Wednesday, June 1, 2011

Pennsylvania Personal Care Homes are reluctant to become Assisted Living Residences

Assisted Living Residences are intended to fill a gap that has long plagued Pennsylvania’s continuum of long term care. 

In the past, the regulatory system in Pennsylvania allowed for personal care homes, which were only permitted to provide limited assistance to residents (but not including daily health care services), and skilled nursing facilities, which have the capability to provide around-the-clock skilled nursing health care. But there were many individuals who needed care that was more than what was permitted in personal care homes but was less intense than what could be provided in a skilled nursing facility. Under the prior regulatory regime these individual were forced into higher cost skilled nursing facilities.  

In 2007, the Legislature addressed this gap by enacting Act 56. That Act created a new classification of care facilities that are able to accept or retain residents with higher care needs including some who are Nursing Facility Clinically Eligible and who eventually may become qualified for Medicaid. However, Medicaid eligibility for residents of ALRs is unlikely to be available anytime soon. While the Rendell Administration intended to seek a waiver to be able to provide Medicaid financing for some ALR residents, the Corbett administration currently seems disinterested in pursuing any such waiver.
Unlike personal care homes, this new Assisted Living Residence (ALR) provider class will be able to deliver some health care services to their residents. ALRs are intended to have more of a private home-like feel than a nursing facility, including such amenities as separate bedrooms and baths and kitchen facilities and provide consumers will more direct control over their care. Facilities can no longer call themselves “Assisted Living” unless they become licensed under the new ALR regulations.

The Department of Public Welfare published final regulations on Assisted Living Residences to implement Act 56 on May 4, 2010. The regulations were approved by the Independent Regulatory Review Commission on June 3, 2010. The assisted living residence licensing regulations took effect on January 18, 2011.
However, the prior generation of personal care homes are not rushing to become Assisted Living Residences. There are 1,362 Licensed Personal Care Homes and Assisted Living Residences throughout Pennsylvania.  As of May 2011, less than 1% of the personal care homes had applied for ALR status. Licensure as an ALR brings with it higher costs, including licensing fees and the cost of having to comply with higher standards and possibly retrofitting facilities that don’t meet those standards.  Many former assisted living facilities have decided to remain licensed in the personal care home category at least for now and are just changing their names.  It is not clear that many consumers are going to understand the difference between a "senior living facility" and an "assisted living residence" in any event.  

As of mid-May 2011 only six ALR licenses had been issued.  A list of licensed ALRs is available on the Department of Aging website at


Anonymous said...

This was one of my primary concerns when we were working on the regulations - what's the incentive/motivation for existing PCHs to apply for AL status (which carries with it more regulations?). It's interesting to see how this is playing out. Thanks for the update, Jeff!
- Michelle Seitzer

Keller's said...

I know as a provider we are still waiting to see how this all works out until we go through the process of another licensure. One of the biggest deterrents for currant PCA's is the qualifications to become an ALF Administrator.

Thomas Taylor said...

You touch on some good points in your post here. I think any questions are best discussed with a professional. This care home put some of my worries to bed.
Nursing Homes Kent