Report: Rules hurt some care homes

HARRISBURG - New safety and training regulations have posed a financial burden for small personal-care homes, forcing some to close, leaving residents scrambling for alternatives and placing a higher burden on county agencies, a legislative report found.

The report, released yesterday by the Legislative Budget and Finance Committee, recommended that the Department of Public Welfare waive some of the new requirements in an effort to keep homes open if residents' lives were not in danger.

The Department of Public Welfare disputed the report's findings and suggested that the data - which came from a fraction of Pennsylvania's 1,589 personal-care homes - might have been skewed by operators who opposed the new regulations.

In a written response, Public Welfare Secretary Estelle B. Richman said the analysis was flawed because the data were not independently validated and the responses were not from a representative sample of all home operators.

"Simply put, operators who don't like the regulations are significantly more likely to respond than homes that have had no problem complying," Richman wrote. "This means the survey is likely to overstate costs and complaints about the regulatory process."

As The Inquirer reported in February, at least 55 residents of personal-care homes in Pennsylvania have died since 2000 under circumstances that raised questions about the quality of their care and whether their deaths could have been prevented. Other residents were beaten or neglected, and at least five were raped.

Richman has acknowledged that state oversight suffered in the early part of her tenure, allowing deficient operators to remain in business. She has vowed to step up enforcement and work to reverse a backlog of annual inspections.

The report released yesterday analyzed the costs associated with regulations put in place in 2005 and found that the Welfare Department had underestimated the financial burden on smaller homes. Among the new requirements: more emergency exits and fire alarms on each floor, along with increased training and staffing.

Small personal-care homes - especially those that depend on Social Security income from their residents - have found it a struggle to afford those improvements, the report said. And an increasing number have been forced to close because of rising costs or have been shut down for unsafe conditions.

The trend has strained county human-services programs that must find new homes for residents, the report said. Even so, there are no current proposals to increase funding.

The report urged the state to issue waivers to homes that cannot comply and find appropriate alternative residences for those who are left homeless when a care home is closed.

A top Welfare Department official who testified said the funding crunch would not change the agency's push to improve conditions.

"We have a responsibility to carry out enforcement of the regulations and will continue to do so without apology," said Kevin Casey, a department deputy secretary.

Between June and November 2006, 61 personal-care homes were closed or were in the process of closing - at a monthly rate of double the number before the regulations were in place, according to the report.

In some cases, the report found, people with chronic psychiatric problems were transferred to homes that could not meet their needs, and some residents were left homeless.

Casey said that the agency was working with mental-health advocates to find affordable options when homes closed, but that it was difficult to find beds for low-income residents.

He also said regulators were trying to speed up annual routine inspections of the homes.

Last month, the Welfare Department announced that it was as much as two years behind on the inspections. As a result, about 73 percent of the state's 1,589 personal-care homes are operating with expired licenses.

Of the 1,190 homes with expired licenses, about 600 have not been inspected at all since new personal-care home regulations took effect two years ago.

In response, the agency has hired 30 retired workers, many of them former nursing-home inspectors, to cut the backlog.