The 2018 General Assembly adopted House Joint Resolution 118 (See Appendix A) requesting DSS study the regulation of independent living communities.

Findings Summary

A detailed account of the findings, including interview quotes and background information, is in the section labeled Findings and Observations. VDSS staff made the following observations from this study:

• Within the senior housing market, there is ambiguity surrounding the term "independent living." Consultants found the term used inconsistently to define everything from age 55-and-older senior apartments to assisted living facilities. This can lead to confusion among consumers looking for a community to meet their individual requirements. Therefore, the department suggests the following working definition of the term independent living community:

Independent living community means any congregate housing reserved for residents age 55 and older who do not require assistance with activities of daily living from community staff members. Independent living communities provide two or more services, such as meals, transportation, laundry or housekeeping for their residents. However, they do not provide nursing or medical care, medication administration, assistance with medication administration, or assistance with activities of daily living. A resident, or representative acting on his behalf, may contract the above services through third-party providers. Also included in this definition are independent living communities which oversee residents either through daily check-ins or emergency call systems monitored by community staff.

• The term "independent living" can be misleading in that independent living residents are not required to be physically self-sufficient, but expected to independently manage care needs without involvement of independent living community staff. Furthermore, the Fair Housing Act forbids independent living communities from inquiring about a prospective resident's physical or mental status as criteria for admission. Independent living communities house an increasing number of residents who meet assisted living level of care criteria. However, they remain in independent living for a number of reasons, including the inability to afford assisted living.

• About three-quarters of independent living communities represented in this study employ at least one method of resident supervision or emergency response beyond the standard landlord-to-tenant obligations. The most common types include daily check-ins, medical alert pendants or bracelets, and pull cord call systems. Residents' family members often rest assured that 911 is only a button push away, or a responsible staff member will be checking in on their loved ones each day with systems managed by the independent living community. However, while some communities have very sound procedures for this, others are more lax.

• In interviews, independent living residents expressed support for a "collective voice" and were in favor of establishing an ombudsman program to address concerns within their housing category.

• No other U.S. state regulates independent living communities. Some regulate similar senior housing categories, but no state requires direct oversight.

Options

After considering these findings, VDSS developed a number of options the General Assembly could consider with regard to oversight of independent living facilities. However, many of the changes could be controversial and would require additional state resources to effectively implement. Below are options the General Assembly could consider:

l) require independent living communities, as defined in this report's executive summary, to register with DSS;

2) require each independent living community to provide prospective residents with a disclosure statement containing information about its accommodations and services;

3) require a written agreement between the independent living community and each of its residents detailing the accommodations and services that the independent living management and staff will provide to that specific resident and what the community will expect from the resident.

4) require the resident and representative of the independent living community to sign a document of acknowledgment if a recommendation is made that the resident move to a higher level of care to protect his/her health, safety, and welfare.

5) require independent living communities that employ daily check-ins or resident emergency call systems to have written procedures for managing these systems and maintain daily logs of system activity to verify that they are consistently executed, as advertised.

6) require each independent living community, with residents who are unable to evacuate independently during an emergency, to develop a method for emergency responders to identify these individuals' housing units.

7) direct DSS to develop regulations governing independent living communities.

8) direct Department of Aging and Rehabilitative Services (OARS) to establish and manage the Office of the Independent Living Community Ombudsman and a complaint line to receive, record and respond to concerns by or on behalf of residents.