Who will take charge?

What will it take to improve care in North Carolina Assisted Living/Adult Care Homes? It will take someone with the authority who understands the complexity of the problems to take the lead to demand clear, understandable policy, facilitate attitude changes and embrace innovative approaches.
Historically, Adult Care Homes were residential social models with unlicensed personnel assisting persons with activities of daily living in a home like setting. Over time facilities were also required to arrange health services from outside professionals. In recent years policy dictated by the State attempts to duplicate the nursing home model of care turning Adult Care Homes into health care facilities expanding the cost and treating unlicensed personnel like licensed personnel. Does the public want Adult Care Home’s to become nursing homes or do they want the more cost effective option to continue to be available to North Carolina’s elderly and disabled population? This is the first policy question, which needs to be answered.
There seems to be sufficient evidence that the punitive, heavy-handed regulatory approach is not working to ensure that the quality and safety all agree is needed and desired is occurring. Setting up quality standards for providers to obtain rather than prescriptive laws and rules might better enable quality care and thus result in more safety for the elderly and disabled.
Would a more positive, educational, training, resourceful approach, with punitive as last resort, better enable the quality all desire?
In considering new and better approaches, studies prove better staffing ratios and more support for direct care workers equal quality and thus improves safety. The forty-five to fifty-five year old women; who make up the direct care worker in this system are "aging out". Due to lack of pay, benefits and job satisfaction, younger women are not choosing this role! Who is going to give care to our seniors unless these critical problems are addressed? The staff to resident ratio has not changed since 1977 except at night it went from 1/50 to 1/30. During the day it is 1/20.
Owner/operators of Adult Care are desperately trying to savage their investment and get out of the business! They are not reimbursed equal to the requirements. They are perceived as criminals and crooks rather than businesspersons and caregivers. The State does little to change these perceptions and assure the public trust.
Who will operate these businesses when longstanding North Carolina partners throw up their hands and quit?
We would all rather stay in our own homes and have the care we need, but this is not feasible for all persons. Long-term care policy for North Carolina must be appropriately balanced, designed and supported to be successful. If the adversarial relationship between advocates, regulators and providers/ owners continues, there will be no caregivers in the future to care for the elderly and disabled. The will for reform must come from the public, legislators, bureaucrats, advocates, direct care staff and owner/operators all working toward a common goal…A level of care that nurtures and protects the consumer, in which owners and the State alike can be proud.