1. Developing Regulations to Protect Older Adults Office of Health Care Quality Student: Grace E. Mandel Preceptor: Amanda Thomas, MPH Health Policy Analyst for Regulatory Affairs

2. Office of Health Care Quality Monitors the quality of care in Maryland’s health care facilities and community-based programs through regulation, surveying and education dhmh.maryland.gov/ohcq

3. Regulatory Process Develop Draft Submit to Office of Policy and Regulations Approval Process New Regulation Formal Informal

4. Why revise a regulation? Adopt new requirements Amend requirement Repeal requirements Remove outdated information OR 1

5. Why revise a regulation? Respond to request from Governor Comply with: – Regulation Review and Evaluation Act (RREA) – New legislation 1

6. Paperwork to Office of Policy and Regulations (OPR) All Updates Require: Notice of Regulation Development Form Background Form Proposed Action Form & If Mandatory under RREA: Work Plan Evaluation Form & If Incorporation by Reference: Incorporation By Reference Form 2

7. Who Participates in Draft Development? Program Coordinators and Managers -Incorporate feedback to develop a new draft 3 Stakeholders & Community Members -Town Hall Meetings -One on One Meetings -Informal Comments &

8. Submit to Approval Process

9. Approval Process 4 Formal Comment Period 5 Administrative, Executive, and Legislative Review Committee (AELR) Reviews Proposed Updates 6 Governor Signs Regulation

10. Assisted Living Defining Characteristics – Autonomy, choice, and dignity – Less expensive than long term care – Designed for adults with limited needs assistance

11. Stakeholder Involvement Forums One on One Meetings Comment Periods Goal: Education & improvement of the regulation

12. Attendance at Forums

13. Satisfaction at Forums

14. Informal Comments

15. Stakeholders

16. Interest Areas

17. Manager Training (1) The assisted living manager shall at a minimum: (i) A 4-year, college-level degree; (ii) 2 years experience in a health care related field and 1 year of experience as an assisted living program manager or alternate assisted living manager; or (iii) 2 years experience in a health care related field and successful completion of the 80-hour assisted living manager training program;

18. Manager Training

19. Comments on Managers Requirement “I am unclear how a college degree will impact one's ability to effectively manage an assisted living facility. What seems more relative and appropriate is experience in the field as well as taking the 80 hour Manager's training Course through the Beacon Institute.”

20. Staffing Ratio “Clarify what “on site staff sufficient in number means”. This is impossible to prove.” “Appropriate staffing is determined by the organization providing the services. This determination is made by careful evaluation of the resident's needs, type of staffing provided and possibility of requiring private duty care givers in situations where appropriate. Too many details go into making this determination and cannot be successfully determined by OHCQ by making a blanket statement for all facilities.”

21. Public Health Impact Protections for residents of Assisted Living facilities Flexibility while also having enforceable standards Easily Interpretable Regulations

22. Special Thanks! Amanda Thomas, MPH – Health Policy Analyst for Regulatory Affairs Dr. John Parrish – Director of Quality Initiatives Unit Dr. Beth Resnick and Paulani Mui, MPH – Johns Hopkins Bloomberg School of Public Health