Could Illegitimacy Threaten the Legitimacy of the Group Living Business in America?

Millions of Americans cannot live alone and manage the many tasks it takes to have a safe day. This is why a variety of group living options with competent assistance and varying program types are needed.

For decades we have used the term assisted living, albeit loosely, to describe the program models about which we speak this week. Regulatory and other requirements vary state by state but I believe an enemy is lurking. What is that?

That enemy is illegitimacy or programs operating outside of the regulatory radar screen and whose very existence lacks safety, staff development, a consistent program model and clinical acumen. These unlicensed, unregulated, poorly maintained structures are popping up faster than you may think and they pose a threat to not only the legitimacy of the group living business but also the safety and well being of persons they house.

I visited one home the last few weeks with windows so poorly maintained they allowed air to flow in as though they were opened when they were closed. I saw dust so thick on baseboards that an asthmatic would be in serious jeopardy. I asked for proof of staff training in CPR/First Aid and was told it would be faxed to me. 3 weeks later, no fax and I doubt if I will ever see it.

Homes like these have no problem locating or attracting residents. Typically these residents are social security recipients and the disabled. Some qualify for benefits over and above what they are collecting; however, the illegitimacy of the home's operation prevents the operators from investigating such options. Surely you cannot call these programs person-centered.

Real estate used is often sub-standard and fire safety is questionable at best. Medications are passed by persons who have not attended approved direct care worker or medication training and rarely is there any training in behavioral management or in how to complement rehabilitative therapies. In some situations resident privacy and resident dignity are greatly compromised.

Add a more serious concern: These unlicensed homes do not participate in the long-term care workforce background check system. Therefore, no one knows if violent felons are employed in the home, registered sex offenders, pyromaniacs or others who have manifested behaviors which do not complement the expected safety and security of the care delivery environment.

What is perhaps most remarkable to me is that I have found hospitals and nursing homes making referrals to these unlicensed, unregulated facilities just so they can say they discharged a patient to a secure setting and not to the street.

As a result, members of the legitimate American care spectrum are contributing to the decline of neighborhoods and care quality by supporting illegitimate entities who do not subscribe to any one set of standards and whose operations consider themselves answerable to no regulatory agency or clinical protocol. This is troubling.

As a result of a lack of commitment to both community and quality care, the potential list of victims includes neighborhoods, residents who live in these homes and what all of us have come to respect as systems by which we live and conduct business. I heard second-hand that one operator of a home similar to the ones I have described remarked to a colleague of mine, "most of the people I have in my home used to be homeless so I'm doing them a favor."

What an illogical remark. A resident's present or past socio-economic status does not disqualify them from receiving quality services in a safe, well-managed, well lighted, regulated, aesthetically appealing environment.

I am not sure about you but I try and remain prepared for anything or anyone I perceive to be an enemy and I take no prisoners when I have to confront them. Why not treat this enemy the same. How can we do that? Here are a few possibilities:

1. Licensed, legitimate programs should report illegitimate ones to licensing personnel and help protect your line of business from inappropriate intrusion by those who do not support properly managed operations

2. Draw attention to hospital or nursing home personnel who favor these illegitimate programs by alerting American Care News. We will investigate, validate each claim and take the matter to hospital boards of directors and nursing home owners and point out the consequences

3. Make sure your programs shine through their regulatory compliant approach

Legitimacy must affect us in numerous other areas. For now let's just make sure it is not neglected in group living and maybe, just maybe we can put enough pressure on our enemy to make them re-think polluting our long-term care landscape.

Thanks for playing along this week. I look forward to our discussion on May 17th. In the meantime you can read articles like this every week by subscribing to: americancarenews.com americancarenews.com.