The question of how to improve fire safety and find the money needed to regulate the state's nearly 500 assisted-living facilities has revealed painful possibilities for South Carolina's elderly and disabled adults.
They include: facilities that must close and send residents onto the street, homes that hesitate to take clients who are on public assistance or who seem difficult to evacuate during a fire, and a poorly funded state regulatory office that does not have the resources to fully protect residents. The chilling scenarios are framed as the results of tougher conditions for both assisted-living operators and the state health agency that regulates them.
Michele Herron is finally going on vacation this Thanksgiving, but she's taking her work -- all eight adults in her assisted-living home -- with her.
Herron, who runs Village Inn Community Care Home in Graniteville, said she cannot afford to hire staff to supervise her residents in her absence. So when she and her husband travel to the mountains this month, they will be taking their residents, who suffer from psychological problems or need medical supervision.
"We're getting a cabin that sleeps nearly 20 and all going up together," Herron said.
Finances weren't always this tight, but when the state Department of Health and Environmental Control tightened the staff-to-resident ratios in recent years, Herron took it as a cut in pay.
She has had to drop from 10 residents, which generally bring in $1,100 each in Medicaid or optional state supplemental funding, to eight.
Like many assisted-living workers, Herron is not happy about the state's proposal to double per-bed licensing fees and raise fire-safety standards. She says she has become increasingly frustrated with DHEC's oversight and inspections.
"It really feels sometimes like they're trying to weed out the little guys," she said. "The big facilities with corporate headquarters paying these fees -- I won't say it isn't going to hurt them, but it's not as hard."
ON WEDNESDAY, more than two dozen people who operate residential-care facilities attended the DHEC board meeting to show their opposition to a proposed regulation that would double their $10-a-bed fee over three years and could force those who could not evacuate residents in eight minutes to install a sprinkler system.
State officials note that fees for community residential care facilities have not risen since 2001. They warn that inflation has raised the agency expenses for inspections, investigations, travel and processing licenses and that the quality of the oversight could suffer if enforcement doesn't receive the funding it needs. The state's growing senior population is expected to place increasing demands on resources.
The public outcry Wednesday was intense, so agency board members postponed action on the regulations, which must also go before the General Assembly. Vicki McGahee, a coordinator of residential care facilities for the state Department of Mental Health, told the panel that data indicates there have been two fire-related deaths in assisted-living homes in almost 20 years.
DHEC board member Coleman Buckhouse said the goal of new fire-safety standards is to prevent deaths.
"What this stuff is trying to do is protect as many people as possible," he said. "No one wants to close anybody down."
DHEC Commissioner Earl Hunter told the roomful of people at the board meeting that the fee increase was estimated to help the agency fund about half of the $700,000 it costs to regulate assisted-living facilities. Officials are planning to rework the changes in regulations.
SOUTH CAROLINA has more than 16,000 residents in 478 licensed facilities that vary in size from private residences to large multicampus settings.
Those with fewer than 20 residents have mostly Medicaid recipients, while 86 percent of residents in facilities that house more than 20 people pay for their own care, according to Lara Williams, the executive director of the state chapter of the Assisted Living Federation of America.
"Nobody wants to see a rate increase on our side of the fences, but at the same time, we understand it, and we want quality inspections and we're willing to pay to have them," Williams said. "DHEC and the facility will work together to provide the best care for the residents. If we have great providers and inspectors, we have happy residents."
In December, Williams will be opening a new facility in Bluffton, Belfair Gardens, serving 23 people who suffer from Alzheimer's or dementia.
Ralph Courtney, the executive director of Tri-Development Center of Aiken County, said DHEC's funding struggles were no different from all other state agencies that have suffered cuts.
"Our problem with any increases in costs is that we have not received rate increases in years while costs have risen," he said. "At some locations, any increases in costs without corresponding increases in revenues received may result in a decrease in the quality of care provided to individuals with critical needs."
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