Arizona senior living provider groups are challenging the need for the training and staffing requirements contained in regulations establishing the state’s first-ever dementia care standards for assisted living communities. 

The Governor’s Regulatory Review Council is considering a final proposal from state health officials establishing the standards for memory care. The proposal is based on HB 2764, signed into law last spring by Gov. Katie Hobbs (D). If approved by the council, the regulations would go into effect July 1. Senior living groups, however, are asking the council to send the proposal back to health officials.

Overall, the bill added a definition of memory care for assisted living under the Arizona Department of Health Services-directed licensure. If the proposal is approved, then any assisted living community with an AL Directed license would be required to add eight hours of training for all direct care staff members as well as four hours of continuing education in memory care training after a person’s initial year of employment.

During recent testimony before the council about the proposal, senior living organizations and lobbyists asked for the proposed rule to be sent back to the state health department to address several of their concerns related to what they called “duplicative” training requirements, staffing rules they said were vague, and the addition of a fourth level of care to assisted living statutes.

Dave Voepel, president and CEO of the Arizona Health Care Association, told McKnight’s Senior Living that although he shares the state’s commitment to improving training and staffing standards in assisted living communities, he has several concerns with the proposal.

He said the training requirements are “overly prescriptive” without offering flexibility for different care settings or allowing sufficient time for implementation, citing the July 1 effective date if the requirements are approved by the council. Many assisted living communities, Voepel added, already have programs in place and need time to meet the regulatory standard without creating unnecessary duplication and additional administrative burdens.

The proposed language regarding staffing, he added, does not account for the varying levels of care provided in assisted living nor the operational differences between communities. And new mandates, although well-intentioned, may unintentionally strain the workforce unless they are coupled with investments in workforce development, training infrastructure and provider support, Voepel said.

“A one-size-fits-all approach may not reflect resident acuity or allow providers to allocate resources in the most effective and resident-centered manner,” Voepel said, pointing out that no additional state funds were allocated for the new training requirements. “A growing number of assisted living communities focus on serving the Medicaid population, and they are already underfunded and struggling for financial viability.”

Voepel said that his association supports policies elevating care standards and hopes for continued discussion with state leaders and stakeholders to refine the new mandate in a way that ensures feasibility and maintains care quality.

The Arizona Assisted Living Federal of America took issue with the 90-day compressed timeline to write a comprehensive rules package for memory care, saying it “deserves a more thoughtful approach.”

Arizona ALFA President Karen Barno told McKnight’s Senior Living also said training requirements are “overly prescriptive, burdensome and vague,” saying the proposed standards introduce subjective staffing requirements. That, she said, opens the door to liability, inconsistent enforcement, and unnecessary cost burdens on providers without improving care outcomes.

“The minimum training requirements should focus on what needs to be taught, and the duration of the training,” Barno said. “However, the proposed draft goes beyond by prescribing wo can serve as a certified trainer. This exceeds the ‘minimum training’ scope outlined in the statute and would create a substantial financial burden on communities.”

Amy McIlroy, president of the Arizona Assisted Living Homes Association, told McKnight’s Senior Living that the regulation lacks detail on how its 1,700 small business owners — who operate assisted living homes with 10 residents or less — will be able to train multiple staff members by July 1 when the state has yet to approve a single training program or provide a method to apply for training program approval.

The proposed rules do not meet clear and concise standards as it relates to who is required to receive additional training,” McIlroy said. “The rules contemplate that the enhanced training requirements are for direct care workers, including contracted workers. The rules are unclear as to whether this applies to anyone who interacts with residents or just caretakers.”

Considering the enhanced penalties for non-compliance, she said she wants to ensure providers are not penalized for something “that appeals to be an impossible goal to reach in the time allowed.” McIlroy added that the new staffing requirements are beyond the scope of the legislation, unclear and create confusion.

Arizona LeadingAge said while it supports the intent behind the law and does not opposed dementia-specific training or programming, it, too, has significant concerns about the proposed implementation rules.

Arizona LeadingAge CEO Jaime Roberts told McKnight’s Senior Living that it asked the council pause approval of the rules package until a number of critical issues are addressed, including integrating appropriate memory care standards into existing directed care regulations, and include a specific, tiered framework for the civil monetary penalty mitigation model that reflects the real-world complexities of care settings.

“We support HB 2764, but rules matter,” Roberts said. “Rules are where legislation becomes reality, and in this care, they don’t yet reflect the thoughtful and balanced implementation the law requires. Providers are ready to deliver high-quality dementia care — they simply need rules that are clear, fair and lawful.”