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REPORT: Best Practices in Assisted Living Examined to Inform Recommendations for California

March 6, 2014

A new report by the National Senior Citizens Law Center (NSCLC) examines California’s assisted living law and compares it with assisted living laws in 11 states.

The survey and analysis are being used to make long overdue recommendations for reforming California’s law based on best practices in the other states.

The authors call on California to update its assisted living law — enacted in 1985 and amended just intermittently since — to reflect the reality of assisted living facilities today: residents have significant care needs.

The report, Best Practices in Assisted Living: Considering Potential Reforms for California, includes recommendations that pertain specifically to direct-care workers employed at assisted living facilities, particularly in regard to training and care standards for medication administration and dementia care.

NSCLC researchers Eric Carlson and Gwen Orlowski looked at whether states had minimum standards for initial training hours as well as hourly standards for continuing education. They also analyzed several training elements, such as whether the state had:

  • CPR and/or First Aid requirements
  • a state-developed curriculum
  • requirements by law to cover certain topics
  • exam requirements
  • trainer standards set by law

The researchers found that of the 11 states surveyed, Connecticut and Washington required the most initial training hours (75) and 5 states had no requirements. They recommend that California significantly increase its minimum initial training standard for direct-care staff from the current minimum of 10 hours.

California and six surveyed states have minimum hourly continuing education requirements for direct-care workers, the analysis found. Washington requires the maximum number of hours (15) but five of the surveyed states have no such requirements.

Regarding medication administration, the analysis found:

  • California and all 11 states permit staff to provide residents with assistance with self-administration of medications.
  • Only four states (Kansas, Oregon, Pennsylvania, and Washington) permit trained facility staff, including direct-care workers, to administer medications.
  • Eight of the 11 states reference medication administration by a nurse, although most assisted living facilities, especially the smaller ones, do not have nurses on staff.

Explaining that many residents are being administered medication by staff with limited training under the pretense that they are merely assisting with self-administration, the researchers recommend that California “establish a regulatory framework for medication administration that properly and honestly balances required expertise and supervision with the setting’s practical realities.”

For dementia care, the researchers recommend that California’s training standards be raised to increase the expertise of direct-care staff. In addition, the report recommends that nurses and other “relevant professionals” be more involved in coordinating and providing care for residents with dementia as well as in training and supervising direct-care staff.

“California lags far behind other states in responding to the needs of today’s assisted living residents,” NSCLC Directing Attorney Eric Carlson testified on February 12 at a Joint Oversight Hearing of the California Senate and Assembly Human Service Committee, the organization’s press release states. He recommends that California adopt new standards to address problems outlined in the NSCLC report.

— by Deane Beebe

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