August Health had the privilege of interviewing Joel Goldman on current regulatory issues in senior living. Joel is a respected authority in the senior living industry on topics such as licensing, risk management, and operations. A partner at the firm Hanson Bridgett, Joel has also presented extensively on regulatory topics for leading senior living organizations. Joel is a founding member of the California Assisted Living Association (CALA), and has served on its Board of Directors since its inception in 1994.
Joel will be a featured panelist at our Incident Management Best Practices Webinar on March 7th. Register here.
What’s a liability trend that you’ve observed recently amongst senior living operators?
What we've seen over the years is increasing resident acuity. Residents are more frail than they were two years ago, five years ago, ten years ago — and it just seems to keep increasing.
Covid may have exacerbated things. We see new residents, who previously might have moved in two years earlier, but their families delayed their move-ins because of Covid. Because of these delays, we're seeing higher acuity at the time of admission.
This higher acuity, when combined with the difficulty in finding competent staff, has made things more challenging for providers and increased their risk.
One solution that helps mitigate, though not eliminate, the risks associated with higher-acuity residents — operators should aim for transparency with families. Too often I see providers creating unrealistic expectations with respect to outcomes. If we’re not being honest, it’s going to create unrealistic expectations, which lead to disappointed consumers.
What’s a recent compliance challenge you’re seeing in the industry?
This is California specific, but there are a huge number of new LPAs (licensing program analysts). The folks from DSS are coming into the communities and we're seeing a lot of rookie mistakes. It's not too surprising, we have people conducting inspections who are less experienced.
In some cases, these LPAs are just going strictly by the book, but in other cases, it's a matter of not really even understanding some of the regulations that apply. For example, I've seen a couple of senior living clients cited for violating a regulation that pertains to adult residential facilities, but not to RCFEs.
This reality of less-experienced LPAs has exacerbated compliance challenges for operators.
You recently spoke on a risk management and liability issues panel at ASHA’s annual convention — what’s an issue that came up at ASHA?
One issue that continues to grow in relevance: what do you do with the assisted living resident who is transitioning to dementia, but doesn't want to be in memory care? They're still high functioning, but at the same time there's clearly cognitive decline and there's risk of serious injury. I see a lot of providers grappling with this issue.
You don't want to force someone into a more restrictive setting than they need to be. You also don’t want to ignore the heightened risks that this resident’s condition presents. This is one of the real challenges that we're facing as an industry.
As a solution, a number of providers have created transitional neighborhoods. You can think of these neighborhoods like “memory care light” or “assisted living plus”, but essentially there are now options for people who have some cognitive decline but who still have more capability than your typical memory care resident.
What do you think operators need to pay more attention to?
I’ve raised this in a number of presentations recently: It is critical for the administrator, executive director, or general manager to be out of their office as much as possible. There is an absolute correlation between the amount of time that the executive director is in his or her office and the number of problems that a building has.
As an administrator, you have to be leading by example. This means getting out there, meeting with your people, talking to your lower-level employees, and getting their input and suggestions. These employees see things that management doesn't see. I don't think we as an industry sometimes show enough respect for the opinions of caregivers.
And along those same lines, a disproportionate number of problems occur during the NOC shift. One suggestion that works very effectively, is to have each member from management — the administrator, the wellness director, the marketing director, etc. — each commit to showing up during the NOC shift once a quarter. Management can introduce themselves to the NOC shift team, talk to them, ask how things could be better. If NOC staff thinks that management might show up, it can prevent some of the crazy and really tragic situations that have occurred previously.