IA

107TH CONGRESS

1ST SESSION H. J. RES. 13

Expressing the sense of Congress regarding the need for a White House

Conference to discuss and develop national recommendations concerning

quality of care in assisted living facilities in the United States.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 7, 2001

Mr. STARK (for himself, Mr. WAXMAN, Mr. COYNE, Mr. FROST, Mr. LANTOS,

Mr. GEORGE MILLER of California, Ms. SCHAKOWSKY, and Mr. STRICKLAND) introduced the following joint resolution; which was referred to the

Committee on Energy and Commerce

JOINT RESOLUTION

Expressing the sense of Congress regarding the need for

a White House Conference to discuss and develop national recommendations concerning quality of care in assisted living facilities in the United States.

Whereas assisted living is a growing and popular long-term

care option for our Nation’s seniors;

Whereas assisted living may be defined as a special combination of housing, supportive services, personalized assistance, and health care designed to respond to the individual needs of a resident who requires help with the activities of daily living in a way that promotes maximum

dignity and independence for the resident;
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Whereas the resident capacity in assisted living facilities is

estimated to range from 800,000 to 1,500,000;

Whereas while over 85 percent of assisted living services are

privately funded, there is a growing trend towards using

public funding, for example the use of Medicaid’s Home

and Community-Based Services waiver increased 29 percent between 1988 and 1999;

Whereas the demand for assisted living facilities is expected

to grow even more rapidly as the projected number of elderly in need of long-term care doubles over the next 20

years;

Whereas while all States have laws and regulations that encompass assisted living facilities, the definition and philosophy of assisted living services varies across the country;

Whereas 21 States do not have a licensing category, law or

regulation that specifically uses the term assisted living;

Whereas assisted living facilities represent many arrangements, ranging from housing residences to facilities that

provide skilled care through contracts with outside licensed entities such as home health agencies, rehabilitation agencies, hospice programs, or other skilled medical

service providers;

Whereas a 1999 General Accounting Office report found that

25 percent of surveyed facilities were cited for five or

more quality of care or consumer protection violations

during 1996 and 1997, and 11 percent were cited for 10

or more problems;

Whereas although assisted living facilities are promoted to

consumers as places for ‘‘aging in place,’’ only 15 States

require resident agreements to describe criteria for ad-
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mission, discharge, or transfer even though assisted living

facilities are promoted to consumers as places for ‘‘aging

in place’’;

Whereas almost half of all States reported that problems with

medications in assisted living facilities occurred frequently or very often;

Whereas in a separate study the Institute of Medicine found

that medication-related errors account for a substantial

number of deaths among inpatients in hospitals;

Whereas States reported that staff quality, sufficient staff,

and inadequate care received the next highest number of

complaints after medication issues, but there is little consistency in regulations of these areas;

Whereas some State laws or regulations specify which and

how many staff must be on duty in assisted living communities at all times, while other States have no such

laws or regulations;

Whereas all States need to enforce sufficient staffing laws or

regulations that provide an adequate level of care to meet

the actual and assessed needs of each resident;

Whereas approximately 20 percent of States do not require

background checks for assisted living facilities and their

employees;

Whereas each State has different regulations and oversight,

leading to unequal quality of care and consumer protections in various regions of the country, for example, in

regulating care in assisted living facilities for Alzheimer’s

disease patients, some States have requirements in the

areas of training, staffing, activities, and environment

while others have no requirements in these areas;
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Whereas not all States extend the long-term care ombudsman’s role to include assisted living residents;

Whereas the Joint Commission on the Accreditation of

Healthcare Organizations (JCAHO) and CARF, the Rehabilitation Accreditation Commission, recently released

assisted living standards, but accreditation is voluntary;

Whereas many lessons have been learned from the development of national nursing home quality standards;

Whereas policymakers, industry stakeholders, and consumers

must work together to strengthen quality and safety

standards in assisted living facilities before abuses, like

those that took place in nursing homes, become commonplace in this newer long-term care setting; and

Whereas a Senate Special Committee on Aging hearing discussed the crucial role of assisted living in long-term

health care, raised concerns about, and challenged the industry to improve, the quality of care and consumer education, and enhance affordability in assisted living facilities: Now, therefore, be it

1 Resolved by the Senate and House of Representatives

2 of the United States of America in Congress assembled,

3 That—

4 (1) the President, in conjunction with the Sec5 retary of Health and Human Services and the Sec6 retary of Housing and Urban Development, should

7 convene a conference to study quality of care issues

8 and develop national recommendations for ensuring

9 consumer protections in assisted living facilities in

10 America;
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1 (2) the Secretary of Health and Human Serv2 ices should issue a report based on the findings of

3 this conference, including recommendations con4 cerning quality of care in assisted living facilities

5 and any gaps in research that should be filled; and

6 (3) this conference should be convened within 1

7 year, and the report based on the conference should

8 be issued in no more than 6 months after the com9 pletion of the conference.

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