Analysis

Topic: Long-term Care
Sponsor: Representatives Woronchak and Vander Roest
Date Ordered Enrolled: December 14, 2000
Date of Analysis: December 21, 2000

Position: The Department of Consumer and Industry Services supports the bill.

Background: The first Alzheimer's special care units were established in the United States in the mid-1960's and early 1970's. These units were established primarily within nursing homes and were intended to meet the dual objective of better serving dementia patients and protecting those without dementia. The interest in special care units for Alzheimer's patients has grown dramatically in recent years as life expectancies increase. At the same time, specialized care began to be provided outside traditional nursing homes for persons with these conditions.

Unfortunately, all of the homes that market special care don't always practice what they promise. In some cases the term "special care unit" was distinguished from other areas of the facility only by the fact that the unit was locked. In cases where the special services were provided there were often hidden costs. One study in the early 90's found that the extra costs were not disclosed prior to admission nearly 40 percent of the time. At least 19 states now require written disclosure of special care services by facilities that advertise special care units for persons with Alzheimer's.

These bills are part of the House-passed long-term care packages. One of these bills has become law (House Bill 5460) and four more were enrolled in the Lame Duck session.

Bill Content: The bills amend the Public Health Code and the Adult Foster Care Facility Licensing Act. They contain identical language which requires a facility that represents to the public that it provides care to persons with Alzheimer's disease or a related condition to provide each prospective patient, resident, or surrogate decision maker with a written description of the services provided. The written description of services provided to residents or patients with Alzheimer's disease or a related condition is required to include all of the following:

- The facility's overall philosophy and mission reflecting the needs of patients or residents with Alzheimer's disease or a related condition.
- The process and criteria for placement in or transfer or discharge from the program.
- The process used for assessment and establishment of a care plan and its implementation.
- Staff training and continuing education practices.
- Physical environment and design features appropriate to support the function of patients or residents.
- Frequency and types of activities for patients or residents.
- Identification of supplemental fees for services.

The bills define "represents to the public" as advertising or marketing the facility as providing specialized Alzheimer's or dementia care services.

The original House Bill 5461 applied only to certain larger adult foster care facilities. At the department's request, the bill was amended to apply to all adult foster care facilities.

Arguments For: As life spans lengthen and the number of people looking for long-term care and assisted living grows, there has been an increase in the number of facilities advertising specialized Alzheimer's or dementia care services. In some cases residents have found that the advertised services turn out to be an empty promise. In other cases residents and their families may find themselves receiving bills for additional "specialized" services that they were not told about when the resident entered the facility. The bill would deal with these problems by requiring the facility to disclose services and fees up front.

Arguments Against: There is no need for the bills. Although there has been a small amount of anecdotal comment about alleged problems in this industry, there is little actual evidence that a problem exists.

Supporters/Opponents: The Alzheimer's Association testified in support of the bills in the House. The Health Care Association of Michigan and the Michigan Center for Assisted Living testified in opposition to the bills.