If you can't meet the standards, evade the standards

The Des Moines Register’s Clark Kauffman reported Monday on some outside-the-box thinking by an assisted living center in Dubuque that has been fined repeatedly for providing inadequate care. I wouldn’t be happy if one of my loved ones were among the center’s 116 residents.

More details are after the jump.

Iowa’s largest assisted living center has found a loophole in the law that will enable it to avoid all future government oversight and regulation even though it has been repeatedly penalized for poor quality care.

The Dubuque Retirement Community, which is currently home to 116 seniors, is giving up its state license to operate as an assisted living center. The home’s owner, Assisted Living Concepts, plans to operate the building as if it were an apartment complex subject only to landlord-tenant laws.

Residents of the home who are dependent and need medical assistance will be able to stay in the building and pay for 24-hour health care provided by Swan Home Health, a wholly owned subsidiary of Assisted Living Concepts.

By separating the housing from the health care services, the company will be able to provide the same care to the same seniors in the same building, but without a license and all of the regulations that go with it. That means state health inspectors and the long-term-care ombudsman won’t be visiting the home and checking on the quality of care that’s being delivered.

The Dubuque facility has only been open for two years, and Kauffman lists the various fines it has received for “problems with insufficient staffing, food service, medication errors and other issues.”

In addition to evading future inspections, the Dubuque Retirement Community will be able to accept new residents again. It had to stop doing so in April when state inspectors put its license on “conditional status,” according to Kauffman.

Laurie Bebo, CEO of Assisted Living Concepts, claims the Dubuque Retirement Community’s staff, residents and families are happy about the changes. (Kauffman doesn’t quote any staffers, and the only resident he quotes was in the process of moving out because managers had raised his monthly rent by 33 percent.)

[Bebo] said the impetus for the change was a desire to let residents remain at the facility longer, past the point where their medical needs would otherwise force a move to a nursing home. By giving up its license, she said, the home won’t be subject to assisted living regulations that dictate when its residents must move to a nursing home.

So, a center that already can’t provide adequate staffing, food and medications for its residents will now be able to keep collecting rent from sicker, less-capable people who would otherwise have had to move to nursing homes. How generous of Assisted Living Concepts to “let” those people spend more time at the Dubuque Retirement Community.

Naturally, representatives of the Iowa Department of Inspections and Appeals are expressing concern about the lack of oversight. State Representative Chuck Isenhart of Dubuque told Kauffman that “he has asked the inspections department to monitor the situation and report back to lawmakers if they feel legislative action is needed.”

I don’t put high odds on the Iowa Legislature closing the loophole that made the Dubuque facility’s switcheroo possible. During the 2009 session, Iowa lawmakers unanimously approved a bill sought by the nursing home industry, even though inspectors and advocates for the elderly opposed the measure. Legislators didn’t heed concerns about letting facilities avoid fines for substandard care then–why start now?

Of course, I would love to be proven wrong.

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