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Birth of an Assisted Living Law

March 1, 2001
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Firsthand stories from a legislative collaboration by John Underwood, Laurel True, Robert Damron, Jerry Whitley & Jenny Mateyoke
A determined Kentucky coalition of various interests worked
more than a year to produce this legislative success. their stories...
John Underwood, executive director, Kentucky Assisted Living Facilities Association:
"This was uncharted territory for everyone. We started with blank notepads at a meeting on January 20, 1999, with the naive notion of ultimately reaching consensus on proposed statutory language that would clearly define assisted living services in Kentucky and concurrently embrace consumer choice and consumer protections.
"Our fledgling Kentucky Assisted Living Facilities Association (KALFA) had just been incorporated. The informal coalition we initiated to work on the new bill was not mandated by legislation or executive order. There were no scathing government reports or a media exposT that prompted the coalition members to gather. No consumer advocacy coup lurked on the horizon threatening the industry.

"There was, however, fundamental and philosophical agreement within this coalition of key legislators, AARP representatives, state agency personnel, KALFA leaders, other consumer groups, individual consumers, regulators and senior service providers on the central issues: Assisted living clients in Kentucky deserve a preferred residential housing and service arrangement that promotes independence, dignity and choice. And any recommended government oversight must be delicately balanced with consumer preferences.

"Fifteen months later, after a combined 60-plus meetings, testimonies and statewide forums, House Bill 148 ("An Act Relating to Assisted Living Communities") was enacted into law during Kentucky's 2000 General Assembly. In the interim, there were no lawsuits, no negative press conferences, no emergency board meetings and no defensive lobbying. The coalition remained intact because consumer choice and protections remained our guiding principles.

"For example, consider some of the terms used in Kentucky's assisted living statutes:

'Client, not patient;
'Community, not facility;
'Living unit, not bed;
'Move-out, not discharge;
'Lease agreement, not provider agreement; and
'Certification, not licensure.

"The AARP, State Rep. Robert Damron and State Rep. Susan Westrom championed the legislation, and it was cosponsored by half of the House of Representatives." Laurel True, member of AARP Kentucky State Leadership Council, chair of AARP Kentucky LTC and Independent Living Work Group: "My first visit to an assisted living community in Kentucky could be described as a day of joy and one of sadness. Sadly, I realized that if such an option had been available, then my father could have lived in this 'home away from home' for three of the three and a half years he was in a long-term care facility. At the same time, it was exciting during my visit to learn that assisted living communities were being planned and developed throughout Kentucky.

"Many of my colleagues in AARP Kentucky were discovering assisted living and shared my enthusiasm for the concept. It became clear to our state legislative committee that AARP Kentucky needed to assume a leadership role in securing the enactment of legislation that would protect both the consumer and assisted living provider. The public, hungry for alternatives, could otherwise be vulnerable to an operator who might seize on the name 'assisted living,' but fail to live up to the commitment. Of equal concern to us was that well-intended state regulators might slowly force assisted living into a 'quality of care' regulatory mode and lose sight of what the consumer values most: quality of life.

"In a very unusual move by a provider trade association, KALFA suggested we join forces and work for the passage of consumer-focused assisted living certification legislation. Some 15 months later, after intense work by many stakeholders and the cooperation of key members of the Kentucky General Assembly, such a law was passed by the 2000 legislature. One legislator described the guiding philosophy of the legislation as being, 'Consumer satisfaction is our most important product.'
"The legislation revolved around three major issues:

'Empowering the assisted living client to directly arrange or contract for a wide array of social and/or medical services as individual needs change;
'Balancing safety with autonomy by permitting clients to participate in activities and lifestyle choices that might present some risks, just as we all do in our own homes; and
'Ensuring each client's privacy through a separate living unit with lockable door, bathroom and individual thermostat controls.

"By maintaining a focus on consumer choice and satisfaction, AARP Kentucky and KALFA have been privileged to witness the implementation of a mandatory assisted living certification program that is good for Kentuckians and good for the industry."

Kentucky State Rep. Robert Damron: "HB 148-An Act Relating to Assisted Living Communities-was legislation that was long overdue. As a result, my colleagues in the Kentucky General Assembly strongly supported the legislation during the 2000 General Assembly. I believe there were three reasons the legislation was successful and so overwhelmingly supported by the members of the Kentucky legislature.