Although provider advocates say that Vermont’s state licensing regulations for assisted living communities and care homes were in dire need of an update, one senior living organization has raised concerns about the process that was used to create the new rules, which it said could have “significant” negative effects for providers and the public.
The state legislature’s Committee on Administrative Rules signed off last week on the new rules, which will affect staffing level requirements, as well as training. The new rules go into effect April 1.
The Vermont Health Care Association told McKnight’s Senior Living that the regulations had not been updated in almost 25 years, so a refresh was necessary. But VHCA Executive Director Helen Labun said that the state did not consider the operational effects that the regulations would have on providers.
In May 2023, the Department of Disabilities, Aging and Independent Living circulated a preliminary draft of updates to licensing rules for residential care homes and assisted living residences. But from the start, VHCA said, unclear language and the integration of multiple regulatory authority areas made a review of those updates difficult. VHCA provided input to the state from a working group of 15 facility-based reviewers but said that few of the group’s comments were incorporated into the final draft.
Compounding the situation, VHCA stated in comments to the legislative committee, was that state officials implied that any long-term care providers not already in compliance with the proposed rules were providing a “substandard quality of care.” This implication had a “chilling effect” on providers willing to voice concerns about the rule, the association said.
After the draft rule was proposed at the end of 2023, VHCA surveyed its members to determine how it would affect operations. In comments to the committee before the rule’s adoption, VHCA raised concerns about the rulemaking process, calling it a “poorly designed” rule.
In her comments, Labun stated VHCA’s position concerning having limited information about the financial implications of the rule, potential effects on resident access to services and ways to mitigate those negative effects. She said that “significant challenges” are expected to occur during implementation that will result in loss of access, disproportionately affecting residents who rely on Medicaid for residential care home services.
The new rules also will create misalignment with other rules, particularly related to professional nursing standards, which “creates confusion, exacerbates current workforce challenges, and sets us up for future regulatory misalignment and operational difficulties,” Labun said in her statement.
Residential care homes anticipate “significant” economic effects, particularly related to the change requiring the use of registered nurses where licensed practical nurses had been used for task delegation, medication management, admissions review and direct care training, the VHCA comments read. The group also anticipates changes in staffing to accommodate new requirements for medication management and training.
Based on the updated rule regarding changes to requirements for RNs in residential care homes, VHAC said, members anticipate needing to transition some residents to higher levels of care in nursing facilities and adjust admissions policies.
“The proposed rule has not been designed in a way that will achieve the state’s goals for quality in long-term care,” Labun wrote, adding that the result will be a risk of “significant harm” to the public interest and the healthcare system. “Respectful engagement with providers during the rulemaking process could have avoided this outcome.”
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