In the wake of a scathing legislative audit that found deplorable living conditions in community homes for the mentally ill, lawmakers took up a bill on Friday that would place the facilities more squarely under the thumb of state health inspectors.
The legislation, which was heard in the Assembly Health and Human Services Committee, would subject facilities that operate under a home-based care model meant to provide mental health patients an independent-living experience coupled with monitoring, support and behavioral skills training — often referred to as community-based living arrangement, or CBLA, homes — to the same stringent requirements placed on other facilities that care for Nevada’s most vulnerable residents.
Operators of those other facilities, which include residential facilities for groups, transitional living facilities for released offenders and halfway homes for those recovering from drug and alcohol addiction, have long argued that the CBLA homes should be subject to the same requirements and oversight that they are.
Lobbyist Helen Foley, representing the Nevada Assisted Living Association, told lawmakers that the concerns of assisted living facilities were “given short shrift last time by the presenters of the original bill creating the CBLAs.” The community-based living arrangement model was created during the 2017 legislative session in what state officials couched as an attempt to provide oversight of non-institutionalized living arrangements.
But a legislative audit in January found human feces smeared on floors, mold and mildew eating away at baseboards, leaking toilets, doors without door knobs, broken glass and other deplorable conditions in the homes and concluded that the CBLA model encouraged providers to “limit their level of care to maximize profits at the detriment of client services” without the proper checks and balances.
Since then, state officials have shut down the offending homes and promised lawmakers that all residents were placed into a “safe, licensed and certified home.” The state also transferred oversight of the homes from individual caseworkers to the Bureau of Health Care Quality and Compliance, which is responsible for regulating a wide array of health facilities from hospitals to adult day care facilities.
This legislation, which was sponsored by the Legislative Committee on Senior Citizens, Veterans and Adults With Special Needs, would shift even more oversight of the homes to the bureau.
If the bill becomes law, the bureau would have the same authority over CBLA homes that it does the other facilities it regulates, meaning it would, for instance, be able to conduct background checks and bar someone from operating or working at a CBLA home if he or she has been convicted of certain crimes. Right now, the state has to rely on the home to conduct its own background checks on employees and provide them to inspectors
“This really helps us to clean that up and to group those homes within all other things that HCQC regulates,” said Division of Public and Behavioral Health Administrator Julie Kotchevar. “So this is, we feel, very important for us to continue to regulate those homes properly and make sure what happened never ever ever happens again.”
The legislation is just one of a handful of bills expected this session to address issues associated with community-based living arrangement homes. A second bill, SB92, that would require anyone who is involved in referring patients to group housing arrangements to be licensed by the state passed the Senate unanimously on Thursday and is now headed to the Assembly for consideration.
“We feel like this bill is another step, along with other bills this session,” Kotchevar said.
The legislation presented on Friday also clarifies that any employment agency that contracts with people to provide personal care services to the elderly or those with disabilities in the state of Nevada must be licensed by the State Board of Health. Democratic Assemblywoman Lesley Cohen, who chaired the interim committee that brought forward the bill, said that the goal is to close a loophole whereby out of state employment agencies were placing individuals in Nevada but not complying with state law.
The bill will also require Nevada’s 2-1-1 referral hotline to include information about the licenses of any medical facility, group home or transitional living home and initiates a new interim study to compare different standards of training employees at different facilities to determine whether there should be a certain baseline level of training or competency.
During the hearing, Assemblywoman Robin Titus expressed some concern that the study might recommend too much additional training that would be overly burdensome. Connie McMullen, a lobbyist for the Personal Care Association of Nevada, also had similar doubts.
“For the personal care industry, there are plenty of training requirements, financial requirements and legal requirements and criteria, and I think I testified to that last session,” McMullen said. “My concern is of the 24 companies that I represent, only three take Medicaid, and that’s because of the requirements and the cost of reimbursement of our state.”
But Cohen told lawmakers that the study is purposefully wide in scope to examine who exactly lawmakers believe really should be required to prove a minimum level of competency.
“Does everyone need to be trained? Does the cook need to be trained? No, probably the cook doesn’t need to be trained. But the bus driver who is helping people in and out of the bus might need to be trained,” Cohen said. “We understand profit margins and expenses and that type of thing, and we’re not looking to make it onerous for any of the CBLAs but to make sure that people are getting that modicum of training to keep the residents safe.”