Assisted Living Explosion Prompts State to Redesign Regulatory Approach

Assisted living providers in Wisconsin can be thankful for a redesigned regulatory approach that has transformed the state’s system for monitoring providers to focus more heavily on those with bad track records instead of imposing an extensive survey on every community, even those who don’t have any serious deficiencies.

It happens in lots of industries—a small percentage of businesses or organizations may misbehave in some way, and as a result the entire industry gets stuck with rules and regulations seeking to prevent that bad behavior from reoccurring. The assisted living industry—at least in some states, as it’s not regulated on a federal basis—is not exempt from this trend.

By most accounts, states are looking at constricted budgets with no indicators of significant improvement in the future. Rather than expending limited resources on unnecessary actions, Wisconsin is focusing on the important: “problem” assisted living communities that aren’t providing the best care to their residents.


A lot of regulatory agencies don’t have enough resources to properly do their jobs, and their budgets are only going to get more strained, agree Jim Murphy, executive director of the Wisconsin Assisted Living Association, and Kevin Coughlin, who up until recently was the Director of the Bureau of Assisted Living in Wisconsin.

“The good thing with the federal part of the regulations is that it also comes with resources,” says Kevin. “That’s a struggle with states. They’re up against these resource challenges.”

He said they’re seeing a number of states looking at the abbreviated survey process that’s been successful so far in Wisconsin, and are focusing their resources on the ones that are actually causing most of the problems.


“We got forced into re-looking into our systems,” says Coughlin. “Assisted living was exploding in growth, and we weren’t able to keep up with it with our resources.”

He said the rapid growth gave the bureau and opportunity to take another look at how it was handling the industry, and if there was a better way of designing the regulatory program to meet the needs of an “exploding new industry.”

In 2002 and 2003, it restructured the agency, including a critical component: establishing an assisted living forum that got together every month and brought assisted living providers, associations, advocates, and stakeholders in general in one room to address emerging issues throughout the redesign process.

Then, the bureau redesigned the survey process to make it more effective, and introduced an abbreviated system for assisted living communities that have a good compliance history.

“It gave good recognition to those communities that were striving to do good work,” Coughlin says. “Basically, our approach was, if it looks good, smells good, tastes good, feels good… we’re going to assume it is good.”

Communities qualifying for the abbreviated surveys began to see it as a quality badge, he says, and the redesign process ultimately led to “some really good collaboration” with the associations, especially WALA.

However, “the state and the [assisted living] providers are not partners,” Murphy emphasized. “We’re collaborators. We have the same goal of quality care for assisted living residents.”

He said that a former Department of Health Services executive has used the phrase “creative tension” to describe the relationship between the industry and the state. “We need strong regulations,” he says, adding that in his state, they’re “really” strong.

“Because of that, some issues happening in other states [such as Florida] aren’t happening here,” Murphy says. “[The BAL] has taken a look at the limited resources they have, and have focused on those that aren’t compliant.”

About 87% of assisted living communities in Wisconsin don’t have any serious deficiencies, he continues, so the bureau turns its attention to the approximately 13% that do.

Regarding Florida, Coughlin says the state has reached out to his state’s Bureau of Assisted Living regarding Wisconsin’s regulatory practices. “They’re incorporating some of the different regulatory initiatives we’ve done into their proposals as they go forward [from the Miami Herald series on the lax regulatory standards for Florida’s assisted living industry].”

Statistics are showing time and time again, he continues, that the best—even though they’re not experiencing as much regulatory intensity—continue to be good.

Providers that belong to the Assisted Living Federation of America and its state chapters are encouraged to look for how they can collaborate with their state regulatory agencies, says Murphy, to make sure they’re paying attention to the industry, and particular attention to the communities that aren’t providing quality care.

“Those are a time bomb waiting to go off, in some states that don’t have these quality care surveys,” Murphy says.

Written by Alyssa Gerace

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