Some ALFs want less regulation as they cope with COVID-19
Three weeks ago, federal health regulators suspended almost all inspections of elder care homes that weren’t related to fighting the coronavirus pandemic.
Some assisted living facility operators want to eliminate those, too.
A private Facebook group of more than 1,500 ALF professionals met online Wednesday afternoon to discuss their concerns about the state’s oversight of the COVID-19 pandemic. The talk was led by Pascal Bergeron, the operator of a Hollywood ALF, North Lake Retirement Home.
As he spoke to the 60 or so operators who participated in the meeting, Bergeron suggested that health regulators should help owners navigate the crisis — then get out of the way.
The Agency for Health Care Administration, or AHCA, which licenses ALFs like North Lake, long has been a target of derision by facility owners. The group Bergeron leads, called ALF Boss, has a page on its website devoted to helping operators deal with the regulatory aspects of the coronavirus.
Bergeron praised AHCA, and its secretary, Mary Mayhew, generally for being “on our side” as the coronavirus swept through the state, especially South Florida.
“The only frustrating part with all these agencies, however, is them wanting to enter our buildings to inspect,” he said. “To make sure we’re doing what is asked of us.
“I wish they would have a little more faith in us, that we want to succeed in this, that we don’t want any lives lost,” Bergeron added. “Having all these different agencies coming into our buildings right now. … I’m kind of not so sure about that one. But we have to comply the best we can.”
Bergeron had invited the Miami Herald to observe his meeting.
Florida serves more than 100,000 residents in 3,000 ALFs, some of which house residents with chronic mental illness or developmental disabilities. Most of the homes in Florida seem to be doing well, Bergeron said. In fact, he was so confident that state facilities would see the crisis through with no casualties that, on March 19, he began an online whiteboard keeping track of deaths, which started with zero.
Minutes later, someone commented that a resident of a Jacksonville home had died. “I was so bummed out,” he remembered. “I felt sick to my stomach.”
Bergeron still thinks the majority of ALFs in the state are “really doing a great job.”
“The numbers are relatively low compared to tragedies that have happened in other states and our assisted living facilities’ numbers are extremely low right now.”
Bergeron said he thinks that’s because of all the precautions ALFs are taking. “I’m gonna knock on wood that we keep those low.”
“Everyone is looking at us right now. Everybody,” he said. “They’re waiting for us to drop the ball on this.”
Two weeks ago, Florida health regulators had reported 33 long-term care residents had been infected with COVID-19, the disease caused by coronavirus infection.
But when journalists and elder advocates asked where the infections were occurring, administrators refused to discuss it, and stopped providing data.
One Broward facility appeared to be an outlier: Six residents of the Atria Willow Wood ALF in Fort Lauderdale died after contracting COVID-19. Twenty of the home’s residents have tested positive for the virus.
Bergeron said he believes the outbreak at Willow Wood happened because someone brought the virus in before standards were put in place to stop transmission, and then “all the alarms were sounded.” He sent them his prayers, and the group took a moment of silence to think of those killed by the virus.
“This is all of our worst fears as operators,” he said. “No one wants to be going through that right now. It’s definitely not time to be throwing people under the bus.”
Some of the meeting participants said the entire ALF trade had been abandoned by the state, which appeared to favor the more powerful nursing home industry when it came to support.
“State talked about helping the nursing homes financially,” wrote Carlos Andres Urbano in the comments section, the administrator of a Homestead ALF, “but the wording seems not to include ALFs.”
Bergeron is also wary. “I just don’t feel like we’re getting the love that we should be getting,” he said. “The state’s always tight with money when it comes to ALFs.”
Bergeron said he thinks the country’s emergency response and stimulus package provides some relief for small businesses, which include privately owned ALFs. He also believes state leaders want to help cashstrapped ALF operators in some way. But he said he still doesn’t have any details. He hopes he’ll know by next week.
For some of the Facebook group’s participants, the concerns were buried in the mundane: Where is the next roll of toilet paper going to come from?
Some commentators said they’re only able to find expensive supplies. Bergeron encouraged them to keep looking for cheaper prices, and leverage the group’s greater buying power. “I think it’s really amazing that everyone has been coming together,” he said. “We’re on the same team.”
Some smaller facilities weren’t able to find food staples in the stores, so the larger homes offered to order food for them from larger distributors.
The state also needs to advise homes of what to do in the event of a confirmed case of COVID-19, Bergeron said. A lot of the facilities, he said, don’t know exactly what the protocol is.
ALFs should keep those with symptoms isolated and try to get their residents tested, Bergeron said.
ALFs, unlike nursing homes, will face greater challenges protecting their residents from the virus. The facilities are not locked, and residents — especially those with mental illness — often wander away. Staff can only follow the state’s protocol and issue the residents masks to wear outside their facilities and isolate them in private rooms, if possible, when they return.
“It’s very difficult to keep those individuals from leaving,” Bergeron said. “At the same time, those individuals are making it very hard and frustrating for us, because we’re trying to secure our buildings. Yet these individuals keep moving back and forth.”
Bergeron said he hasn’t received any guidance from the state on how to keep residents safe when operators can’t control movement in and out of their homes. Some, he added, are considering adopting emergency rules that allow owners to evict residents who violate stay-at-home orders.
“But what happens after that?” Bergeron asked. “I don’t see that being a good situation. I see the resident wanting to come back into the facility, and then what?”
Operators also are concerned about another potential threat on the horizon: hurricane season.
In the aftermath of 2017’s Hurricane Irma, long-term care operators were ordered to either install — or contract for — generators powerful enough to keep elderly and frail residents cool during a power outage.
Many never did. And they could face fines if regulators insist on enforcing the state’s disaster preparedness laws.
Right now, he reminded the group, the main focus is on protecting residents. “We take care of human beings; that’s what we do.
“We’re a group that’s been through a lot. We’ve been through hurricanes. We’ve been through all kinds of things of this nature and we’re very tough during these times. We will find a way through. We will use the resources we have. We will do the best we can.”
Carol Marbin Miller: 305-376-3211, MarbinMiller
Pascal Bergeron, the operator of a Hollywood ALF, North Lake Retirement Home