Arizona seniors, families could see major changes in assisted living as Legislature passes reforms

Arizona seniors residing in assisted living facilities could soon have better protections and standards enshrined in state law.

Proposed legislation to increase the Arizona Department of Health Service's ability to regulate assisted living facilities passed the Legislature on Thursday, after a final 59-0 vote in the House of Representatives. It now heads to Gov. Katie Hobbs' desk, where her signature to make it law is likely.

The bill, sponsored by Rep. Tim Dunn, R-Yuma, would:

• Make assisted living facilities pay stiffer penalties for endangering residents. The bill raises the cap on fines from $500 to $1,000, and allows that penalty for each resident affected by a violation, and for every day the violation persists. Current law prohibits the Health Department from fining facilities more than $500 per violation per day — no matter the number of residents affected.

• Prevent facilities from hiring or continuing to employ people whose names are on Adult Protective Services’ abuse registry. Now, facilities can hire people on the list — even though they are placed there if protective services finds they abused, neglected or exploited a vulnerable adult. The bill requires facilities to verify that none of their employees are on the registry by March 31, 2025, and to re-verify that annually.

• Require the Health Department to create memory care standards for "directed care" facilities — those licensed to serve residents who need the most help. Currently, Arizona has no standards for what constitutes "memory care" — but facilities still use the term, and it typically comes with an elevated price tag.

• Expand training requirements so all caregivers working at directed care facilities must receive an initial eight hours of dementia care training — double the current minimum — and four more hours every year.

• Establish a 25-member vulnerable adult study committee charged in part with researching "best practices related to APS at the state, municipal and community levels" and identifying "best practices for data collection and data sharing" between the agencies that serve vulnerable adults.

If signed into law, Dunn's bill would provide solutions to several problems exposed in The Arizona Republic's "The Bitter End" investigative series, which chronicled violence between residents at Arizona assisted living facilities.

"To me, any change is a victory," said Cathy McDavid, whose mother was killed three years ago by another resident at north Phoenix's Bethesda Gardens. Her mother's story was the impetus for The Republic's investigation.

"No, it's not everything we wanted, but there's next year ... I'm really pleased. And I think my mother would be really pleased. And I feel like I've made a little bit of a difference."

The proposed legislation passed the Senate 18-7 on April 3, and first cleared the House 49-10 at the end of February. When it arrived at the Senate, it had provisions to require facilities have a special license to offer memory care, and expanded training requirements for caregivers working in memory care units.

Amendments from Sen. T.J. Shope, R-Coolidge, removed the specialized memory care license requirement and made it so any caregiver in a facility licensed to serve residents who need the most help must adhere to new minimum dementia care training standards.

Shope also amended the bill to remove a requirement to add two advocates for people with disabilities to the board that licenses and penalizes facility managers.

Facility managers historically have outnumbered resident advocates on the board, and many have sympathized with those they regulate. Under the bill's final language, more than half of the board's members will be retired or current managers.

Daughter shares mother's story of neglect with lawmakers

Bonnie McLeod, whose 85-year-old mother, Betty, lives in a memory care facility in Bullhead City, said she thinks the bill's provisions for new training requirements and higher fine caps are essential. She testified at a Senate hearing in March.

Betty was diagnosed with early stage Alzheimer's in 2002, McLeod said. Her family made the decision to move her into an assisted living facility nearly three years ago. McLeod helped pick the place for her mom — she remembers how neat and clean it felt at first, how nice the people there seemed.

That was before McLeod learned that facility employees left her mother's dentures in for so long that Betty's gums had grown and stuck to them.

Betty needed Novocaine for a dentist to remove the dentures, McLeod said. She had to go six months without dentures, subsisting on baby food.

McLeod's sister filed a complaint with Adult Protective Services. The program — which in the past has had a dismal record of substantiating allegations — substantiated her claim last year.

A facility employee was placed on Protective Service's registry for failing "to ensure the vulnerable adult received the necessary oral hygiene maintenance, which resulted in the vulnerable adult contracting a severe oral infection and requiring surgery." McLeod said that employee no longer works there.

"The facilities promise you the moon — you take your family members there, right? Because you can't take care of them. You want them to be taken care of," McLeod said in an interview. "And they're not being taken care of."

Advocates promise to come back for more: 'We don't give up'

Dunn's bill was one of two aimed at tightening controls over senior living facilities in Arizona that passed the House and went to the Senate for consideration this session — but it's the only one to emerge.

The other bill, sponsored by Rep. Quang Nguyen, R-Prescott Valley, was blocked by Shope's Health and Human Services Committee last month, despite passing the House with overwhelming bipartisan support. He was asked why, but never responded.

That proposal would have allowed residents and their families to put cameras in residents' rooms and required assisted living facilities to report physical altercations between residents to the Health Department.

A provision prohibiting facilities from hiring people on the protective services registry is the most significant part of Nguyen's bill that survived as a part of Dunn's.

But advocates say they'll come back to the Capitol next year with more reforms.

"Rep. Nguyen took a lot of the things that were not in other bills and he championed that, and he didn't back down. But unfortunately, politics sometimes prevails," Dana Kennedy, state director for AARP Arizona, said.

"We don't give up," Kennedy said. "I still think being able to provide a tool to families ... allowing them to put cameras in facilities I think would really help — so we're not going to give up on that."

Residents' families say they plan to stay involved, too.

"You know, they say the longest journey begins with one step. This is my one step. This bill is my one step," McLeod said. "I'm not stopping after this bill."

Arizona Republic reporter Caitlin McGlade contributed to this article.

Reach Sahana Jayaraman at Sahana.Jayaraman@gannett.com. Follow her on X, formerly Twitter, @SahanaJayaraman.

This article originally appeared on Arizona Republic: Arizona Legislature OKs major reforms for assisted living facilities