Local elder-care advocates say that two bills currently being reviewed by the Washington state Legislature are fundamental to improving the quality of life for seniors being cared for in adult family homes.

One of the measures, House Bill 1277, seeks to improve state oversight of adult family homes, which are facilities licensed to provide long-term care for up to six individuals in a residential setting. The other measure, House Bill 1494, would place disclosure and other requirements on private-sector referral agencies that for a fee refer seniors and their families to long-term care facilities, such as adult family homes or nursing homes.

As the legislative session enters its final days, the latter bill appeared at press time to be likely to reach the governor's desk, while the fate of the other looked less certain.

Currently, 176 licensed adult family homes with a total of about 980 beds operate in Spokane County. In Washington state, there are about 2,900 licensed adult family homes. The vast majority of people receiving care in adult family homes are seniors, but many homes also provide care to adults with developmental disorders or other health conditions.

H.B. 1277, which is similar in wording to Senate Bill 5092, would raise licensing fees for adult family homes to pay for an increase in oversight by the Washington state Department of Social and Health Services (DSHS). That added oversight would include more inspections of the facilities and stiffer penalties for violations of state standards, among other measures.

The bill passed the House of Representatives 57-40 on April 6, and the most recent revision of the bill says the increase in fees would be determined by the Legislature in the state operating budget, rather than by the DSHS. As of late last week, the bill still was being reviewed in the Senate, and at press time it wasn't clear if it would go to a vote on the Senate floor before the end of the Legislature's regular session on April 24. If any revisions are made by the Senate, the bill also would have to go back to the House for concurrence review before going to the governor's office for signing.

Opponents of the legislation argue that an increase in licensing fees could put some adult family homes out of business or cause facilities to cut employees to pay for such increases in fees.

Linda Petrie, a long-term care ombudsman at Spokane Neighborhood Action Programs, says the money that's generated by the state from adult family home licensing fees currently covers just 6 percent of the cost of oversight of the facilities. Petrie, who works in five Eastern Washington counties, says the rest of the money needed to pay for such oversight comes from the state general fund.

Petrie says other long-term care facilities, such as skilled nursing homes, already pay licensing fees that cover the entire cost of the licensure and the majority of DSHS's oversight activity. Nursing homes annually pay $327 per bed, as outlined by Washington state code.

While some local agencies, including Aging and Long Term Care of Eastern Washington, support the proposed measure to increase the licensing fee and related oversight, Petrie says that as a state ombudsman she can't take a specific position on that bill or H.B. 1494. Yet, there are many care issues in adult family homes that she says she hopes will be addressed if the two bills pass.

"Certainly the oversight is important; we have a lot of good homes, but we also have those where there are serious problems," Petrie says. "I don't want to see them go out of business as far as affording these kinds of raises (in license fees), but on the other hand I think it's really beneficial to have the oversight."

Louise Ryan, the state's long-term care ombudsman, says that increase in licensing fees could be as much as $390 per bed, which would total around $2,400 a year for an adult family home with the maximum six beds. That increase would generate about $5.5 million to pay for oversight of the facilities, she says. Ryan, who works at a nonprofit community-action agency in Federal Way, Wash., called the Multi-Service Center, says that adult family homes that care for Medicaid-funded patients also would get back that per-bed license fee in their state reimbursement for such patients.

Currently, the initial cost to apply for a license for an adult family home is $900, of which $800 is a processing fee. Annual license renewals currently are $100, Ryan says.

Opponents of the measure, whose testimony is summarized in a House bill report, say that increasing those fees could cause adult family homes to have to cut back on their staff, which would affect residents' quality of care.

They also contend that most violations of standards are committed by uncaring operators and not the industry as a whole, and thus the focus on increased oversight should be on the homes that have infractions against them, and not on all facilities.

Irene Owens, the Olympia-based office chief for the policy unit of DSHS's residential care services, says that while some adult family homes might struggle to come up with money to pay for the increased fees, it's a tough issue because of the budget deficit the state is facing.

"We're having to look at things differently now" from when the first adult family homes were licensed in the late 1980s, Owens says. "When adult family homes started out, they were much more of a mom-and-pop business." Now, she says, "There are some people who have multiple homes, and it looks very different than it did than when they started out."

While the increase in licensing fees is a major component of the legislation, other provisions of the bill are designed to improve the regulation of adult family homes, which proponents of it say are much needed.

Nick Beamer, executive director of Aging and Long Term Care of Eastern Washington, based in Spokane, says that H.B. 1277 could help to reduce the number of repeat violations by adult family home operators because of the steeper fines the bill would impose.

Right now, the penalty fee for violations of adult family home standards is set at a limit of $100 per day per violation. The bill seeks to instead make that amount a minimum daily fine, as well as enacting a fine of up to $3,000 for each incident that violates adult family home licensing laws.

H.B. 1277 also stipulates that a fine of up to $10,000 may be imposed on a current or former provider operating an unlicensed adult family home.

Beamer says that another proposal that's part of H.B. 1277 calls for a decrease in the window of time between regulatory inspections of the facilities from 18 months to 15 months.

"Things like this are put in place to protect very vulnerable citizens that are living in adult family homes," he says. "This oversight and the inspections are really important to making sure that adult family homes are operating in a professional and quality manner."

Beamer adds that a proposed increase in the number of training hours for caregivers in adult family homes is another critical component of the bill to ensure sufficient care for residents.

Specifically, H.B. 1277 would require that adult family home license applicants and resident managers of the homes have at least 1,000 hours of direct caregiving that took place in the three years prior to the license application. That is an increase of 680 hours from current state law.

As mentioned earlier, the other legislative measure, H.B. 1494, involves the regulation of private referral agencies that help families with elders needing long-term care to find an appropriate facility. Proponents of the measure have concerns that some of the practices of some referral agencies might not be in the best interests of the consumer.

Washington's long-term care ombudsman Ryan says there currently are about 50 private referral agencies in the state.

The bill would require referral agencies to disclose fully to clients their fees and refund policies, as well as whether or not an agency representative has visited the facilities to which he or she is referring clients.

It also would require referral agencies to explain to clients how to file a complaint with them and to use a standardized intake form for all clients.

The bill has passed both the House and the Senate, and as of press time, it was awaiting approval by Gov. Gregoire.

Efforts to locate a Spokane-based referral agency for comment were unsuccessful.

However, Pamala Temple, co-founder and CEO of a national Seattle-based referral agency, A Place for Mom Inc., says that some referral agencies already follow their own strict disclosure standards that go beyond requirements of the proposed legislation.

She asserts that A Place for Mom, which has two employees based in Spokane, has clear guidelines in place to protect its clients, including an up-front disclosure policy on how it generates its revenue.

Temple says that A Place for Mom charges a fee to the facilities it refers its clients to, rather than requiring the clients to pay the company a fee to be placed into a facility that meets their needs.

She adds that she and the company aren't against the regulation standards called for in H.B. 1494, but that she's concerned with the wording of the bill that could confuse consumers as to the meaning of the word "client."

In most cases, Temple says, it's adult children who are looking for an appropriate facility for their aging parent, and the wording of the bill and a reference to another state provision in it could confuse consumers and agencies as to who—the aging parent or their children—is allowed to sign a disclosure statement.

"They did put some language in there that the client's representative or family can also be seen as the 'client,' so they can sign off on disclosureBut later in the bill they point to the Washington state Uniform Healthcare Information Act that says the patient has to sign, which creates a problem for consumers," Temple says.