See a statement from James Balda, Argentum president & CEO, on the coronavirus. Read more.

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Federal Update
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A MESSAGE FROM ARGENTUM

These past four months have been among the most trying any of us have ever faced. Many of the challenges have been felt particularly hard in senior living communities, compounded by a scarcity of testing supplies and protective equipment. But at the same time the best has shown through, as direct care and support staff have risen to the occasion to care for our nation’s seniors while meeting an ever-expanding list of obligations at home. As we adjust to a new normal, at least for the foreseeable future, Argentum has been working with policymakers in Washington, D.C. and throughout the states to advocate on behalf of residents and staff.

When a shuttered Capitol Hill forced us to abruptly cancel our annual Public Policy Institute & Fly-In, we quickly recalibrated and met with Congressional leaders and administration officials to relay the critical needs of senior living expected in these extraordinary times. With Congress advancing four rapid succession legislative responses, we focused our efforts on prioritizing access to virus testing and PPE, financial relief, and liquidity to meet the increasing financial stresses, and legal protections to defend those on the frontlines.

Our efforts at the national level have been augmented throughout the states. Many legislatures were in the midst of advancing key proposals affecting senior living–from electronic surveillance to medical marijuana and comprehensive reforms to the industry at large. But just as we shifted on Capitol Hill, working in concert with our state partners, we met the new challenges at the state house too by leaning on longstanding relationships with regulators and legislators.

The future may remain clouded in uncertainty, but the need for our industry has never been clearer, and that’s why we will continue to advocate on your behalf to ensure senior living can survive and thrive well after this pandemic fades into a memory.


FEDERAL UPDATE

In the wake of COVID-19, our priorities shifted from retirement income security and workforce development to protecting residents and staff. Early on we recognized how this virus presents unique challenges to senior living, with those at greatest risk being people over 60 years of age with underlying health conditions. As lawmakers crafted response packages, we urged lawmakers to prioritize the well-being of our most vulnerable and their caregivers and to ensure the long-term viability of senior living to meet these needs.

PPE & Testing
The most important of our requests has been in preventing the spread of the virus, where we’ve stressed the critical importance of adequate testing for suspected cases. Protecting healthy residents and staff requires timely and verifiable testing, and we urged policymakers to prioritize tests for our communities to give a better sense of when and where to escalate infection control procedures as needed.

Beyond testing, we underscored the urgent need of our direct care staff for personal protective equipment (PPE) to properly protect against the spread of the virus, such as face masks, respirators, eye protection, gowns and gloves, as well as cleaning supplies and hand sanitizing products. See letters

Families First & Paid Leave
As the scope of the pandemic became clearer and ordinary life ground to a halt, we recognized the need for safe childcare for our employees. In the course of a week, schools went from being in session to more than three in four of the country’s public and private school students facing mass closures. Ensuring that our nurses, care staff, housekeepers, food service workers, and maintenance staff would not have to worry about keeping their children safe or risking a lost paycheck required immediate action to address the childcare crisis.

As part of the Families First and Coronavirus Response Act, the Department of Labor granted certain exemptions to the paid leave provisions for essential healthcare workers, including senior living workers as we requested to ensure that our nation’s seniors would still be able to get the care they need during this crisis.

CARES Act and Supplemental Funding
Senior living has been at the forefront of the pandemic, and as a result, has experienced significant operational and financial stress. As lawmakers moved onto the $2.2 trillion economic-stimulus package, Argentum focused its advocacy efforts to safeguarding the long-term financial viability of the industry, given the additional supplies, overtime costs, and childcare needs that Argentum member companies stepped up to provide their employees.

The CARES Act included several provisions for senior living operators to meet their financial obligations. This included the $100 billion Public Health and Social Services Emergency Fund (PHSSEF) designated for healthcare providers, which was increased to $175 billion as a result of

H.R. 266, a supplemental funding package for the CARES Act. Since passage, Argentum members, lobbyists, and other industry associations have been collectively advocating for senior living to receive funds to offset increased operating expenses and reduced revenue.

Additionally, senior living providers are eligible for funds from the $450 billion Treasury fund for mid-size businesses or the $670 billion for small businesses, depending on particular eligibility. In forthcoming legislation, we are seeking changes to the small business loan eligibility to expand the scope for all communities with fewer than 500 employees to be eligible, regardless of the total corporate size.

Provider Liability
Beyond our efforts to prioritize the industry in Congress’s proposals, Argentum and our state partners have been engaging in an extensive initiative to protect the industry from future legal liability. The pandemic has resulted in conflicting guidance issued by regulators and combined with the insufficient protective equipment, we are concerned that the heroic efforts of our front-line workers could be exploited by lawsuits against them.

Argentum and other stakeholders are working in collaboration to have every state governor or legislature address this issue. We’ve provided a model that can be tailored to each state’s needs and have worked directly with each state to determine how best to insert language favorable to both operators and providers. To date, more than half of the states adopted some form of protections, including several that met all or most of the key elements of our model.

Protection for employees during this pandemic is also being pursed at the federal level through the forthcoming legislative package as well as by invoking the PREP Act to ensure that senior living employees are covered on a nationwide basis.

Other Issues
COVID-19 has been all-consuming, but it has not been the only pressing issue facing the industry. Prior to the pandemic coming to the fore, we were active in protesting a regulatory change to CCRCs that could have significant financial impacts. We submitted formal comments in opposition to the Medicaid Fiscal Accountability Regulation (MFAR) that could increase provider taxes by six- or seven- figures annually. We requested the rule be withdrawn or to eliminate the provisions relating to CCRCs. A final rule is expected later this year.

Legislatively, we were also active in opposition to H.R. 2474, the Protecting the Right to Organize (PRO) Act. We are concerned that it would effectively repeal right-to-work provisions currently used in 27 states, strip workers of essential rights, and violate employees right to privacy. This bill was narrowly passed by the House in February but is not expected to be considered by the Senate, although it could be reconsidered in future Congresses.

Finally, we were pleased to see the final passage and enactment of H.R. 4334, the Supporting Older Americans Act. First passed in 1965 and last reauthorized in 2016, the Older Americans Act serves more than 10 million Americans each year by supporting caregivers, providing employment, community service opportunities, nutrition and transportation options, and preventing abuse and neglect. The latest iteration will reauthorize the act for five years with increased funding, improving elder abuse prevention, promoting multigenerational opportunities, expanding the availability of services for those living with younger onset Alzheimer’s disease, and supporting age-friendly communities.


STATE UPDATE

As of press time, at least 20 legislatures adjourned their sessions as a result of COVID-19, while nine states convened a session specifically to address the challenges stemming from COVID-19. More than 2,500 pieces of legislation have been introduced throughout the states specifically in response to the pandemic, adding to the thousands of other bills that had otherwise been under consideration, but have since shifted out of focus entirely.

ARIZONA
TRAINING REQUIREMENTS FOR ASSISTED LIVING CAREGIVERS (SB 1210)
Signed by Governor

Prescribes training and testing requirements for certification as an assisted living facility caregiver. A person who successfully completes the 62-hour training and competency requirements developed by the Arizona Health Care Cost Containment System administration for in-home direct care workers satisfies the training requirements for assisted living facility caregivers, in lieu of the in-person classroom training, except for medication administration training required by the assisted living facility caregiver’s scope of practice. The caregiver will still be required to pass both the state test and submit fingerprints.

CALIFORNIA
9-1-1 REPORTING REQUIREMENTS (SB 1068)
Pending Legislative Action
Requires immediately telephoning 911 when an injury or other circumstance results in an imminent threat to a resident’s health, including, but not limited to, an apparent life-threatening medical crisis.

RYAN’S LAW: COMPASSIONATE ACCESS TO MEDICAL CANNABIS (SB 1216)
Pending Legislative Action
Allows terminally ill patients access to medicinal cannabis, with reasonable restrictions permitted by facilities.

REPORTING ELDER AND DEPENDENT ADULT ABUSE (AB 3229)
Pending Legislative Action
Establishes reporting requirements for suspected elder abuse.

COLORADO
ASSISTED LIVING RESIDENCE REFERRALS (HB 1101)
Signed by Governor
Requires an agreement between an assisted living residence referral agency and a prospective resident of an assisted living residence to be in writing and include: The right of the prospective resident or representative of the prospective resident to terminate the referral agency’s services for any reason at any time; and a requirement that the referral agency communicate the cancellation of the agreement to all assisted living residences to which the prospective resident has been referred.

SUNSET CONTINUE CERTIFICATION OF NURSE AIDES (HB 1183)
Signed by Governor
Implements the recommendations of the department of regulatory agencies in its sunset review and report on the certification of nurse aides by the state board of nursing.

SUNSET CONTINUE NURSE PRACTICE ACT (HB 1216)
Signed by Governor
Implements the recommendations of the department of regulatory agencies in its sunset review and report on the “Nurse Practice Act,” under which nurses are regulated by the state board of nursing.

NURSING HOME DEFINITION FOR RESIDENTIAL PROPERTY TAX (HB 1083)
Pending Legislative Action
Defines a nursing home to include, among other things, a nursing home that provides convalescent care and rehabilitation services for purposes related to memorandum issued by the state’s property tax administrator on April 17, 2019. The bill specifies that land on which a nursing home is situated and any improvements affixed to that land is classified and assessed as residential real property, regardless of a resident’s length of stay.

FLORIDA
ASSISTED LIVING DEVICES (HB 767)
Signed by Governor
Allows ALFs to admit or retain residents that require the use of assistive devices, which are defined as any device designed or adapted to help a resident perform an action, task, an activity of daily living, a transfer, prevention of a fall, or recovery from a fall.

ASSISTED LIVING MODERNIZATION (SB 402)
Pending Legislative Action
Provides comprehensive reforms to the state’s assisted living requirements.

ASSISTED LIVING MODERNIZATION (SB 1726)
Pending Legislative Action
Provides comprehensive reforms to the state’s assisted living requirements.

GEORGIA
ALZHEIMER’S AWARENESS DAY (HR 1051)
Pending Legislative Action
Recognizes February 10, 2020, as Alzheimer’s Awareness Day in Georgia.

ELDER ABUSE REPORTING (HB 978)
Pending Legislative Action
Prohibits retaliation against a person relating to a report that a disabled adult or elder person is in need of protective services or has been the victim of abuse, neglect, or exploitation.

ELDER ABUSE & ASSISTED LIVING OVERSIGHT (HB 987)
Signed by Governor
Provides comprehensive assisted living reforms; introduced as a result of the Atlanta Journal Constitution investigative series of senior care homes.

ELDER ABUSE PENALTIES (HB 955)
Pending Legislative Action
Repeals enhanced penalties relating to simple battery and battery 3 against a person who is 65 years of age or older or by an employee, agent, or volunteer in a long-term care facility.

ILLINOIS
DEMENTIA TRAINING REQUIREMENTS (HB 4818)
Pending Legislative Action
Requires the Department on Aging to develop and implement a dementia training program that must include instruction on the identification of people with dementia, risks such as wandering, communication impairments, elder abuse, and the best practices for interacting with people with dementia.

IOWA
LIABILITY PROTECTIONS AS A RESULT OF COVID-19 (SF 2338)
Signed by Governor
Provides limited liability protections for health care providers as a result of COVID-19. Defines “health care facility” to include “residential care facilities” and “assisted living programs.” Increases the cap on non-economic damages to $750,000 and eliminates the exception to the current $250,000 limit on non-economic damages for damages for injury or death of a patient.

MARYLAND
LICENSURE OF ASSISTED LIVING MANAGERS (HB 707)
Pending Legislative Action
Renaming the State Board of Examiners of Nursing Home Administrators to be the State Board of Long-Term Care Administrators; establishing a license for assisted living managers.

MASSACHUSETTS
CLARIFYING THE CLASSIFICATION OF ASSISTED LIVING RESIDENCES (H 4063)
Pending Legislative Action
Clarifies that assisted living residences are not and were never intended to create residential tenancies within landlord tenant law; and are not and were never intended to be residential or commercial landlords within landlord tenant law.

BASIC SERVICES FOR ASSISTED LIVING RESIDENTS (H 625/S 365/H 3542/S 1897)
Pending Legislative Action
Permits assisted living residences to advertise, market, and otherwise promote or provide or arrange for the provision of basic health services for assisted living residents and shall administer such care and service to include injections; application or replacement of simple non-sterile dressings; management of oxygen on a regular and continuing basis when the resident’s medical condition warrants; or application of ointments or drops.

MICHIGAN
ELECTRONIC MONITORING OF RESIDENTS (SB 77)
Pending Legislative Action
Permits nursing homes to allow a resident or his or her representative to monitor the resident through the use of an electronic monitoring device if all of the following requirements were met: The monitoring was completely voluntary and was conducted at the election of the resident and, if required for approval, his or her representative; All costs of the monitoring, including the cost of the electronic monitoring device and its installation, were paid by the resident or the resident’s representative; There was a notice posted on the door of the resident’s room stating that the room was being monitored by an electronic monitoring device.

MINNESOTA
PERSONAL CARE ASSISTANCE SERVICES (SF 3457)
Pending Legislative Action
Establishes additional duties for personal care assistants and qualified professionals; establishing a payment rate methodology for personal care assistance services; requiring commissioner of human services to study methodology; requiring providers to submit workforce data.

NEW YORK
ELDER CARE/IDENTITY THEFT (S 7712)
Pending Legislative Action
Incorporates identity theft into the definition of elder abuse for purposes of support services and programs for elder persons.

MEDICAL AID IN DYING (A 2694/S 3947)
Pending Legislative Action
Permits a mentally competent, terminally ill patient to request medication to be self-administered for the purpose of hastening the patient’s death, and to provide certain protection and immunities to health care providers and other persons, including a physician who prescribes medication in compliance with the provisions of the article to the terminally ill patient to be self-administered by the patient.

OHIO
ELECTRONIC MONITORING OF RESIDENTS (HB 461)
Pending Legislative Action
Permits a long-term care facility resident or the resident’s sponsor to authorize the installation and use of an electronic monitoring device in the resident’s room under certain conditions. Requires a resident’s roommate to fully or conditionally consent to electronic monitoring on a form prescribed by the Director of Health. Requires a long-term care facility to post a notice stating that an electronic monitoring device is in use in a particular room and submit an annual report to the Department of Health on the number of devices in use.

INSPECTION OF RESIDENTIAL CARE FACILITIES (HB 509)
Pending Legislative Action
Specifies that an existing licensed residential care facility may request an expedited licensing inspection from the Director of Health when the facility is seeking approval to increase or decrease its licensed capacity or make any other change for which the Director requires a licensing inspection to be conducted.

OKLAHOMA
ELECTRONIC MONITORING OF RESIDENTS (SB 1739)
Signed by Governor
Requires assisted living centers and continuum of care facilities to provide the same notifications as nursing facilities as it relates to electronic monitoring; modifies the term “representative of a resident” to mean any court-appointed guardian, the parent of a minor, a relative, or other person designated in writing by the resident. A representative cannot be the owner of a facility subject to the provisions of the Nursing Home Care Act, the Continuum of Care and Assisted Living Act, the Residential Care Act, or the Group Homes for the Developmentally Disabled or Physically Handicapped Persons Act.

ANTIPSYCHOTIC DRUGS (SB 1392)
Pending Legislative Action
Requires assisted living centers to take certain actions when a resident is prescribed an antipsychotic drug. These actions include quarterly assessments for the desired responses and possible side effects of the medication, ensuring all staff understand the benefits and side effects of the medication, note the rationale for using the drug, and monitor at least monthly for inappropriate use.

PENNSYLVANIA
GENERATORS (HB 2292)
Pending Legislative Action
Establishes generator requirements for long-term care nursing facilities, assisted living residences, nursing homes, personal care homes and hospices; providing for powers and duties of the Department of Health and other State agencies; and imposing penalties.

VIRGINIA
LONG-TERM CARE OMBUDSMAN (HB 1148)
Signed by Governor
Reorganizes provisions of the Code related to the Department for Aging and Rehabilitative Services. The State Long-Term Care Ombudsman Program is relocated in the Code and the Respite Care Grant Program is eliminated. The bill also calls for additional education services to be provided by the Department with respect to Alzheimer’s disease and related disorders.

MEDICAL MARIJUANA (SB 185)
Signed by Governor
Allows nursing home, assisted living facility, hospice program, and hospice facility employees and staff members who are authorized to possess, distribute, or administer medications to residents to store, dispense, or administer cannabidiol oil or THC-A oil to a resident who has been issued a valid written certification for such medication.

INDIVIDUAL SERVICE PLANS (SB 686)
Signed by Governor
Requires the Board of Social Services to amend its regulations governing assisted living facility individualized service plans to require (i) that individualized service plans be reviewed and updated (a) at least once every 12 months or (b) sooner if modifications to the plan are needed due to a significant change in the resident’s condition and (ii) that any deviation from the individualized service plan be documented in writing or electronically, include a description of the circumstances warranting deviation and the date such deviation will occur, certify that notice of such deviation was provided to the resident or his legal representative, be included in the resident’s file, and in the case of deviations that are made due to a significant change in the resident’s condition, be signed by an authorized representative of the assisted living facility and the resident or his legal representative.

WASHINGTON
RETIREMENT SAVINGS PROGRAM (HB 2516)
Pending Legislative Action
Establishes the Secure Choice Retirement Savings Program, requiring employers to participate in that have more than five employees and have been in business for at least five years if the employer has not sponsored, maintained, or contributed to an employee retirement plan at any time during the preceding two calendar years

WISCONSIN
COVID-19 RESPONSE & PROVIDER LIABILITY PROTECTIONS (AB 1038)
Signed by Governor
Specifies that any health care professional, health care provider, or employee, agent, or contractor of a health care professional or of a health care provider is immune from civil liability for the death of or injury to any individual or any damages caused by actions or omissions taken in providing services to address, or in response to, the COVID-19 outbreak, if certain conditions are met. The term “health care provider” includes assisted living facilities.

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