ANNAPOLIS Seventeen years ago it began with her grandmother.
Since the day that Audrey P. Monroe took her frail, elderly grandmother into her home, she’s provided the same “love and care” to more than 60 elderly people, a few at a time, operating as a small assisted living center. They are a family, she says, and one that’s now threatened.
Monroe and other small facility owners are worried that a law passed by the Maryland State legislature in 1996 will force them to close their homes or operate illegally. Although the law was passed three years ago, some small facility owners said they have only found out about it this year.
“I thought, if I can take care of my grandmother, then I can do this for other people,” Monroe said. “My clients all live in the same house as my family and me. We use the same bathroom; we eat at the same table and with the same silverware. We’re a family in here.”
Until the law was passed, the assisted living industry was unregulated. The legislation puts all facilities, small and large, under the same rules and fees.
Last year, the 2,800 small programs won a year’s delay from the legislature even before regulations were written. This year Sen. Delores G. Kelley, D-Baltimore, introduced a bill that would put off compliance until July 1, 2000.
The small facilities need more time because they cannot afford to make the changes as quickly, Kelley testified before the Senate Finance Committee. Many of the small facility owners take clients with very limited income, between $250 to $400 monthly, making it almost impossible to make the changes estimated to cost from $3,000 to $13,000 per year, she said.
The Licensing and Certification Administration of the Department of Health and Mental Hygiene, the agency in charge of regulating the facilities, supports the delay, acknowledging that smaller facilities need more time to comply. However, this deferment is not something they foresee continuing indefinitely, said Carol Benner, director of the administration.
“Our restrictions are no stricter than any other state,” Benner said. “When we regulate a previously unregulated industry there is always an outcry.”
The administration has always conducted inspections of these facilities for serious, health risk situations, Benner said. But new regulations would close facilities for less life-threatening problems, like the lack of sprinkler systems or handicap ramps.
“They are asking us to turn our homes into facilities. We have to put up exit signs above our doors. The people who come to us, come for the homelike settings,” said Shirley Brooks, owner of Brooks Home Caring, a small facility in Randallstown.
Facilities are now required to have a nurse oversee distribution of medicine and a dietician on staff, Brooks said. The license fees have been raised from $25 to $100 a year. The fire inspection fee went up from $25 to $45 per visit. But what makes her angriest is she just found out about the 1996 law when she received her license renewal packages this year.
The structure of the new system seems to favor the large facilities, while putting the small operators out of business, said Eric Brooks, her husband.
The Brookses fear if the small facilities close, most of their clients will find themselves on the streets because they can’t afford larger facilities.
Inconsequential regulation violations, such as inadequate handicap doorways, should never cause a small facility to close, said Sen. J. Robert Hooper, R-Harford.
Hooper, a freshman senator, said not only does he support the new bill but he would have opposed the original legislation.
“I’m looking out for the little guys. These people are providing a service for the community,” Hooper said. “The doors may not be big enough and all kinds of nitpicky things but they’ll never get the love these people give in the smaller homes.”
Love is how Monroe describes her relationship with her clients.
“The folks we get, the larger places won’t take,” Monroe said. “They come to us with what they have on their backs. They have no family.”
One man, a retired military man, has been with Monroe for 15 years.
“When he dies, I will have to bury him,” Monroe said. “I am the one who will stand next to his grave at the funeral with just my family.”