Preserving a regulatory structure that allows for continued innovation and responsiveness to consumer needs and AL core values.

1. Assisted Living at a Crossroad
FL ALFA
September 12, 2013
Monica L. Wilson
561-536-3670

2. AL – The New Nursing Home
Stakeholders
Is it inevitable?

3. Residents
• Increased frailty of residents
• More ADL assistance
• More chronic medical
conditions
• More cognitive impairments

4. Regulation
• Fear of nursing home style
of regulation
or
• Desire to increase level of
regulation/change
regulation with a focus on
health care

5. Political Process
• Reactions to media stories
• Feds inching in on process
• Medicaid LTC Managed
Care

6. Assisted living is a social/hospitality model
Myth
Coordination of health careand ancillary services

7. Consumers prefer
Senior Living
Assisted Living
Nursing
home
to

8. Assisted LIVING
• Lifestyle
• Choices
• Amenities
• Environment
• Support
• Access to health care

9. Assisted LIVING Core Values
• Promoting Dignity
• Protecting Privacy
• Support for decision-making and autonomy
• Offering Choices
Quality of Life
AL Pioneers – the originators of “cultural change”

10. Barriers
• Political process
• Low tolerance for
risk/paternalism
• Emotional response to problems
• Associations
• Regulation
• Facility/Company policy policies
and procedures (often a reaction
to regulation)
• Shareholders/need to focus on
profits
• Lack of Vision
• Lack of Curiosity/Understanding
needs of stakeholders

11. Media
Newspaper, T.V. etc Consumers
• Close to 1 million living in
AL
• Recent ALFA poll – satisfied,
feel safe, enjoy high quality
of life
• Little to no ALF regulation
• Poor enforcement
• Lack of federal oversight
• Suggests federal oversight
desirable and necessary
• This is bad, bad, bad for
consumers

12. Reactions
• Public/people typically react emotionally, think dramatically not quantitatively
• Politicians responses
• Pressure on regulatory agencies to show they’re protecting vulnerable citizens
• Associations try to change conversation/control message
• Industry leadership
Your leadership required/desired

13. Positive Outcomes
Quality
+
Industry Leadership
+
Good Regulatory Process

14. Regulation– Cary Coglianese
Supposed to Work
Supposed to effectuate some
improvement in the conditions of the
world.
Improvement means that the
conditions with regulation are better
than what they would have been
without the regulation.
3 Steps
1. Regulation is implemented,
which leads to changes in
2. The behaviors of
individuals/entities targeted or
affected by regulation, which
ultimately leads to change in
3. Outcomes, such as
amelioration of underlying
problem or other changes in
conditions.

15. Basic Elementsof Regulation
Behaviors
Outcomes

16. Florida
FrontEnd
• Add analysis to decision
making process when
introducing new regulation
• No formal lookback
process/analysis of
individual regulations
• ALF Workgroup &
Negotiated Rulemaking
• Limited quantitative
information – relies heavily
on anecdotes and
knowledge base of
participants
How is regulation of AL in Florida
working?

17. Characteristics of Desirable Regulatory Practice
• Open and transparent process
• Includes citizen participation
• Promotes flexibility for citizens and business/industry
• Analysis of relevant alternatives
• Minimizes burden
• Aims for simplicity
-- UnitedStates –EuropeanCommission High-LevelRegulatoryCooperation ForumCommon
UnderstandingonRegulatoryPrinciplesandBest Practices , June,2011

18. ConsistentApproach to RegulationDevelopment
• Identify the behavior/condition want to impact
• Identify the desired outcome
• Identify the regulatory options
• Apply decision-making criteria
Want to apply a more consistent, analytical approach to minimize
the inclination to implement a nursing home style of regulation.
Require regulatory entities to apply analytical approach and more transparency.

19. Decision-makingCriteria
• ANTICIPATED IMPACT/EFFECT
• COST-EFFECTIVENESS
• NET BENEFIT
Adapted from Measuring Regulatory Performance
EVALUATING THE IMPACT OF REGULATION
AND REGULATORY POLICY, August 2012, Cary Coglianese

20. Decision-makingCriteria
• What is the anticipated IMPACT/EFFECT?
– How much do we anticipate each option will change
the targeted behavior or lead to improvements?
(degree of change)
– Are there feasible alternatives?
– How does the option provide for flexibility for
industry/allow for innovation and identifying least
costly methods for compliance? Shouldn’t be overly
prescriptive.
– Does this option also allow consumer/citizen flexibility
and options?
Adapted from Measuring Regulatory Performance
EVALUATING THE IMPACT OF REGULATION
AND REGULATORY POLICY, August 2012, Cary Coglianese

21. Decision-makingCriteria
• COST-EFFECTIVENESS
– What will each regulatory option cost?
– What is the anticipated cost-benefit?
• Does not just encompass monetary or quantitative
evaluation. Intangible benefits should also be
considered.
• Values/Equity/Fairness
– Will different groups be affected differently?
– Anticipated impacts on vulnerable population?
– Do nothing option
– Zero Risk illusions
Adapted from Measuring Regulatory Performance
EVALUATING THE IMPACT OF REGULATION
AND REGULATORY POLICY, August 2012, Cary Coglianese

22. Decision-makingCriteria
• NET BENEFITS/EFFICIENCY
– Which option will yield the greatest net benefit?
– Least burden?
– Does this result in additional documentation
requirements? Can they be streamlined?
– Do the regulatory options take into consideration all
stakeholders?
Adapted from Measuring Regulatory Performance
EVALUATING THE IMPACT OF REGULATION
AND REGULATORY POLICY, August 2012, Cary Coglianese

23. Healthcareand Assisted Living
• Florida Framework
– LNS, ECC
– Both could benefit from updating and revisions
• Memory Care an emerging issue

24. Menuof Options
• Consumer & Provider Choice
• Disclosure