Arizona legislators call for more transparency, improved safety in assisted living

Arizona has joined a growing list of states where governments are calling for more transparency from assisted living communities through legislation following local media reports questioning resident safety in the setting.

HB 2653, introduced last week in the Arizona Legislature, would require assisted living communities to report resident injuries to the Arizona Department of Health Services and to families, allow cameras in common areas and in resident rooms, and forbid communities from hiring employees who have a history of abuse, neglect or exploitation of a vulnerable adult.

Arizona LeadingAge CEO Jaime L. Roberts said that she supports legislation aimed at safeguarding the well-being of older adults but that she has concerns about HB 2653, which drew inspiration from prior legislation that permitted the monitoring of facilities serving people living with intellectual disabilities. 

Roberts proposed a “thoughtful reconsideration” of several provisions in the bill to “strike a balance between ensuring safety and preserving the privacy and autonomy of assisted living residents.”

She said that it is “crucial” to acknowledge the “distinctive nature” of assisted living communitie that are homes for older adults.

“Residents and their families choose these environments for their residential feel, steering away from institutional settings,” Roberts told McKnight’s Senior Living. “Many of these seniors actively engage in the community, exercising their right to vote, and may only require minimal assistance. It is paramount to recognize and respect the right to privacy for seniors, their visitors and the dedicated staff within these facilities.”

A provision of the bill allowing residents or families to install electronic monitoring devices in rooms raises concerns about the potential effect on the privacy of roommates, visitors, other residents and staff members, Arizona Health Care Association Executive Director David Voepel said. 

As of 2021, at least nine states had laws mandating that assisted living communities accommodate resident requests to install electronic monitoring equipment in their rooms: Connecticut, Minnesota, Missouri, North Dakota, Oklahoma, South Dakota, Texas and Utah. New Jersey also has a “Safe Care Cam” program that loans micro-surveillance equipment to healthcare consumers, including families of assisted living and nursing home residents.

Overall, Voepel said, his organization is open to more transparency.

“The camera legislation doesn’t go near far enough legislatively to protect residents and roommate privacy and leaves too much to the rules process,” he told McKnight’s Senior Living. “If we’re going to do something, we should have comprehensive language that takes the guesswork out of the rules process.”

He said other states have good language in place that is working, including Iowa, which is considering a law for nursing homes.

Roberts also addressed requirements for reporting any serious injury, medical issue or fall by a resident.

“While we understand the importance of such reporting, it’s worth noting that assisted living facilities and skilled nursing facilities are already subject to similar obligations,” she said. “The interpretation of terms like ‘fall’ could introduce complexities, making compliance potentially burdensome.”

Voepel addressed a requirement under the bill mandating that employers verify that employees or potential employees are not on the Adult Protective Services registry for past incidents of elder abuse.

The Arizona Health Care Association shares best practices with its members, including those related to looking up potential employees on the APS list, and will continue to work with the governor’s office and the bill’s sponsors to suggest changes, he said.

The Arizona Assisted Living Homes Association, which represents 1,585 smaller residential assisted living home locations, raised concerns about how the proposed legislation may impact current licensees and the privacy of individual residents.

“We recognize that the proposed legislation introduces requirements that are intended to help protect residents, and AALHA applauds that goal, but it should be balanced with the interests of small business owners,” AALHA President Annette Quinata, MSG, told McKnight’s Senior Living. “Owners of facilities licensed for 10 or fewer residents do not have access to the same level of resources as large centers, and already have to comply with extensive regulations in order to operate a licensed assisted living home.”

The Alzheimer’s Association Arizona chapter also put forth a proposal to address memory care minimum training standards, which is something the AALHA supports, as approximately 15% of older Arizona residents have Alzheimer’s disease or related dementia diagnoses.

“A large majority of residential assisted living homes are licensed for directed care services,” Quinata said. “As an organization, we are in support of additional training for managers and employees. More training is important as it helps to prevent abuse and neglect.”

Push for more regulation

Arizona Gov. Katie Hobbs (D) also announced during her recent State of the State address her plan to advocate for a package of bills to ensure that long-term care facilities “cannot hide or erase their violation history,” increase fines, standardize inspections, and establish standardized credentials for Alzheimer’s, dementia and memory care.

The focus on long-term care, including assisted living, comes after several high-profile death and abuse cases were highlighted in the Arizona Republic’s investigative series “The Bitter End,” which chronicled resident injuries, care issues and sexual assaults in assisted living communities and nursing homes.

Sen. Mark Kelly (D-AZ) raised the issue of safety and transparency concerns at Arizona assisted living communities during a US Senate Special Committee on Aging hearing last week that focused on safety, staffing and pricing in assisted living. Kelly also mentioned the Arizona Republic series and the “horrifying” stories it shared.

The national Alzheimer’s Association submitted comments for the record of the hearing, calling for federal involvement to increase the dementia care workforce and training in assisted living, and it also urged the Aging Committee to take steps to support states in implementing and improving dementia training for direct care and other workers in assisted living communities.

AARP Arizona Director of Advocacy Brendon Blake said that his organization planned to push for enhanced regulation of assisted living communities and nursing homes in the state. He said that the organization will advocate for increased fines and measures to ensure that staff members are trained, that substandard care is reported and that medication administration is improved.

“It’s kind of the Wild West,” Blake said in a statement. “Our system is weak when it comes to punishing bad actors.”

The National Center for Assisted Living’s 2023 edition of its “Assisted Living State Regulatory Review” report noted that 20 states updated assisted living regulations, statutes and policies in the past year.