A relatively new ordinance in one Michigan city is getting pushback from some senior living communities that are being charged for nonemergency 911 calls. The ordinance, they say, does not distinguish between the offerings of various levels of service and care nor recognize that some settings do not employ caregivers.

The city of Sterling Heights, MI, passed an ordinance last March that charges independent living communities, assisted living communities and nursing homes an $800 fee for a lift assist and a $500 fee for a nonemergency medical response. The Detroit suburb moved to implement the fees after noticing an increase in those types of calls, which they label a “misuse” of 911. The city said that the fees allow some of its costs from these calls to  be recouped.

After adoption of the ordinance last March, the city conducted in-person visits to communities and facilities in April to educate them about the fees before enforcement began on May 1. The ordinance states that nonemergency calls to “residential living facilities that are compensated to maintain staff to assist their residents is an inappropriate and unwarranted drain on city resources, which at times has caused delays in response to true emergencies.”

The city pointed out that operators can buy devices to help staff members lift residents if they fall, according to The Detroit News. 

A city attorney told the media outlet that the fire department handles more than 240 lift assists annually, on average, in assisted living communities and an average of more than 400 nonemergency medical responses, including calls to transfer residents to the hospital because they ran out of medication. 

The ordinance further states that nonemergency ambulance transports are regularly provided by first responders due to “a lack of facility staffing, a disinterest by the facility in addressing these needs for their residents, a lack of proper equipment at the facility, or other reasons that do not warrant or justify the use of city emergency responder resources.”

No caregivers employed

Waltonwood Senior Living contends that the ordinance should not apply to the independent living community at its Waltonwood Lakeside campus in Sterling Heights, which also offers assisted living and memory care. Waltonwood Director of Operations Steven Tyshka told The Detroit News that he agrees with the city of Sterling Heights on charging assisted living communities, but he argued that the ordinance should not be applied to unlicensed independent living, where caregivers are not employed.

A Waltonwood spokesperson told McKnight’s Senior Living that it is committed to transparent communication with residents and their families, “ensuring they understand the specifics of the services we provide at each level of care.”

“We are working to proactively address the Sterling Heights ordinance, emphasizing the clear distinction between independent and assisted living in our communities and navigate these changes effectively,” the spokesperson said. “We are dedicated to upholding the highest standards of care and compliance while also ensuring our residents are informed and supported every step of the way.”

The Michigan Assisted Living Association agreed, saying that independent living residents are “clearly not contracting for any personal care or assistance,” adding that those residents often sign up strictly for room and board.

“It is frustrating that Sterling Heights does not acknowledge the difference between independent living and assisted living,” MALA General Counsel Robert L. Stein told McKnight’s Senior Living.

Not a statewide trend

Fortunately, the Sterling Heights ordinance is not a statewide trend, Stein said, adding that MALA is hopeful that the issue will be resolved “favorably and fairly” for independent living residents. 

“We are aware of providers using private ambulance companies in lieu of calling the city responders for these types of services,” Stein said. “This approach is not a permanent solution but offers some flexibility and cost savings.”

In response to the fees, Waltonwood Lakeside informed its independent living residents in November that it would institute an $800 charge to residents who receive a lift assist from the city to recover its costs, according to the Detroit News.

Tacoma, WA, implemented a similar ordinance in 2019. The Washington Health Care Association and LeadingAge Washington partnered with city safety forces to decrease the number of 911 calls for lift assistance for long-term care facilities. The organizations educated first responders on the training and staffing requirements of assisted living communities compared with skilled nursing facilities, and provided education to community and facility staff members.

The bill was effective upon the governor’s signature Jan. 8.

The law empowers a labor union to file a complaint in court against a contractor or subcontractor for unpaid wages on behalf of workers in certain construction, reconstruction, demolition, alteration and maintenance projects, regardless of whether the workers belong to the union or are unaffiliated with any union.

“It is our expectation that empowering labor unions to pursue actions in court on behalf of construction workers, whether they belong to the union or to no union at all, will inure to the benefit of all workers in this industry and their families,” the governor said in a statement. 

“Every worker should be properly compensated for the work they undertake — no exceptions,” Murphy said in a press release issued in conjunction with the bill-signing. “This bill allows unions to take up for those workers without representation seeking wage claims.”

State Sen. Troy Singleton (D), Assemblywoman Annette Quijano (D) and Assemblyman Anthony Verrelli sponsored the bill.

“This bill signifies a monumental shift in protecting workers’ rights, extending the reach of unions and ensuring that no worker is left behind in the pursuit for fair wages and just treatment,” Quijano said. “Unions being able to start wage claims could encourage employer compliance and potentially lessen the state’s need to closely monitor and enforce these laws.” 

Business groups had opposed the bill, arguing that the legislation “would allow labor unions to act in the place of the state government by filing lawsuits on behalf of workers they don’t represent,” The Center Square reported. 

Labor groups, on the other hand, applauded the new law.

Laborers’ International Union of North America Vice President and Eastern Regional Manager Mike Hellstrom said that the law provides an additional layer of support to construction workers who might find themselves on the losing side of a wage dispute and denied pay they had already earned.

“It is good news for New Jersey, for law-abiding employers and, most of all, for workers,” Hellstrom said.

Expanding the ability to enforce penalties on assisted living communities that violate a resident’s rights is a new goal for Maryland’s top attorney.

Attorney General Anthony G. Brown last week unveiled his top legislative priorities for the new year, including expanding the rights and protections under the nursing home Patients’ Bill of Rights to assisted living settings. 

Brown is proposing to expand his office’s ability to seek relief and penalties when certain rights and guarantees in the Bill of Rights are violated, including a resident’s right to receive care and services, freedom from mental and physical abuse, freedom from physical and chemical restraints, and the ability to manage personal finances.

In announcing his priorities, Brown said that his initiatives are aimed at increasing transparency and accountability in the healthcare sector as well as recovering damages in certain environmental and other public welfare cases in a more equitable way to hold wrongdoers responsible in proportion to the amount of harm they are deemed to have caused.

“Our legislative agenda is focused on protecting the health, safety and well-being of Marylanders,” he said in a statement.

State senior living associations said they are reviewing Brown’s proposed legislation and update to the Patient Bill of Rights.

Ensuring that Maryland’s older adults have access to high quality care and services is a high priority for LeadingAge Maryland and its members, who have been actively engaged on a variety of regulatory and legislative efforts related to assisted living providers.

“Assisted living providers fill a critical need in our healthcare system,” LeadingAge Maryland President and CEO Allison Roenigk Ciborowkski told McKnight’s Senior Living. “Though we have not yet seen the final bill language, the actions proposed in draft form and as shared by AG Anthony Brown in the recent press release seem reasonable and to mirror what is already in place in nursing homes.”

She added there are hundreds of smaller assisted living providers in the state serving nine or fewer individuals, so it will be important for the state to weigh how any changes might affect these small providers.

“I have tremendous respect for Maryland Attorney General Anthony Brown, and we share a longstanding partnership and commitment to patient rights,” Health Facilities Association of Maryland / Maryland Center for Assisted Living President and CEO Joe DeMattos told McKnight’s Senior Living.

Similarly, LifeSpan Network CEO Kevin D. Heffernan told McKnight’s Senior Living that he would refrain from comment until a bill is introduced in the Maryland General Assembly.

“LifeSpan’s highest priority will always be the care and safety of residents, and we look forward to the opportunity to work with AG Brown, as always, on issues that involve Maryland’s most vulnerable older adults,” Heffernan said.

Other initiatives on Brown’s list of legislative priorities center on holding corporations accountable in proportion to the actual amount of environmental, health, safety and other public welfare harm they cause to the state, and requiring prior notice and consent for out-of-network procedures and hospital outpatient facilities fees.

California has the largest number of skilled nursing facilities and assisted living communities of any state, according to SNF Data and Statista. 

The current minimum wage increase plan would affect approximately 400,000 workers in the Golden State. It is meant to increase the state’s hourly minimum wage from its current $15.50 for healthcare-related workers. The incremental wage increase for covered workers would be $23 per hour from June 1, 2024, to May 31, 2025; $24 per hour from June 1, 2025, to May 31, 2026; and $25 per hour from June 1, 2026.

The Newsom administration was opposed to the dramatic wage increase at the onset of discussions. Other opponents included the California Assisted Living Association, the California Association of Health Facilities, LeadingAge California and the California Chamber of Commerce, which argued that the “astronomical increase in labor costs that will result from SB 525 is simply not sustainable.”

According to KFF Health News, “the governor’s latest budget asks the state legislature to add an annual trigger making the minimum wage increases contingent on state revenues and to clarify which state employees are included, citing ‘the significant fiscal impact’ of the law.” 

Newsom told reporters Wednesday that he had been assured that such triggers would be forthcoming, “even though it wasn’t in the bill,” multiple media outlets reported. 

“We’re confident all parties that committed to that agreement are going to meet it and do so very shortly,” the governor said.

It’s been a rough few months for the assisted living sector as lay media reports put a spotlight on the varying — or a lack of — regulations covering operators, a situation they said has led to tragic outcomes for some residents.

Georgia assisted living operators are the latest to come under scrutiny.

In 2019, the Atlanta Journal-Constitution published a series of stories critical of assisted living and Georgia’s enforcement of state regulations. In the wake of that series, the state Legislature adopted a reform package that increased fines and requirements for assisted living operators in the state. A recent follow-up story, however, alleged persistent shortcomings and a seemingly “unhurried approach” in the state’s oversight of assisted living and personal care facilities.

Industry advocates say that it is unfair to paint all providers with one brush, but they acknowledge that the attention is a reminder that “good policies and procedures, routine staff training, and oversight to ensure staff are following the policies are vital for providing great care.”

This latest media spotlight on senior living providers follows the New York Times / KFF “Dying Broke” series in November about the cost of assisted living and the Washington Post’s “Memory Inc.” story package in December focusing on resident elopements at assisted living and memory care communities. 

Telling assisted living’s story

In a message to members that was shared with McKnight’s Senior Living, LeadingAge Georgia President and CEO Ginny Helms said that the latest AJC article brought awareness to a serious problem in a large personal care home in Greensboro, GA, including the deaths of two residents and a sexual assault of another resident. But she added that she knows that member communities “demonstrate commitment to quality, person-centered care” daily, and she said she finds it unfortunate that those providers are “lumped in with communities cited for poor care.”

Helms shared several resources that members can use to create strong policies, including an upcoming webinar by the state’s quality improvement organization, Alliant Health Solutions, on an effective process for identifying the root causes of problems. 

And although LeadingAge Georgia has met with legislators and consumer advocates about their desire to tighten legislation and regulations due to media stories about poor care in some settings, Helms encouraged operators to invite lawmakers into their communities to “see for themselves the great quality of care our members provide.”

“Legislators and aging advocates are really focused on ensuring great care for older adults. Our members provide great care,” Helms wrote. “It’s important that the legislators and aging advocates come to your communities and see for themselves what great care looks like so that we can help influence policy rather than be dealt overly burdensome legislation and regulations.”

Balancing safety with resident wants

Any instance of poor care, neglect, abuse or exploitation is “unacceptable,” according to the Georgia Center for Assisted Living, the state affiliate of the National Center for Assisted Living. But GCAL Communications Director Devon Barill told McKnight’s Senior Living that assisted living provides “life-affirming care for elderly Georgians every day, and residents and families are consistently satisfied with the care they receive.”

“We regularly hear from happy and satisfied residents and their loved ones regarding their enriching assisted living experiences, and the vast majority of caregivers that work in assisted living do so because they have a passion for serving seniors,” Barill said. “We recognize there is more work to be done, and we continue to evaluate how we can advance the care provided in all of Georgia’s long-term care settings and foster a workforce that is well-trained, dedicated and passionate about the sacred mission of caring for our elderly.”

Balancing safety and security with resident and family wants, GCAL said it has worked to enhance assisted living in Georgia through member participation in the American Health Care Association / NCAL National Quality Award program. The association said it also regularly updates policy recommendations, provides education opportunities and has supported past state policies on developing administrator licensure and implementing criminal background checks for workers.

The well-being of older adults and members of the direct care workforce has become a top priority in Maryland with the recent signing of an executive order meant to address challenges related to the state’s aging population. Senior living industry representatives say the effort has “tremendous” potential for operators in the state.

Last week. Gov. Wes Moore (D) signed an order establishing the Longevity Ready Maryland initiative, which directs the state Department of Aging to prioritize the well-being of older adults, people living with disabilities and their caregivers. 

Through the initiative, the state aims to build a longevity-ready and aging-friendly state by establishing new policies and programs, evaluating the efficacy of current services, identifying new support options for older adults and caregivers, and coordinating with public and private partners.

The initiative has a “tremendous” potential focus on the upside of aging and aging services, according to Maryland Center for Assisted Living President Joe DeMattos. 

“The potential for the executive order is an important first step in focusing on people across settings, consumers across settings, and in integrating those settings so Marylanders know where to receive care and to receive the right care, in the right place, at the right time, relative to their aging process,” DeMattos told McKnight’s Senior Living. 

He said he also has hopes that the initiative will address workforce challenges that have faced operators since before the pandemic. The experience, DeMattos said, taught him that only one healthcare workforce really exists. 

“The entire healthcare sector in Maryland is attempting to tap into a single healthcare workforce, which is insufficient to meet even our current needs,” he said. “So one of the hopes of this executive order is that we begin to put in place more earnestly new models for training and elevating the healthcare workforce.”

To that end, DeMattos said he hopes to see more use of peer-on-peer training in supervised educational environments that more closely resemble apprenticeship training programs for certified nursing assistants. In addition, he said he hopes to see a scaling up of existing models offering wraparound support for entry-level healthcare workers. 

LeadingAge Maryland has been involved in conversations about the multi-sector state Plan on Aging since the spring and is excited to see those efforts formalized in the Longevity Ready Maryland initiative, President and CEO Allison Roenigk Ciborowski told McKnight’s Senior Living. 

“We will continue to collaborate and advocate for all older Marylanders to ensure they have opportunities for aging well, and access to the services they need, when they need them, in the place they call home,” she said.

The plan

The Longevity Ready Maryland initiative adopts a whole-of-life perspective, aiming to develop a coordinated strategy across various state agencies, the private and philanthropic sectors, and other stakeholders to tackle real-life challenges throughout the lifespan. 

Helping state residents lead healthy, financially secure, socially connected and purposeful lives — regardless of socioeconomic status — is the goal of the plan, according to Maryland Department of Aging Secretary Carmel Roques.

“Integrating a longevity lens into every government department and agency, promoting coordinated responses, and helping the state shape how public services are planned and delivered, will help us prepare, serve and utilize our changing population,” Roques said in a statement.

The Department of Aging already has begun collaborating with other state agencies to develop a data tool and dashboard to report longevity goals, redesign the state’s long-term services and supports system, and examine affordable housing options for older adults. 

Over the next 18 months, the state expects to seek feedback to develop recommendations for the plan. A final plan is expected in 2025 and will be implemented over the next decade. A workgroup will include representatives from area agencies on aging, older adults, organized labor, older adult advocacy organizations, caregivers, state agencies and aging experts in healthcare, technology, academia, innovation and philanthropy. 

“If we are going to meet the 21st-century needs of this rapidly changing demographic, we must evaluate our programs, advocate for change, target resources and formulate data-driven policies with a whole-of-government approach,” Moore said in a release.