1 Regulation of Nursing Homes and Assisted Living Facilities Legislative Audit Bureau February 2003

2 Types of Nursing Homes u 418 skilled and intermediate care facilities u 40 facilities for the developmentally disabled u 4 institutes for mental disease

3 Types of Residential Assisted Living Facilities u 1,334 community-based residential facilities u 662 adult family homes u 118 residential care apartment complexes

4 Long-Term Care Regulatory Staff u 42.8 FTE central office staff u FTE positions in the five regional offices u Regional staff include FTE for nursing home regulation and 26.0 FTE for assisted living facility regulation

5 Nursing Home Regulation u Strong federal role in the regulation of nursing homes u Survey teams, including at least one registered nurse, visit nursing homes u Routine inspections in nursing homes last for several days u Nursing home inspectors have more work experience in long-term care

6 Assisted Living Facility Regulation u State statutes and administrative code control the regulation of assisted living facilities u Individual inspector visits the facility for an inspection u Routine inspections last for less than one day u Assisted living facility inspectors report less prior work experience in long-term care than do nursing home inspectors

7 Citations, FY through FY

8 Regulatory Issues u Average number of federal citations issued to nursing homes varied from 1.4 to 4.6 among the regions u 82 percent increase in the number of complaints against assisted living facilities outpaced the 35 percent estimated capacity increase u 47 percent of assisted living facilities were not visited for at least one year

9 Forfeitures Against Nursing Homes u State forfeitures assessed against nursing homes increased from $545,000 to $1.3 million u 65 percent of citations issued in FY were awaiting review for forfeiture assessment as of February 2002 u We recommend the Department report on administrative costs related to forfeiture assessment

10 Forfeitures Against Assisted Living Facilities u Total assessments increased from $42,000 to $96,000 u Assessments were made only against community-based residential facilities through FY u We recommend a written procedure to guide the assessment process for assisted living facilities

11 Informal Dispute Resolution u Federally required process for nursing homes u Decisions are not timely, and 50 percent of the citations are not changed u Providers dispute the independence of the process u Additional management information is expected in the summer of 2003

12 Criminal Charges u Two attorneys and six investigators in the Medicaid Fraud Control Unit u Routine flow of information from the regulatory process to the Medicaid Fraud Control Unit for criminal investigations u 24 caregivers, 1 assisted living facility, and 1 facility for the developmentally disabled charged

13 Milwaukee Nursing Homes u Milwaukee homes are larger and have lower occupancy u Declining number of citations in Milwaukee, but increasing number of citations in the rest of the state u Higher staff turnover in Milwaukee than in the rest of the state u Lower percentage of allowable Medicaid costs reimbursed in Milwaukee

14 Regulation of Nursing Homes and Assisted Living Facilities Legislative Audit Bureau February 2003