Lack of oversight of assisted living and residential care homes in Vermont puts residents at risk, according to a new report from the state auditor. But a senior living advocate defended the state, saying that the state already has implemented safeguards to correct many of the shortcomings identified in the report.
Vermont Auditor Doug Hoffer looked back at seven years of inspection data and said he found substantial noncompliance in more than half of those inspections. Rather than conduct annual inspections, Hoffer found that the state Department of Disabilities, Aging and Independent Living, or DAIL, only inspected assisted living communities and residential care homes once every two years — and that 11 facilities had not been inspected since 2018.
He also accused the state of not following up in a timely manner on serious issues.
But one senior living advocate said that the state already had identified its shortcomings and “moved from itemizing shortcomings to a strategy that prioritized the right steps at the right time toward their overall mission.”
Helen Labun, executive director of the Vermont Health Care Association, told McKnight’s Senior Living that several years ago, DAIL identified understaffing as a concern on the regulatory side for assisted living and residential care homes. The agency already had started increasing its capacity, as well as revisiting rules, statutory interpretation and timelines connected to those residences.
After pandemic delays, the state agency moved forward with expanding its staff, splitting the direction of assisted living / residential care homes and skilled nursing facility surveys between two directors. DAIL anticipates hosting a stakeholder process for rule updates this summer.
“We don’t expect changes based on the auditor’s report,” Labun said. “We do expect changes based on the strategy that DAIL had already put into place for improving their performance in safeguarding the health and well-being of older Vermonters.”
In February, the Department of Vermont Health Access, the state’s Medicaid agency, issued a report with DAIL reviewing the payment model for assisted living and residential care homes. Recommended payment increases were included in the proposed state House budget, which now is up for review in the Senate, Labun said.
“I think the biggest takeaway is actually in there: that the state both assesses their own capacity for inspections / regulatory enforcement and also assesses their role in funding long-term care facilities at a level that makes high-quality care feasible,” she said.
Audit addresses inspection process
The state auditor’s report found that of the 691 inspections DAIL conducted between Jan. 1, 2016, and June 30, 2022, 53% found substantial noncompliance, risking residents’ well-being. In the most severe cases, the community involved was found to have caused serious injury or harm, impairment or death, the auditor said.
Vermont has 17 assisted living residences and 97 residential care homes in the state, as well as 37 nursing homes.
“Deficiencies that occur in a state-licensed facility should not be treated differently from the same deficiencies that occur in a nursing home,” Hoffer wrote in a forward to the report. “In both cases, vulnerable Vermonters are at risk.”
The report included several recommendations to DAIL to improve its performance. The auditor also recommended legislation that would adopt the same inspection timeline for assisted living residences and residential care homes that are in place for nursing homes.
Among the recommendations were:
- Developing a system to ensure that licensure inspections are conducted annually,
- Creating a facility licensure process to include a full inspection,
- Inspecting facilities when ownership changes,
- Establishing a system to track trends and repeat deficiencies,
- Updating the state website to include all inception results and
- Setting timelines for followup on deficiencies.
The most frequent deficiencies cited in the report involved a lack of written care plans for each resident, staff training, medication administration processes, food storage issues, a lack of falls prevention interventions, and failures to reassess residents annually.
In response to the report, DAIL Commissioner Monica White acknowledged the need for increased regulatory oversight of state-licensed long-term care facilities. White also noted that DAIL created a new regulatory unit within its Division of Licensing and Protection Survey and Certification Unit to allow for increased oversight of those facilities.
“I concur with the [state auditor office’s] emphasis of the need to assure proper oversight of state licensed long-term care facilities providing care to Vermonters,” White wrote, who added that the findings and recommendations “largely align” with the department’s plans.
