2008 public policy outlook for assisted living

It is impossible to talk about public policy in 2008 without recognizing that the year could bring significant changes in the political arena. A looming Presidential election, along with the normal cycle of House and Senate races, will impact what does and does not get done on Capitol Hill. To that end, many of the 2007 federal legislative issues of interest to assisted living providers and consumers will be continued in 2008—and most likely to 2009.

The following are key federal issues from 2007 that will be carried over in 2008.

Medicare Part D

The Assisted Living Federation of America (ALFA) and other trade and advocacy associations will continue to support legislation to eliminate the copay for assisted living dual-eligible residents. These residents are eligible for both Medicare and Medicaid and as a result, they are our most vulnerable residents. Currently under Medicare Part D, dual-eligible residents living in nursing homes do not have a copay. Unfortunately, what may have been an oversight in the original Part D legislation is the requirement that dual-eligible residents in assisted living settings must make a copay for their prescription drugs. Champions of this legislation to eliminate the copay include Senators Gordon Smith (R-Ore.), Hillary Clinton (D-N.Y.), Bill Nelson (D-Fla.), and Congressmen Lloyd Doggett (D-Texas) and Lincoln Diaz-Balart (R-Fla.).


The Community Living Assistance Services and Supports Act (CLASS Act) sponsored by Senator Edward Kennedy (D-Mass.) provides a national model to help elderly and disabled citizens maintain independence and choice in meeting their long-term care needs. Through voluntary payroll deductions, all participating citizens will be eligible for a monthly benefit, depending on the functional needs of the individual. The individual will have choices to determine how the benefit is spent to meet his or her needs and desires. Assisted living would be one of the allowable choices.

Elder Justice Act

The Elder Justice Act, introduced by Senator Orrin Hatch (R-Utah) in 2007, is designed to prevent abuse and neglect of the elderly. This bill would provide needed protection for our most vulnerable citizens.

Patient Safety and Abuse Prevention Act

The Patient Safety and Abuse Prevention Act, introduced by Senator Herb Kohl (D-Wisc.) in 2007, would seek to protect residents of long-term care settings from employees with criminal histories. Kohl is chair of the Senate Special Committee on Aging.

Secret Ballot Protection Act

Support of the Secret Ballot Protection Act, introduced by Senator Jim DeMint (R-S.C.) would ensure that all workers continue to have the basic right to a secret ballot when determining how to vote in union elections. Opposition to the so-called Employee Free Choice Act (EFCA) will continue. While we do not anticipate any action on this bill in 2008, EFCA could be high on the congressional to-do list in 2009.

Grassroots Advocacy

As in past years, ALFA’s main focus for Capitol Hill will continue to be grassroots advocacy. It is critical to educate our lawmakers and their staffs about assisted living, how it is regulated, and the quality care that is provided to a million residents nationwide. ALFA produced an advocacy DVD, Discover Assisted Living—Facts about America’s Fastest Growing Long-Term Care Option, to explain assisted living to elected officials and their staffs.

While the activity at the federal level may be somewhat slow pending the November elections, activity at the state level will make up for any federal lull. Regulatory reviews and revisions will be occurring in approximately a dozen states, including New York, Pennsylvania, Maryland, and Arizona. In many of these states, the regulation reviews are going to be comprehensive. In New York and Pennsylvania, the rules are being developed to implement new laws that made sweeping changes on how assisted living is regulated in each of these states.

ALFA is looking forward to seeing the first assisted living communities licensed in the state of New York and the District of Columbia. While laws have been on the books in both cases for a number of years, actual licensure of communities has been progressing slowly but should finally happen in 2008.

Other key issues at the state level will involve ALFA’s efforts to ensure that hospice residents can move in and remain living in assisted living communities. ALFA is actively pursuing legislation in Tennessee and South Carolina to make this a reality.

While much of the work at the state level is often reactive to bills introduced, ALFA will be busy working with its ALFA state affiliates to be proactive and make sure that state laws and regulations embrace ALFA’s core principles. These principles support meaningful resident-centered and consumer-driven oversight of assisted living at the state level.

The Future

Without a crystal ball, it is hard to predict what 2008 will truly bring for assisted living providers and consumers. However, everything points to an active year at the state level, and reinforces our continued need for advocacy at both the federal and state levels.

Maribeth Bersani is Senior Vice-President of Public Policy for ALFA. For further information, phone (703) 894-1805 or visit


To send your comments to the author and editors, e-mail bersani0108@nursinghomesmagazine.com.

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