No person or organization is perfect, but providers of healthcare and eldercare have a sacred obligation and are held to the highest standards. Because patients and residents very lives are at stake, providers must strive for perfection with a comprehensive set of processes, protocols and standards to keep residents safe and mistakes at the barest minimum. Rules and regulations violations are seen by the senior living field as shameful aberrations that must be immediately and effectively identified and rectified rather than just a part of doing business, as may be the case in industries where the stakes are not so high.
The Assisted Living Federation of America (ALFA) released its 2012 Top Ten Deficiencies report which outlines the most the regulations that assisted living communities most commonly violate. The report, which ALFA publishes annually, is designed to help its members (assisted living communities across the country) understand aspects of their operations that may need special attention.
The Good News
The good news is that the report found, fortunately, that issues of abuse and neglect were the least common of all assisted living violations, and abuse and neglect is is not among the most top ten issues in any state. That said, any instance of elder abuse or neglect is unacceptable and contemptible, and no one in the assisted living industry will be wholly satisfied until there is a 0.00% rate of abuse and neglect violations at senior care facilities.
The Bad News: Top 10 Violations
Here is a ranked list of the rules and regulations that assisted living communities across America violate most:
1. Medication Administration
Violations involving medication were the most frequent of all. Examples of such violations include failing to dispose of expired medications or neglecting to order refills for patients in a timely manner. More serious medication administration violations, such as mistakenly giving residents the wrong medication, are much rarer.
2. Resident Administration Requirements
These violations involve communities failing to follow proper protocol for the admission of residents. Examples could include residents admitted without a proper evaluations or needs assessment, residents admitted without a tuberculosis check or required vaccinations, or residents admitted without necessary documentation.
3. Ongoing Resident Assessment
While specifics vary state by state, assisted living facilities are required to reassess resident’s well-being and care needs periodically, and update their care plans. Failure to follow protocol for going ongoing resident reassessments was the third most common issue at assisted living communities nationwide.
4. Maintenance and Building Code
Violations involving building code was the fourth most commonly cited issue. This could include issues ranging from cleanliness, placement of furniture, lighting levels, to a leaky roof.
5. Staff Training
Assisted living communities staff not only must be trained before they can begin working, there are are also ongoing training requirements in most states. Failure to ensure that staff are trained, and that their training is documented, will result in a violation.
6. Resident Care
ALFA’s report noted that this category includes violations involving all aspects of resident care, and it’s alarming that this made the top violation list. Examples of improper resident care could include an instance where a resident was not assisted in a timely manner after ringing for help, not adhering to a resident’s care plan (i.e. resident’s teeth not brushed daily by staff when that’s listed as a requirement in care plan), or not changing the soiled undergarment of an incontinent resident in a timely manner. ALFA’s report does not outline which violations involving resident care are most common, but it’s to be hoped that egregious violations are very rare.
7. Emergency Preparedness
Assisted living communities are held to high standards in terms of emergency preparedness because their residents would be very vulnerable in emergencies such as fires, earthquakes, tornadoes or hurricanes because of frail health and limited mobility. Communities that don’t have adequate plans, do not conduct routine drills, or which have failed to document their plans and drills, are cited for violations. We’re proud to say that our partner communities did very well during Hurricane Sandy, and were not only able to keep all their residents safe, but many were even able to shelter displaced elderly people from the public at no cost.
8. Food Service
This category includes violations involving the handling or storage of food and meals, and their service. They can also include violations involving menu requirements. For example, a community that serves a meal that varies from the daily menu, or that does not offer an alternate entre, could also be cited for a violation.
9. Staff Health
These violations include failure to ensure or document that their staff members have been tested for contagious illnesses illnesses such as tuberculosis and others.
10. Administrative Record Keeping
These are violations that involve paperwork but don’t fall into any other category, and that do not risk resident health or safety.
The assisted living industry is to be commended for it’s efforts to achieve and maintain excellence by taking an honest look at areas where it needs to improve.
On our state pages we list a summary of the state’s assisted living laws (they vary greatly by state). We invite you to review your state’s assisted living laws.
We welcome your comments below.
