Police and emergency workers at the Twin Spruce personal-care home near Sunbury in 2004 after a fire killed 3 residents. At that time, more stringent rules for fire safety had been beaten back by the personal-care industry.
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Part 3: Writing their own rules
Drive for change left Pa.'s personal-care industry at the wheel.
A six-month grace period on a tougher staff training requirement.
An 18-month delay for fire alarms for the hearing impaired, and on a mandate for two fire exits on each floor.
A grandfather clause exempting existing homes from having larger bedrooms for wheelchair-bound residents.
In a statement, Rendell defended the end product, saying the rules "not only benefit the providers but allowed us to raise the standard for delivering quality personal-care services in Pennsylvania."
Asked about the politics, Rendell noted only that the regulations were approved by the legislature's health committees.
Welfare Secretary Estelle Richman, the governor's key official in revising the regulations, said she made the best deal she could, given political realities.
She added that she believed the new regulations amount to a significant improvement.
"The industry is large and powerful," said Richman, who took office in January 2003 while the debate was under way. "Hundreds of operators came in and said, 'You're putting me out of business.' "
On the other side, "There were not tons of people living in personal-care homes coming in and saying, 'My life is unsafe.' "
"Keeping my standard up here," she added, raising her hand up high, "and not having [the regulations] go through doesn't help anybody."
Industry representatives say their goal was to avoid burdensome red tape without compromising resident safety. Some homes supported updated regulations.
"I don't support compromises on fire-safety standards," said Matt Harvey, a former personal-care-home executive who led an unsuccessful legal challenge to the new rules. "But there is a lot of overkill."
The moratorium on enforcement ended in October, but the new rules still are not in effect for hundreds of homes. That's because regulators agreed that the old rules would stay in place for each home until their annual inspection is completed.
The understaffed department is way behind in annual inspections, so the updated health and safety protections still are not being enforced in hundreds of homes, regulators acknowledge.
As state lawmakers and policy-makers debated the new rules, they heard a series of horror stories from advocates about the long history of deaths, abuses and regulatory failures in personal-care homes.
But those speaking for personal-care-home residents found themselves outgunned in the Capitol by a well-funded industry that launched an effective campaign of phone calls and letters, both from facility operators and residents.
As a result, the Harrisburg debate over improving personal-care-home regulations focused almost exclusively on making changes to satisfy the industry, according to interviews with key stakeholders and a review of hundreds of pages of public comments and testimony.
"They were taxpaying businesses in their districts, and legislators were hearing from them in a big way," said Sue Walther, a mental-health advocate who led a statewide coalition seeking better protections in personal-care homes.
"This was a Republican legislature. It's 'all hail to small business.' "
While its members were not major campaign donors by Harrisburg standards, the industry had operators in nearly every legislative district, and strong trade organizations in the capital.
