Before the coronavirus slammed Georgia, the state legislature was on the verge of passing reforms to make senior living homes safer.
Rep. Sharon Cooper, R-Marietta, was lead sponsor of a bill that had passed the House with overwhelming bi-partisan support and that senior advocates and the care industry both embraced. Through the legislation, lawmakers were about to usher out a status quo where death and abuse cases were routinely punished with fines of $601, someone with a GED could manage a facility with 100 or more elderly residents, and a single worker could be left to handle 25 people with dementia during the night shift.
Before final action on the bill, the Georgia General Assembly suspended its session because of the pandemic. Now, with the legislative session set to resume in June Gov. Brian Kemp says COVID-19 has made the reforms even more essential. “One of the key battlefields in our fight against COVID-19 is Georgia’s long-term care facilities, and Rep. Cooper’s bill is critical to ensuring we protect our state’s most vulnerable from this virus and in the years to come,” Kemp said in a statement.
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However, the bill’s passage is not yet certain. Some powerful players in the long-term care industry now want what they see as “critical” fixes to the bill, which has to make it through a Senate committee before getting a Senate vote. The time lines for passage will be short, and the state’s budget woes are certain to be the focus when the legislature reconvenes.
The family of Nan Durrett is among those who hope this moment won’t be lost. They would like the state to take action to fix a system they experienced first hand after Durrett suffered in her final weeks at a metro-area assisted living home.
“I would like something good to come out of the horror we’ve been through,” said Clarissa Strickland, her sister. “I would like to see change to the whole industry.”
State standards lax
Cooper's bill was written to address problems exposed last year in an investigative series published by The Atlanta Journal-Constitution. The series found nearly 700 cases where residents suffered from neglect or abuse in assisted living communities and large personal care homes across the state.
Breakdowns in care often were rooted in insufficient staffing and poor training, the newspaper also found. Staffing violations were cited at 76 facilities over a four-year period. In an industry with low pay for caregivers and rampant turnover, even the minimal training the state requires was often missed, the newspaper found.
While directors of skilled nursing facilities have to be licensed in Georgia, the state doesn't require directors of large assisted living communities or personal care homes to have any license or certification or specific training. Someone with a high school degree and enough experience in a health care facility can run a home. The AJC found that 35 states have higher standards.
Given that most people living in assisted living or personal care homes today are often extremely frail, have multiple chronic health conditions or have dementia, industry leaders and advocates said having more qualified caregivers is essential.
That was before the coronavirus revealed just how vulnerable Georgia’s seniors are if they live in long-term care settings.
Already, more than a third of the state's assisted living or large personal care homes have had at least one confirmed case of COVID-19, although most still haven't done widespread testing. Arbor Terrace at Cascade, an upscale assisted living home in Atlanta, experienced one of the worst long-term care outbreaks in metro Atlanta so far, with 54 residents testing positive and 17 deaths.
Sen. Brian Strickland, R-McDonough, anticipates that he will carry the bill in the Senate. He said, if anything, the impact on seniors in these facilities during the coronavirus crisis puts a shining light on why more protections are needed. He anticipates some may say that facilities have been so hard hit during the pandemic, that now is not the time for more requirements. He doesn’t believe that will be persuasive given all that’s transpired in recent months.
“I don’t think now is the time to back off from the standards we expect and should require,” Strickland said.
Industry wants flexibility
When Cooper worked with both the industry and advocates to craft a bill, she said she tried to focus on changes that would prevent the kind of abuse and neglect the AJC series exposed. Residents with dementia were often victims, the AJC found, and Cooper's bill would require memory care units to have more staffing and better trained staff than they do now. The units would also have to be certified by the state. Now, the state licensing agency doesn't even track which facilities have memory care units.
The staffing in these units couldn’t dip below one caregiver for every 12 residents, under the bill. Now, the state sets only one staffing minimum across a facility, whether it’s a memory care unit or not: one caregiver for 15 residents during the day and one for 25 residents at night, though higher staffing is required if needed to properly care for residents.
"I would like something good to come out of the horror we've been through. ... I would like to see change to the whole industry." —Clarissa Strickland, whose sister suffered in her final weeks at a metro-area assisted living home
The bill also would require assisted living communities for the first time to have nurse staffing — either an RN or LPN. The required hours would vary by the number of residents. Plus, administrators would have to meet new requirements and be licensed.
While these changes are designed to prevent neglect and abuse from happening, Cooper's bill also calls for more severe punishments when residents are harmed. Currently, fines rarely exceed $601 even for the worst incidents, including violations that result in deaths. The legislation would increase fines to a minimum of $5,000 for the worst violations.
“I think we came out with a very good bill to start attacking the problems in these facilities,” Cooper said.
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She said the crisis in senior care homes during the pandemic highlights many of the problems that her legislation is trying to address.
Genia Ryan, president of the Georgia Senior Living Association, said her organization worked with Cooper, the governor’s office and others on HB 987 to help secure passage in the House and her industry wants it to move forward. “We hope the bill will be considered and passed in the Senate when they reconvene in June,” Ryan said. “We believe this is a good bill for our industry and residents of assisted living communities and personal care homes throughout Georgia.”
But some others in the industry say they want to see the Senate make changes, in part because of how the coronavirus has impacted the state.
Tony Marshall, president and CEO of the Georgia Health Care Association, which represents both the nursing home and assisted living industry, said his group would prefer that the state require administrators to get certified by completing training and passing a test, instead of going through a licensure process overseen by a new state board.
Also, he said worker training time lines currently in the bill need more flexibility, so workers could get training after they start the job, instead of before. Homes already struggle to find staff, and Marshall said new hires are usually needed immediately.
"We support the bill, but there are provisions we think are critical to be fixed," Marshall said.
» RELATED: AJC investigation finds 600 cases of neglect, many at upscale homes
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The bill, if passed, wouldn’t require immediate changes. Facilities would have until July 2021 to meet most of the new requirements. But some worry that won’t be enough time to create effective education programs called for in the bill while the pandemic is ongoing.
Ginny Helms, president and CEO of LeadingAge Georgia, which represents non-profit organizations that provide senior care and housing, said her organization is “very supportive” of the bill. But she said it may take more time, given the pandemic, to develop the training programs called for in the bill to make sure they are effective, and she plans to push for tweaks to the bill to make that possible.
She said more qualified staff is essential, especially now. But she said she wants the bill to pass.
“To me one of the biggest pieces of this bill is the nurse oversight,” she said. “I think with the accuity of the residents there needs to be a strong nursing oversight available and the bill has that.”
A family’s loss
Soon after Durrett moved into The Phoenix at Tucker, her sister and niece said they recognized the need for higher standards.
Durrett, who had Parkinson’s and dementia, went into the facility in early February after she fell at home and spent a week in the hospital. But her family says that at Phoenix, there wasn’t enough staff to respond quickly when she needed help.
The family said they learned an alarming lesson about how thin the staff was at night when Durrett suffered a fall. The staff was aware she had fallen, but they left Durrett on the floor for at least 20 to 30 minutes as she spoke to her sister via cell phone. A panicked Strickland said she tried to call the facility’s main phone line to get help but no one answered. Strickland said she was later told by a staff member that it was routine to leave residents on the floor if they were not injured until nighttime medication deliveries were complete.
“I wondered how could you even assess if someone was hurt until they got them up,” she said.
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After the facility restricted visits because of the pandemic, Durrett developed a fever and cough, eventually losing her appetite and dropping 11 pounds. Her family complains that the facility didn’t respond adequately or keep them well informed. When Durrett was finally taken to a hospital, a physician told the family her symptoms and rapid decline left no doubt she had COVID-19, though she later tested negative. Nurses held up a phone on April 8 for one last FaceTime call between sisters.
The assisted living facility, which is part of Roswell-based Phoenix Senior Living, didn’t comment on the family’s assertion that Durrett didn’t receive adequate care but in a written statement said it has maintained transparent and ongoing communications with residents’ families. The company also expressed condolences to Durrett’s family.
Advocates agree with Kemp’s comments that the demands of the coronavirus make passing and implementing the reform bill more important than ever, and they don’t want the legislation to stall. “To better protect the Georgians who live in these homes, Chairman Cooper and the Georgia House crafted a compromise between what advocates wanted and what the providers wanted,” said Kathy Floyd, director of the Georgia Council on Aging. “I hope the Senate will pass HB 987 with little or no changes.”
MaryLea Boatright Quinn, director of government affairs with the Alzheimer’s Association, Georgia Chapter, said that families that rely on assisted living and personal care homes have suffered. “This pandemic has shown us the need for more oversight and training in these facilities where so many vulnerable Georgians live,” she said.
