Commissioners Novello, Stone and Chairman O'Brien Announce Aggressive Actions to Protect Residents in Adult Homes

Department of Health, Office of Mental Health and Commission on Quality Care for the Mentally Disabled
Enhance Multi–Agency Coordination to Protect Residents and Hold Adult Homes Accountable for Insufficient Care

Albany, May 8, 2002 – State Health Commissioner Antonia C. Novello M.D., M.P.H., Dr.P.H. today was joined by Office of Mental Health Commissioner James L. Stone and Commission on Quality Care for the Mentally Disabled (CQC) Chairman Gary O'Brien to announce a series of strong actions that will further strengthen the State's oversight of adult homes; actions that when implemented will result in New York having some of the toughest regulations in the nation. Dr. Novello also announced the members of a recently established adult home workgroup and said that the workgroup would hold their first meeting at the end of this month.

The actions include: mandatory death reporting and immediate investigations of such reports; multi–agency created profile of deaths at the homes to identify patterns; emergency regulations that will increase fines on adult homes; and increase surveillance, including joint teams made up from DOH, OMH and CQC and an additional surveillance team for rapid response. These strong actions taken by the three state agencies will not only serve to ensure that further protections for adult home residents are implemented but will also serve to make homes more accountable for care that is inadequate and for the utilization of their finances as well.

"These strong steps will help us build on, streamline and strengthen the oversight responsibility the DOH, OMH and CQC have over adult homes. By increasing fines, enhancing audit and surveillance staff, and requiring better care for adult home residents, New York will have some of the most comprehensive oversight measures regarding adult homes in the nation," Dr. Novello said. "During the recent twelve months, the Department has been aggressive in holding adult homes accountable by initiating 74 enforcement actions, but more needs to be done. I am confident that through the partnership with Commissioner Stone and Chairman O'Brien residents at adult homes and their families will get the peace of mind they need and deserve. When these actions are fully implemented, the care provided in adult homes will not only be of the best quality but homes that are found to provide inadequate care will be held accountable and properly sanctioned."

Commissioner Stone said, "We are working together hand–in–hand with the DOH and CQC to strengthen our oversight of adult homes by enhancing surveillance activities and focusing more on the care provided to the mentally disabled. The legislation proposed today will help to ensure that residents in adult homes are in an environment that is safe and conducive to their needs."

Chairman O'Brien said, "I look forward to continuing to work closely with DOH and OMH to improve the quality of life for residents of adult homes. I am particularily pleased that, consistent with the Commission's enhanced oversight of adult homes, the new initiatives include a significant committment of resources to allow CQC, in collaboration with DOH, to develop a strengthened adult home resident advocacy program."

The state will also take steps to clamp down on Medicaid fraud by conducting audits of services at providers as well as requiring homes to provide additional audited financial information for State review.

Governor Pataki's recent adult home legislation will be amended to require adult homes whose residents are receiving mental health services to hire a nurse to oversee medication management, maintain temperatures at appropriate levels, as well as to increase fines and formalize the licensing of adult home administrators.

The new workgroup, which will look at key issues related to adult homes, especially those related to the needs of the mentally disabled, will meet this month and report to the Department of Health by September 1, 2002 with its recommendations on how to improve conditions at adult homes.

The following individuals have agreed to serve as members on the newly formed adult home workgroup. Additional positions will be filled including a geriatician, RN, pharmacist, dietitian, another adult home operator, and an adult home employee representative. The members of the adult home workgroup include: State Health Commissioner Novello, Office of Mental Health Commissioner Stone, CQC Chairman O'Brien, Office of the Aging Director Patricia Pine, Harvey Rosenthal (New York Association of Psychiatric Rehabilitation Services), Karen Schimke (Schuyler Center for Analysis and Advocacy), David Rosen (Medisys, Jamaica Hospital), Dr. Neal Cohen, psychiatrist, Leon Hoffman, (operator of New Brookhaven, Leben House adult homes), Alfred Brandon (resident of New Monsey Park adult home), Dr. Richard Milone (psychiatrist, PMC board member), Rosa Gill (social worker), Florence Weil (NAMI). A representative from the State Attorney General's Office will also be asked to participate in the workgroup.

Over the last year, at the direction of Governor Pataki, DOH, OMH and CQC had already been working more closely together inspecting adult homes and the quality of care provided by the homes. This partnership has included enhanced surveillance activities to improve quality of care and the promotion of consumer participation in adult homes. The new actions will further enhance the partnership by ensuring that quality care is being provided at adult homes.

Death Reporting and Investigations:

  • A letter was sent on April 30, 2002 to all adult homes from the Commissioner of Health reminding homes of their statutory responsibility to report all resident deaths and attempted suicides within 24 hours to the Department of Health. The letter also indicated that felony crimes against residents must be reported to an appropriate law enforcement authority as soon as possible and no later than 48 hours after the event. Reporting of these events to CQC for residents receiving mental health services was noted as well. The letter indicates that failure to report will result in a citation and an immediate enforcement action.
  • A second, follow up letter was sent to all adult homes on May 3rd notifying homes of the increased penalties for failure to report deaths and attempted suicides in accordance with emergency regulations enacted on May 3..
  • Immediate investigations of reported deaths will be conducted. In addition, death report profiles or patterns for each adult home will be reviewed by a multi–agency review team to determine the need for further follow up surveillance actions.
  • DOH, CQC and OMH will develop a consolidated death reporting form for adult homes to replace individual agency reporting forms. The consolidated form will be completed and distributed to adult homes this month.

Emergency Regulations:

  • Emergency regulations, with an immediate effective date, were issued on May 3, 2002 increasing the penalty from $50 to $1,000 per day per incident for failing to report a death or attempted suicide.
  • In addition to increasing the fine for failure to report, the emergency regulations permit the imposition of fines for a broadened definition of systemic deficiencies.

Surveillance Actions/Joint Surveys:

  • New survey teams comprised of inspectors from CQC, OMH and DOH with experience in psychiatric care, medications and social work have started conducting inspections at adult homes. In addition, the Department of Health will implement a process that expedites enforcement actions against adult homes that are found to be providing insufficient care. The focus of the new survey teams will be death reporting as well as review of death cases, medication management, physical plant and case management.
  • The State Health Department, at the Governor's direction, will commit $1 million in funding to add approximately 12 new surveyors to conduct additional surveys and death and other serious incident report investigations. The current number of adult home inspectors totals 34, including 17 in New York City.
  • DOH, OMH and CQC will develop an "Immediate Response Team" that will be available to conduct immediate surveillance activities at adult homes with problems that pose an imminent risk to resident welfare and safety.

Financial Accountability and Medicaid Fraud Activities:

  • Profiles on Medicaid providers servicing adult home residents have been developed to identify potential patterns of overuse and abuse. A multi–agency team will meet to review the profiles and develop indicators for potential overuse and abuse. Follow up surveys and audits will be conducted. Physicians identified to be a party to any violations will be referred to the Department's Office of Professional Medical Conduct for disciplinary action, where appropriate.
  • Increased targeted Medicaid audit activities will be conducted based on review of unusual service patterns, desk reviews and other surveillance results.
  • Adult home cost reports are being revised by CQC to better identify and disclose adult home financial relationships with medical and mental health providers as well as related party transactions. Audits will be conducted to assess the accuracy of the cost report information.
  • Medicaid reimbursement regulation will be amended by redefining a clinic threshold visit to eliminate visits made solely for podiatric purposes.

QUIP Funding – Adult homes that have applied for QUIP funding – $3.3 million to be awarded by August 15, 2002 – have been immediately advised that their plans for the use of QUIP funds must be reviewed and endorsed by their resident councils. Such endorsement must be provided to DOH prior to the granting of any award.

– A multi–agency team will review proposed QUIP funding awards to assure that adult homes with quality or significant operational problems do not receive awards.

– Audits will be conducted to assure that QUIP funds are spent by adult homes in accordance with their approved plans.

State Will Require Quality of Care Changes at Adult Homes:

  • Medication Management – Impacted adult homes will be required to hire a fulltime RN to supervise and oversee the home's medication management.
  • Temperatures – Adult homes will be required to ensure that resident room temperatures are maintained at appropriate levels to ensure resident comfort. DOH/OMH engineering staff will be conducting on–site visits to determine the best ways for facilities to safely meet new standards.

Adult Home Training:

  • DOH, OMH and CQC will conduct mandatory 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 of adult homes.

Peer Support Services:

  • DOH, OMH and CQC will administer a Peer Support Services Demonstration Project that will focus on the provision of advocacy services by peers and resident advocates. Activities will include support for the development and operation of resident councils, training residents and councils with respect to their rights, assisting residents in negotiating resolution of problems;and providing outreach services to link residents to other services in the community.

Consumer Information:

  • Quarterly press releases will be issued identifying recent adult home inspections and the results of those inspections. The first release will be issued during May 2002 and willcover the first quarter of 2002.
  • Adult home statements of deficiencies (SODs) will be made available on the Health Department's website and updated on a regular basis. The posting will start during May.

The Governor's program bill which was released last month will be amended to include the following provisions: require impacted adult homes to hire a fulltime RN to supervise and oversee the home's medication management; require impacted adult homes to ensure that room temperatures are maintained at appropriate levels; expand authority to DOH to name a temporary operator without court approval; require adult home administrators to be licensed by DOH; require Public Health Council establishment approval for new adult care facilities; and authorize the State to ban new admissions to an adult home.

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.

Recent legislation proposed by Governor Pataki prohibited referrals to ACFs, including adult home residences for adults and enriched housing that do not have valid operating certificates, increased fines for violations related to care and required 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).

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.

5/8/02–43 OPA