Assisted living facilities fear big fee hike

Tuesday, July 23, 2002 | 11:19 a.m.

Meeting A meeting of facility owners, administrators and state legislators is being held today at 5 p.m. at the Bridge Assisted Living of Paradise Valley, 2205 E.Harmon Ave. The meeting is open to the public.

At the least, the 170 percent hike in annual licensing fees proposed by the Nevada Bureau of Licensure and Certification will force the already struggling industry to dig deep into its pockets and the pockets of its clientele, local facility owners said. If approved by the Board of Health and signed by the Secretary of State, the increase would hit facility owners before the 2003 license renewals are due in December.

The proposal sets up a tug of war between the fixed budget of the state agency, which relies solely on the fees, and seniors' fixed income. Facility owners say it could spur a crisis in the long-term care industry.

Private facilities say they will have to pass on the higher fees to their residents. Public facilities, which are limited on what they can charge by state law, will have to make up the difference by cutting costs, said Mark McConnell, co-owner of the Charleston Retirement and Assisted Living Center.

But the bureau doesn't have a choice, because it already is operating at "bare bones," having closed a Reno office and leaving several positions unfilled, Bureau Health Facility Surveyor Diane Allen said.

"Nevada is the highest in the country (in licensing fees) due in large part that they have no budget through the state," McConnell said. In California facilities pay a flat annual fee of $250 for licenses and in Texas, $100 plus $5 per bed for residential facilities, he said.

In Nevada they pay $300 plus $35 per bed -- before the increase.

Facility owners said they understand the budget crunch, but maintain that the fee increase could create a care crisis for senior citizens at the state's more than 355 licensed assisted living facilities if facilities are forced to close or raise rates above what residents can pay.

"It's going to have a huge impact on the community," said Linn Thome, administrator for the Bridge Assisted Living of Paradise Valley. "With the malpractice crisis going on, it is just going to exacerbate the situation."

Facility owners hope a meeting tonight with legislators will result in some solutions. They would like to see the Bureau of Licensure and Certification supported by the state's general fund. The bureau hosted a public workshop in Las Vegas Monday to discuss the proposed increases and seek ways to decrease the economic impact on smaller facilities.

State Assemblywoman Chris Giunchigliani, D-Las Vegas, who is running unopposed for District 9, said that the Legislature may have to question how bureaus are funded, despite a current statewide budget crunch.

"State bureaus have been underfunded for years, and when the fees become exorbitant they affect those who need access to long-term care," Giunchigliani said.

Group residential facilities and individual residential care homes would be the hardest hit by the fee changes. The annual per-bed fee would rise from $35 to $95 for a group residential home and from $35 to $135 for individual residential care.

For McConnell's 129-bed Charleston Retirement facility, that represents an increase from $4,515 to $12,255 a year. It's a cost McConnell can't pass on to his residents, he said, as more than 75 percent of them receive state aid such as Medicare or Medicaid. A public facility receives less than $1,000 a month for those residents, as opposed to the $2,000 to $4,000 private facilities receive for their clientele, Allen said.

A larger number of facilities and an increased number of complaints against them are two major reasons for the budget shortfall, Bureau Health Facility Surveyor Lisa Jones said. In previous years the cost of researching complaints was not even factored into the bureau's costs, she said.

"When the number of complaints was much smaller, we could absorb the costs," Jones said. "But as the complaints have increased and the severity of the complaints has increased, we are taking every step to try to be respond to those complaints. But to be able to do that you have to have staff available to get out to the site in a timely manner."

The rates have not been increased since 1997, Allen said.

In addition to reducing the cost of overhead operations, the bureau is also considering ways to reduce the impact on smaller businesses. One proposal is to lower the fees for facilities like McConnell's, which have residents on state aid, or to allow facilities to pay the licensing fees over the course of the year instead of in one lump sum, Allen said.

McConnell fears, however, that the fee increases may force some assisted living facilities to forfeit their licenses to stay in business, turning their facilities into the equivalent of a regular apartment complex that helps residents with meals and cleaning, but not medication or other health needs. That means that some senior citizens may not get the quality of care they need, he said.