Is Adding On-Site Care the Next Requirement for Your Senior Care Community?

Michigan state senators introduced a bill last fall that amends the state’s public health code to include the requirement of designated on-site private examination rooms in certain senior living communities, which encompasses assisted living centers and skilled nursing facilities.

Senate Bill No. 747 requires both “homes for the aged” and nursing homes that provide medical or dental care on the premises of the community to have designated, private rooms for that specific purpose, and that these rooms are used exclusively for medical and dental examination or treatment of residents, and not for any other use.

In Michigan, there are only about 180 licensed “homes for the aged” (which are licensed to care for 21 or more people), meaning that only a small percentage of the state’s assisted living communities could potentially be impacted by this current version of the bill. However, as this is only the first draft of the bill, there is a possibility its provisions could expand to include more senior care communities, and the idea could even spread to other states.


Healthcare taking place in violation of public health codes?

What’s currently going on, according to Dr. Stuart Boekeloo, a dentist with years of experience in providing on-site dental care, is that facilities are allowing examinations and treatments to take place in multi-purpose rooms.

“As I did more and more research on the topic of on-site care, I saw that it’s almost an accepted practice in senior living to have a dentist, podiatrist, or other healthcare providers come in and use the conference room, or the hair salon, to render care,” he says.


This, however, “violates a lot of current state and federal mandates,” he continues, and often, it’s not up to the licensing standards of the healthcare providers who are coming to the facilities.

“It’s clear that on-site care is the way of the future in reducing total costs and hospital readmissions, but issues of violating federal and state mandates must be addressed,” says Boekeloo.

Michigan senators caught wind of this practice, he says,which prompted them to initiate the amendment to its Public Health Code, Act 368 of 1978.

Trade group’s response: Bill doesn’t fit our model of care

But some senior care provider groups don’t support the bill in its current state, saying it doesn’t fit with the assisted living model.

The local affiliate of the Assisted Living Federation of America (ALFA) opposes the requirement to provide an on-site care room.

“We’re not in support of creating private medical exam rooms,” says Kathleen Murphy, general counsel for the Michigan Assisted Living Association. “We have some concerns regarding the way the bill is written and how it doesn’t seem to recognize the philosophy of assisted living and the model of care that we embrace in our state.”

Additionally, the bill could infringe on resident choice. “We believe that residents should have the right to have a home health care visit or some type of portable health care delivered to them in their private apartment, if they wish to do so.”

The trade group is working with Senator John Proos, who introduced the bill along with four other local senators, and his staff to educate them on the various “home-like” models of assisted living.

“While his intentions are honorable—he believes there’s a lack of privacy in assisted living—we’re trying to portray assisted living in a different light, to show there are opportunities for privacy and dignity,” whether or not there’s a designated on-site care room, says Murphy.

Will the upcoming hearing result in a modified bill?

Boekeloo has been asked to testify at the upcoming hearing when the Committee on Health Policy addresses the bill, after Senator Proos asked him to be a part of the discussion and talk about his experience and involvement with treating residents at senior care communities.

“Just about every facility I’ve ever been to—and that’s probably more than 30 facilities—very few facilities have a designated room for care,” says Boekeloo. “You’ll find barbershops, beauty salons; you’ll find all these amenities, and there’s all these publications that are saying that on-site care is needed, and these other amenities are needed to help boomers transition into healthy old age.”

But these amenities should be designated for specific purposes, he says, which is what the bill requires.

“Rather than providers coming in and setting up shop in a hair salon, or in patients’ bedrooms or showers, they’ll have a standardized area where they can complete their exams and do some minor work in a room that actually meets their licensing standards,” says Boekeloo.

This makes sense, he continues, because to cut hair, you have to be a licensed venue, and the same goes for food preparation and serving. “Why is it acceptable for healthcare providers to come in and practice without proper licensing?”

However, the Michigan Assisted Living Association says there are already licensing rules in place.

“We don’t think there is a recurrence of invasion of privacy, or of healthcare being delivered in common areas,” says Murphy. “Our licensing rules would prohibit it, and there are state licensing rules that already make it a violation of residents’ rights to have their privacy violated in that way.”

In some respects, then, this legislation is duplicative, she says. Boekeloo, on the other hand, maintains there is a gap that’s a “total oversight” not only by providers, but also by equipment manufacturers—and that’s where his company comes in. In 2009, Boekeloo created Aleydis Centers, LLC, the only company that offers the infrastructure for a multi-care treatment room.

By the end of the month, Boekeloo is hoping to announce a partnership with a “major” assisted living player with communities in more than 30 states to install 70 treatment rooms in the next three years. The first Aleydis center has already been installed in a St. Jill, Mich. PACE (Program of All-Inclusive Care for the Elderly) facility.

“I don’t think baby boomers are going to tolerate current methods of on-site care,” says Boekeloo. “They’re going to be far more demanding.”

This may be so, but Murphy says her organization isn’t trying to deny residents the availability of healthcare in assisted living communities.

“Obviously, we support the idea of having health care as an option for assisted living residents,” she says. “But [the senator’s] concern seems to be more about privacy, not the lack of portable care. We are opposed to the bill as it is currently written. We are confident that we will have the opportunity to work collaboratively with the bill’s sponsors to learn more about their concerns and discuss other possible approaches.”

Although the bill was originally thought to be on a fast track, according to Murphy, she says it’s still relatively early on in the process, and the bill is only in its first draft. Senator Proos had not responded to SHN’s request for comment as of press time.

View the Senate bill here.

Written by Alyssa Gerace