Wednesday, May 23, 2018
Health

ALF reform may be in jeopardy

TALLAHASSEE — After years of people dying of abuse in Florida's assisted living facilities, lawmakers this year unveiled some of the toughest legislation in the nation to protect residents and punish the worst abusers.

But with just about a week left in the legislative session, major proposals to shut down dangerous homes, investigate deaths and dramatically raise credentials of caregivers will now require the Senate's most powerful leaders to save it. The 60-day session ends next Friday.

A Senate bill hailed by advocates as one of the most comprehensive in a generation was never heard in the overbooked budget subcommittee on Tuesday — a decision that can lead to the death sentence. Two other ALF reform bills also stalled.

With committee hearings now ended, efforts to bring the bills to a vote will require top lawmakers leaders to step in and steer it to the floor for final passage.

"It would certainly be disappointing if the Senate were to fail and not get something useful passed out of this session," said Larry Polivka, who is leading a governor's task force investigating problems in ALFs. "Why not at least complete what they have developed at this point?"

The impasse comes after a year of scrutiny of the state's troubled ALF industry that began in May with a Miami Herald series showing dozens of people dying of abuse and neglect in facilities — nearly once a month since 2002 — but regulators failed to close the homes.

Months later, a legislative inquiry and a Miami-Dade grand jury found troubling problems in oversight of an industry that now houses more seniors and people with mental illness than any other institution in Florida.

Sen. Rene Garcia, a Republican from Hialeah whose district includes some of the most heavily fined ALFs in Miami-Dade, insists his proposal, SB 1884, still has the leadership support to move the reforms forward.

"Absolutely the bill is not dead. It's not dead at all," Garcia said. "There's a lot of work that has been put into this bill on both sides. I feel fairly safe this will be heard on the floor."

On Wednesday afternoon, Gov. Rick Scott repeated his position that protecting frail elders is a top priority, although he did not directly answer a question on whether he'd push House and Senate leaders to pass the bills.

"We have got to make sure we take care of the citizens that end up being in our assisted living facilities, we have to make sure they get taken care of with respect," he said. "It is significant."

While the reforms are vulnerable to defeat, there are several possible routes for lawmakers to get the bills to a vote.

For example, the Senate could drop its own version and take up the House bill, which resident advocate Brian Lee says goes easier on the industry and forfeits some of the key protections.

Alternatively, powerful Rules Chairman Sen. John Thrasher, R-St. Augustine, could ensure one or all of the Senate proposals get a full hearing.

"It's moving," Thrasher said. "It's got to go through the process, but we've got plenty of time to deal with it so I think we will."

The sponsor in the House, Eddy Gonzalez, R-Hialeah Gardens, says he and Garcia are negotiating to hammer out differences on their bills, which still vary in their training requirements for ALF workers and the severity of penalties for caretakers caught abusing or neglecting residents to death.

While the House bill would slap a $10,000 fine on homes that cause a resident's death, the Senate version is tougher, stripping state regulators of the power to cut deals with homes in egregious death cases and immediately removing their licenses.

Additionally, a Senate bill gives residents the right to appeal when they're thrown out of an ALF, while the House does not.

When people experience problems in ALFs, they often don't complain because they're afraid of being booted from the homes, said resident advocate and former long-term care ombudsman, Brian Lee. "The House bill is half the bill of what the Senate's proposal was," he said.

House Speaker Dean Cannon, R-Winter Park, said he's going to let the process play out, but does not plan to throw his weight behind making sure the reforms pass.

The reforms have sparked major differences between advocates for ALF residents and industry leaders, who have lobbied for years to remove what they call onerous regulations.

Patricia Lange, executive director for the Florida Assisted Living Association, said she hopes to see something pass that punishes the bad actors without hurting those facilities that follow the rules.

"We believe there has always been adequate regulation in place . . . enforcement has always been the issue," she said. "If you look at AHCA's (the Agency for Health Care Administration) record in the past year, you'll see they've been doing that."

But a Herald investigation found that despite the agency taking harsher action on bad homes — closing more than a dozen since the newspaper series in May — AHCA still continues to provide millions in state dollars to facilities where investigators have turned up abuse and neglect deaths.

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