Ms. Bebo's Letter to City Council

January 3, 2008

The Honorable Mark Welch
City of Port Townsend
250 Madison Street, Suite 2
Port Townsend, WA 98368

Re: Victoria House, Port Townsend, WA

Dear Mayor Welch:

We write in response to your letter of December 11, 2007, regarding events concerning certain residents of Victoria House Assisted Living. While we would have preferred to respond sooner, my travel schedule and the holidays have delayed my response.
While we appreciate the City Council's concern over the welfare of all the residents in the City, including those residing at Victoria House, some of the statements in your letter appear to be based upon either inaccurate information or state conclusions which simply are unsupported by any facts. In addition to responding to the concerns raised by the Council in your letter, we welcome the opportunity to appear before your council subcommittee and to meet with any council member interested in speaking with us.
Victoria House provides excellent care for its assisted living residents. Ours is one of the most regulated industries in the state. Each of our residents (or his or her legal representative) signs a contract and receives written disclosures regarding the level of care that they will receive at Victoria House. These disclosures are required by law and prevent any implied understandings or, more appropriately, misunderstandings, from taking place. Each and every one of the eight (not eleven) residents affected by the termination of the State Medicaid contract received these disclosures.
Your letter also suggested that the City has been told that none of the individuals impacted by the decision to terminate the Medicaid contract required transfer because their medical conditions required a higher level of care than that provided at Victoria House. Because your letter does not specify what you were told and by whom, it is difficult to respond to your concern. Medical privacy laws preclude us from discussing the circumstances of individual residents; however, we can say that there had been conversations with representatives of DSHS regarding the condition and the needs of each resident. The record of those conversations is either known or available to representatives of the State and authorized members of the individual resident's families.

The Honorable Mark Welch January 3, 2008 Page 2
In addition, you should be made aware that over the course of the last year, Victoria House recognized that several of these Medicaid residents were requiring higher levels of care than those provided at the residence. Because of these higher care needs we thought it appropriate for these residents to be transferred to other facilities that provided this higher level of care. Unfortunately, the residents refused to move and we were forced to initiate the Involuntary Transfer/Discharge process required by Washington law. The Involuntary Transfer/Discharge process was initiated because we believed that the increased care needs of a few residents, put other residents and the facility at risk. Because providing the highest level of care to our residents is our paramount concern, we knew we had no alternative but to transfer these residents.
During this transfer process, the local DSHS representative refused to support our position. Because of this lack of support, we eventually abandoned the process. Unfortunately, we believe that the local DSHS representative's position had more to do with the vocal nature of the residents involved and less to do with the care needs of these residents. Because of the local DSHS representative's lack of support, we felt that we could no longer maintain a Medicaid contract in the DSHS Region 5 which encompasses the Olympic Peninsula and the Olympia area. It should be noted that in similar instances we have not experienced the lack pf support from DSHS in its other Regions. Accordingly, we have not taken the extraordinary step of canceling our Medicaid contracts in these other regions. Again, while we cannot discuss the specifics of individuals in a public setting, we remain willing and able to discuss our concerns with appropriate personnel from the agency.
As we previously explained in our letter to the City Attorney, because we had not received meaningful responses from the agency regarding the care issues we had raised about some residents, we made the difficult decision to terminate the contract. We do appreciate the Council's recognition of the fact that the Medicaid reimbursement rates are inadequate and fail to address the changing needs of residents, making aging in place extremely difficult. Nevertheless, while the reimbursement rates played a part in our decision, it was not the primary basis for our action to terminate the contract.
While we cannot disclose the identity of our former residents or where they have transferred to, we can share that half of the residents impacted transferred to other assisted living facilities. However, the other residents identified by us as requiring a higher level of care have been unable to find placement in other assisted living facilities because those facilities are unable to care for their needs. Indeed, these residents have been informed by the other facilities that they are inappropriate for assisted living and in fact require skilled nursing care or specialized dementia from a nursing home or dementia care facility. Thus, Victoria House is not the only Assisted Living provider that believes that these residents required higher levels of care.

The Honorable Mark Welch January 3, 2008 Page 3
Finally, your letter implies that Victoria House promised that it would somehow become a "permanent home" for these Medicaid residents. We would like to clarify that only in very rare cases does an assisted living facility become a "permanent home" for an elder resident. In our opinion, assisted living facilities are part of the Long Term Care continuum. As a resident's conditions changes, his/her housing and care needs change. The suggestion that Victoria House promised to keep these residents indefinitely is unsubstantiated and at odds with the notion of the continuum of care.
We take the care of residents, and their rights, very seriously. Again, that was one of the reasons why we have written contracts, written disclosure statements, and frequent communication with the families of residents. As a result, the suggestion in your letter that the decision to terminate the Medicaid contract was in any way retaliatory is incorrect, unsubstantiated, and extremely unfair. There are mandatory reporting requirements for any unethical or unsafe conduct observed or suspected. There are anonymous hotlines to assist the residents in reporting any such accusations. The State Ombudsman's Office is available to advocate for residents. The fact is that we have received no complaints or communications alleging that the termination decision was retaliatory or has affected quality of resident care. The people who work at Victoria House, many of whom live in your city, work hard to provide quality care. They do not deserve to have their efforts disparaged.
As we previously reported in our letter to the City Attorney, the majority of the residents affected by termination of the Medicaid contract have successfully made arrangements to pursue care in other facilities. We remain committed to making the transfers as seamless as possible and we are working with the families of the residents to achieve that goal. We look forward to the opportunity of meeting you and answering any other questions that the Council may have.
Very truly yours,
Laurie A. Bebo
President and Chief Executive Officer