State Health Commissioner Announces Further Actions to Protect Residents at Adult Homes in New York State

Actions Build on Recent Legislation Proposed by the Governor to Ensure Proper Care at Adult Homes

Albany, April 30, 2002 – New York State Health Commissioner Antonia C. Novello M.D., M.P.H., Dr.P.H. today announced actions the State Health Department will take to further strengthen its regulatory responsibility over adult homes in New York State. Dr. Novello said she will immediately commence a working group of experts to review the care being provided to adult home residents and to offer recommendations on how that care can be improved.

Dr. Novello also urged the Legislature to immediately act on the Governor's recently proposed legislation that will ensure that residents of adult care facilities (ACFs) receive quality care and are placed in homes that do not have outstanding violations directly impacting the health, safety or welfare of residents.

"The State Health Department is doing more now than ever before to protect and provide a safe environment for residents of adult homes," Dr. Novello said. "This industry has been beset by problems that have been decades in the making. Since taking over responsibility for adults homes surveillance just four years ago, this Department has taken aggressive action to protect residents at adult homes, but more needs to be done and the actions I'm announcing today, and the legislation proposed by the Governor, will strengthen the Department's oversight role while adding needed protections for this vulnerable population."

The actions that will be taken to further strengthen the Health Department's oversight of adult homes include:

  • Create a working group to come up with recommendations on how to ensure that residents in adult homes are receiving the best care. The panel will include consumer advocates, representatives from DOH, Office of Mental Health, State Office of the Aging, and the Commission on Quality of Care for the Mentally Disabled, as well as industry representatives.
  • Adult Home statement of deficiencies (SODs) will be made available on the Department's web site (www.health.state.ny.us) and updated on a regular basis.
  • A quarterly press release will be issued identifying recent adult home inspections and the results of those inspections. The first release will go out next month for the period January 1, 2002 through March 31, 2002.
  • Emergency regulations will be promulgated that will clarify the requirement to report deaths at adult homes.
  • A letter will be sent this week to all adult home operators reiterating the requirement that all deaths be reported to the State Health Department consistent with the 1994 law.
  • DOH will increase resources to review and investigate death reports from adult homes. Dr. Novello noted that last year the Department spent an additional $600,000 to augment its surveillance staff for adult homes. The current number of adult home inspectors totals 34, including 17 in New York City.
  • The Department will conduct regional training sessions for adult home operators to promote best practices that will improve the quality and safety of care and services provided to residents in these facilities.
  • Propose an amendment to the Governor's recent adult home legislation to require input from adult home resident councils on Quality Incentive Payment Program (QUIP) funding allocations.
  • Provide funding for a demonstration program for consumer groups to provide peer support services in adult homes

The actions announced today by the Commissioner will build on the recent legislation proposed by Governor Pataki that will prohibit referrals to ACFs, including adult homes, residences for adults and enriched housing, that do not have valid operating certificates, increase fines for violations related to care and require additional discharge planning requirements for patients released from inpatient facilities licensed or operated by the Office of Mental Health (OMH) or the Office of Alcoholism and Substance Abuse Services (OASAS).

On average, DOH annually conducts 575 unannounced surveys of adult homes in New York State and, in addition, investigates more than 500 complaints. In 2001, DOH investigated approximately 560 complaints, resulting in 181 violations. As a result of these surveillance efforts, the Department has initiated 74 enforcement actions over the past 12 months – more than at any other time in State history.

The following are among the highlights of the Governor's recent adult home proposal:

  • Expands current law by requiring that DOH notify OMH, local social service districts, the State Department of Corrections (DOC), the State Division of Parole (DOP), hospitals and state licensed psychiatric centers of those ACFs cited for violations that directly affect the health, safety and welfare of residents, including enriched housing programs and residences for adults. Health facilities would be strictly prohibited from discharging a patient to a home which has been cited by the State for such violations;
  • Prohibits agencies and health care providers who receive a "Do Not Refer" list from directly referring a patient to any ACF required to be licensed that does not have a valid operating certificate;
  • Authorizes issuance of a "Do Not Refer" list and prohibits referrals from commonly used sources, when there are conditions found to be unsafe. This will provide DOH with a tool that can be used in serious but less egregious situations. It provides another source of information about conditions in a facility that are important to consumers, allowing them to make more informed choices;
  • Sets forth a maximum fine of $5,000 per violation. If a recurring violation is cited against an adult home, residence for adults or enriched housing program within a 24–month period, the maximum fine levied would increase to $10,000 per deficiency. The proposal would also remove a provision of current law that allows ACF operators to avoid State monetary penalties if they submit a written corrective action plan to DOH within 30 days of being cited for deficiencies; and
  • Requires that all State Office of Mental Retardation and Developmental Disabilities (OMRDD) developmental centers and all inpatient programs operated or licensed by OMH or the State Office of Alcoholism and Substance Abuse Services (OASAS) to assure that before discharging patients to an adult home, residence for adults or enriched housing program, that the residential placement is consistent with the patient's needs.

Current law requires DOH to notify OMH, local social services districts, and hospitals in the locality when the Department issues an adult care facility a notice of revocation, suspension or denial of an operating certificate, limitation on admissions, Department order, Commissioner's order or an enforcement action to seek fines for violations of provisions specified in SSL Section 460–d (7)(b)(2), which are commonly referred to as endangerment violations.

New York State law also provides for civil penalty for violations occurring in adult homes, residences for adults and enriched housing programs of up to $1,000 per day for violations in accordance with a fine schedule promulgated in regulations. Current law does not provide for an increased penalty for repeat violations. Also, current Social Services Law provides that an adult care facility operator can avoid fines for most violations by rectifying the violations within 30 days of receiving a notice of the violations. Under the newly proposed legislation, these provisions would be changed as noted in the bullets listed above.

State Surveillance Initiatives Underway

Important State initiatives that are being taken by the State Department of Health (DOH), the State Office of Mental Health (OMH) and the State Commission on the Quality of Care for the Mentally Disabled (CQC) to ensure quality care in ACFs, include:

  • Creation of joint surveillance teams comprised of surveyors from DOH, OMH and CQC to complete unannounced inspections of ACFs in New York. The joint surveillance teams will enhance the State's current initiatives to review the care being provided, especially mental health services, as well as the living conditions in specific homes. Providers are required to submit written corrective action plans;
  • Development of a DOH automated ACF survey report process to provide greater access to report findings, violations and corrective action plans so that surveillance staff from the three agencies can better track and analyze the latest information on homes statewide;
  • Strengthened OMH surveillance teams to more closely monitor the quality of mental health services being provided to residents on–site, including dedicated staff to complete surveys. The surveillance teams are responsible for conducting unannounced site investigations of ACFs in response to complaints and reported incidents;
  • Strengthened CQC ACF oversight so that the Commission can routinely conduct programmatic and financial reviews of homes, and respond to complaints regarding the services provided to residents. This includes dedicated staff to complete surveys;
  • Implementation of a contract with the New York City Health Services Review Organization to compliment state staff and conduct additional surveys of ACFs with histories of violations. Homes surveyed include those in which 25 percent of the residents are receiving mental health services on an ongoing basis. To date, inspections at 50 homes statewide have been completed as part of this ACF surveillance program.

Quality of Care Priorities

Furthermore, the Governor has directed DOH, OMH and CQC to coordinate efforts through surveillance initiatives to ensure that ACF operators are working to:

  • Improve the practices and procedures for medication management services provided to residents, including assistance with the appropriate type and dosage of prescription drugs as directed by a physician's orders;
  • Refer residents to appropriate health–related services with an increased focus on primary care services, medical follow–up and mental health services; and
  • Promote the recovery and independence of individuals with a mental illness, through the use of practices that have proven effective in other settings.

Promotion of Consumer Participation

Specific activities being implemented by DOH, OMH and CQC to further improve conditions in New York's ACFs include:

  • Sharing effective resident council activities being used by residents in a particular home to see if those approaches would also be successful in other adult care facilities in New York. This approach may help strengthen communications between residents and operators, while improving conditions in particular homes; and
  • Enhancing family and consumer participation activities under the direction of OMH, enabling residents and family members to take active roles in offering constructive ideas on ways to improve the operation of facilities.

During a routine inspection of ACFs, state inspectors conduct interviews, observations and record reviews to assess operational practices of the provider. The inspectors examine areas related, but not limited, to quality of care, management of resident financial accounts, resident rights, nutrition, medication practices, case management, and environmental/fire safety.

In response to State inspection reports, ACF operators have 30 days to submit corrective action plans to the appropriate State agencies noting how the home is going to correct cited violations. This is generally done to ensure compliance has been achieved or maintained. Unannounced complaint inspections are also conducted as necessary and may include subsequent visits in cases in which the complaint was substantiated.

4/30/02–40 OPA