Local officials who work with the aging are worried about the impact of a state bill that would give county social-services departments the final responsibility for making sure people who are discharged from adult-care homes end up in a safe place.
The bill, introduced by state Rep. David R. Lewis, R-Harnett, would require only that an adult-care home use its "best effort" to help a resident find a new home.
The bill would apply in cases where an adult-care home resident is discharged for failure to pay or when the facility can no longer provide the care the person needs. That could happen because the patient's condition has worsened or improved.
Discharges also happen when patients endanger themselves or others.
"The way the rules and regulations read now, (care homes) have to make sure the discharge is safe and orderly," said Grecia Gaura, a regional long-term-care ombudsman for the Northwest Piedmont Area Agency on Aging, which includes Forsyth County. "If a resident is to leave, they have to find placement for that patient to go."
Gaura said the bill, if made law, could put residents in a bind because social-services departments already have large caseloads.
That's a worry Joe Raymond has, as well. Raymond is director of the Forsyth County Department of Social Services.
"The essential problem as it is written is that it seems to potentially greatly increase our workload with no consideration of how it is going to be paid for," Raymond said Wednesday. "I don't think that is fair to the taxpayers or to county government."
Social services is already responsible for 145 older adults for whom the agency has been appointed guardian. The department gets no state and federal money to offset that cost, Raymond said.
"This feels a little like we are going to be left handling situations that facilities don't want to deal with," Raymond said.
The assisted-living industry thinks the ultimate responsibility for handling discharged patients should not rest with the businesses. Lou Wilson, a lobbyist for the N.C. Association of Long Term Care Facilities, said that when a resident becomes too ill or disruptive, he or she could endanger the safety of others.
"I don't think facilities should be let off the hook of a safe and orderly discharge, or even helping that person find a place," Wilson said. "But to say to the facility that it is totally your responsibility, that is wrong."
The bill passed its first reading in the N.C. House and was referred to the committee on health and human services.
The bill has sparked discussion about the duty and ability of state-licensed homes, which earn higher reimbursement for caring for residents with dementia, to continue caring for them when their situations take a turn for the worse.
The number of beds dedicated to secure care in North Carolina has increased 240 percent since 2003, according to state figures. The surge reflects a marked increase in dementia patients.
The state's 178 special-care units advertise that they're qualified to take residents with dementia. To accept such residents, the facilities must tell guardians or relatives how they will respond to changes in a resident's condition. They also have to spell out how they will deal with changes specific to dementia.
"The facilities are the ones that made the decision to accept the individual, and they signed a contract" agreeing to look after the person, said Gail Holden, director of adult services for Wake County Human Services.
In the Northwest Piedmont, Gaura said, some residents of adult-care homes have accidents or illness and are sent to the hospital — then are refused permission to come back. "I have had facilities try to discharge people to homeless shelters," Gaura said.
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