The Emergence of Assisted Living Licensure: Stakeholder Views and NAB Initiatives

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The Emergence of Assisted Living Licensure
Stakeholder Views and NAB Initiatives

• NAB Mid-Year Meeting
• November 15, 2007
• Las Vegas Nevada

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Panelists

• Pam Dukes, SC Board of Long Term Care Health Care
  Administrators
• Ted LeNeave, VA Board of Examiners of Nursing
  Home Administrators
• Vicki Goettsche, ID Board of Asstisted Living
  Administration
• Margaret McConnell, NV Board of Examiners for
  Long Term Care Administrators
• Co-Facilitaors Randy Snyder, MN Board of
  Examiners of Nursing Home Administrators
• Randy Lindner, NAB

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Agenda

• Purpose
• National Perspective - The Changing Landscape
• What? Acuity?
• Medication Use in AL
• The Changing Face of Assisted Living
• State Regulatory Overview
• State Requirements for Assisted Living
  Administrators
• Lessons Learned
• Initial Obstacles
• Benefits
• Challenges
• NAB Next Steps

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The Changing Landscape
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What? Acuity?

• Isnt Assisted Living a NON-medical model of
  care?
• Isnt Assisted Living for active seniors who just
  need a little help?
• How can we have RISK if this is
• non-medical care?
• Source Assisted Living Nurses Association

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Medication Use in Assisted Living (AL)

• Recent 2007 study shows the average number of
  medications ordered for residents was 13
• Relatively high use of high risk medications
  (psychotropics, anticoagulants, cardiovascular
  agents)
• Psychotropic medication use ranges from 35-58 in
  AL
• Young, H., Sikma, S. K., Reinhard, S.,
  Munroe, D. J. (2007). Medication management in
  assisted living settings Findings in four states
  (Oregon, Washington, New Jersey, Illinois).
  Manuscript submitted for publication.
• Reinhard, S. C., Young, H. M., Kane, R. A.,
  Quinn, W. V. (2006). Nurse delegation of
  medication administration for older adults in
  assisted living. Nursing Outlook, 52(2), 74-80.
• Source Assisted Living Nurses Association

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The Changing Face of Assisted Living

• Coming to us older--half over 85 yrs old
• Staying longer (even with SNF on campus)
• Medical paradigm changing to community care
• Increasing acuity because of market demand
• Increasing acuity because of licensing
  flexibility
• Source Assisted Living Nurses Association

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The Current Regulatory Landscape

• Licensure by the State
• Alabama Initial regs required state law exam
  only, must expand to include knowledge based exam
  in two years
• Delaware (NHA License)
• District of Columbia Legislation passed,
  regulations under development
• Idaho requires NAB National Exam
• Indiana recently passed legislation requiring
  licensure, regs under development
• Kansas (Adult Care Home Admin license or engage
  in operator training)
• Maine (NAB NHA or AL National Exam or training
  program required in Level IV Facilities)
• Missouri (NHA for Level II Facilities, NHA or
  education requirement for Level I) are
  currently planning to separate NHA and AL
  licensure requirements
• Montana (NHA license or Assisted Living
  University Training Program)
• Nevada requires NAB National Exam, is currently
  implementing Administrator in Training Program
• New Jersey (NHA license or AL Certification)
• Ohio (NHA or Health Care Prof License, or College
  Degree)
• Oklahoma (NHA license, or AL Certificate)
• Pennsylvania recently promulgated regulations for
  AL licensure
• South Carolina requires NAB National Exam and
  State Law Exam
• South Dakota (Health Care Professional License or
  Approved Training Program and Competency
  Evaluation)
• Virginia regulations effective January 2008 AL
  Licensure with NAB RCAL Exam

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Recent Industry Position on Executive Director
Training
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Resource Links

• National Center for Assisted Living State
  Assisted Living Regulatory Review
• http//www.ncal.org/about/state_review.cfm
• State of Nevada Regulations for Administrators of
  Facilities For Long Term Care
• http//leg.state.nv.us/NRS/NRS-654.html
• State of Idaho Residential Care Administrators
  Act
• http//www3.state.id.us/idstat/TOC/54042KTOC.html
• State of South Carolina Regulations for Long Term
  Health Care Administrators
• http//www.scstatehouse.net/coderegs/c093.htm
• State of Virginia Draft of Final Regulations
  Governing the Practice of Assisted Living
  Administrators
• http//www.dhp.state.va.us/nha/leg/DraftALF0710200
  7.doc
• Page 158 of agenda book

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State Requirements for Assisted Living Panel
Members

• Pam Dukes, SC Board of Long Term Care Health Care
  Administrators
• Ted LeNeave, VA Board of Examiners of Nursing
  Home Administrators
• Vicki Goettsche, ID Board of Asstisted Living
  Administration
• Margaret McConnell, NV Board of Examiners for
  Long Term Care Administrators

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Virginia Regulations for Assisted Living
Administrators NAB 2007 Mid Year ConferenceLas
Vegas

• Ted A. LeNeave, Chairman
• Virginia Board of Long Term Care Administrators

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Virginia Assisted Living Administrator Licensure

• Governor approved regulations on 10/26/07
• Regulations will be effective on January 2, 2008

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3 Pathways to AL Licensure

• Administrator-in-training (AIT) Program
• Certificate Program
• Degree and practical experience

Note Each pathway ends with passing grade on NAB
AL Exam No State Jurisprudence Examination
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1. AL Administrator-in-Training Pathway to
Licensure
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2. AL Certificate Program Pathway to Licensure
3. AL Degree and Practical Experience Pathway to
Licensure
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Preceptor Requirements

• Hold a current, unrestricted Virginia AL
  Administrator license or Nursing Home
  Administrator License
• Employed full-time as administrator 2 of past 4
  years
• Supervise no more than 2 AITs at a time

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Licensure by Endorsement

• Holds a valid unrestricted license (if coming
  from state issuing credentials)
• Has practice 2 out of four years preceding date
  of application, or
• Has education and experience equivalent to VAs
  requirements, and
• Has passed the National Examination

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Licensure Renewal (annual)

• 225 Renewal Fee
• 20 CEUs
• 10 can be self study
• 10 hours in excess may be transferred over to
  next renewal year
• All must be NAB approved

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Lessons Learned

• Why was ALA licensure initiated?
• Who lead the effort?
• Ted LeNeave Chair, VA Board of Examiners of
  Nursing Home Administrators

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Lessons Learned

• What were some of the initial obstacles?
• Industry Resistance
• Grandfathering not allowed by law
• Regulations laborious
• Protect integrity of profession
• Exam Development
• Margaret McConnell, NV Board of Examiners for
  Long Term Care Administrators

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Lessons Learned

• What public protection activities do you see as
  valuable to the citizens of your state?
• Pam Dukes, SC Board of Long Term Care Health Care
  Administrators

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Lessons Learned

• Have there been challenges to the current
  regulations?
• Vicki Goettsche, ID Board of Asstisted Living
  Administration

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NAB Next Steps

• To the Panel What do you wish NAB had provided
  you during your journey?
• To attendees Should NAB address a national
  perspective on this issue?
• Practice Act?
• Endorsement Standards?
• Other Guidelines?
• What pieces of public safety should be addressed
  at the front end rather than wait for 51
  different models?

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Contact Information

• Tel [phone]
• Fax [phone]
• www.nabweb.org
• To view this presentation click on Member
  Resources 2008 Mid-Year Meeting Highlights
• National Association Of Boards of Examiners of
• Long Term Care Administrators
• 1444 I Street NW, Suite 700
• Washington DC, 20005-2210