma, not only doubles the fine to $1,000 but allows that figure to be assessed for each patient impacted. There also is language allowing additional penalties based on the scope and severity of the violation.
What the bill also will mean is that owners can't escape fines simply by transferring the license to a different legal entity who then has been able to start with a clean slate.
And it closes a loophole in state law which says that operators can keep their perpetual license simply by paying the annual renewal fee. The new law says they can be shuttered for failing to pay fines.
Hobbs said that what's in HB 2764 goes beyond regulation of assisted living homes.
"The problems we've mentioned today aren't limited to just one or two types of facilities and are not unique to long-term care,'' she said. "This bill provides critical reforms for all healthcare institutions.''
What that specifically means, Hobbs said, is giving new tools to the health department to "crack down on fraudulent healthcare facilities which use illicit billing practices to fuel the sober living home crisis.''
There have been numerous incidents where individuals -- many from Native American communities -- are talked into being placed into what are supposed to be residential treatment facilities. But multiple investigations have revealed that the operators simply use their ID to bill the state and federal government for services that are never provided.
"It's critical that those who are suffering with behavioral health issues and with substance abuse issues can seek the help they need in a safe and supportive environment, one that leads them on the path to true recovery,'' said Stephen Roe Lewis, governor of the Gila River Indian Community.
Dunn said what the governor signed Monday has been five years in the making.
He said it started with a special committee created by then-House Speaker Rusty Bowers. The panel then came up with a list of priorities.
But getting them through the process, Dunn said, was not simple.
"We started chipping away at those priorities,'' he said. Some got enacted along the way, like having independent companies do some of the inspections.
Dunn acknowledged, however, much of what has addressed until now was "the low-hanging fruit.'' But he said it did include $300,000 for an audit of Adult Protective Services. And he credited that report with helping focus on what still needed to be done.
He said coming up with comprehensive legislation meant creating an entirely new class of licenses for assisted living facilities that want to provide memory care services, something that has not existed until now.
That specifically empowers the health department to establish minimum training standards for staff and contractors as well as requirements for annual continuing education.
And coming up with a package, Dunn said, required bipartisan cooperation.
He credited the work of former Rep. Jennifer Longdon. And he acknowledged Hobbs including the issue of inadequate oversight in her State of the State address helped bring everything together.
"The timing was right,'' he said.
What also helped drive the issue was the very public push by Cathy McDavid. Her mother, Joann Thompson, a memory care resident of Bethesda Gardens in north Phoenix, was killed three years ago when she was beaten to death by another resident.
McDavid said one of the promises she made at the time was to do her best to promote long-term change. That led her to reach out to a newspaper reporter to share her story and "raise public awareness as well as garner the attention of people with the ability to make things happen.''
"Today, we've done right by improving the quality of life for our loved ones residing in facilities and taking strides to keep them safe,'' she said.
Hobbs, in signing the bill, told McDavid this is for her mother "and all the other Arizonans who deserved better, who went into these facilities seeking help but received excuses and substandard care.''
Still, proponents of change said they did not get everything they wanted.
Dana Kennedy, state director of AARP Arizona, said one thing her organization wanted was video monitoring, a system that would allow relatives to set up a closed feed where they could actually check in on a 24/7 basis to see exactly what is going on in a patient's room.
"I do believe that we need to equip families with the technology to be able to monitor their loved ones in a long-term care facility,'' she said.
Kennedy said she wants a system that facility owners cannot refuse to allow. But participation would be voluntary among families who also would have to pay to set up the equipment and the feed.
She also said there are privacy concerns that could arise if a patient is sharing a room with someone else.
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