Rules covering Pennsylvania's personal care home industry and penalties for serious violators are overdue for an overhaul in 2004, state officials, consumer advocates and providers say.

Those key parties for several years have been discussing how best to update legislation and regulations from the 1980s pertaining to 1,700 facilities housing more than 50,000 Pennsylvanians, most of them elderly. The officials agree that the nature of those residents and facilities has changed radically in the past two decades, without accompanying regulatory changes.

Proposals under discussion by the Rendell administration, lawmakers and lobbyists, which they hope to see approved this year, would increase training requirements for personal care home administrators and staff, create a new government funding stream to bolster care and toughen penalties on those whose care or neglect harms residents.

The most comprehensive proposal, additionally, would place some existing homes in a new category of state-regulated housing called "assisted living." It would have tougher standards than personal care homes but less than nursing homes.

The assisted-living term has been used in marketing by newer facilities, but without any official meaning. All 1,700 homes, regardless of size, age, staffing and offerings, have been covered by the same personal-care rules.

Increasingly, people entering personal care homes are more frail than those admitted in the past, and they're remaining longer, frequently by their own choice, even as their abilities decline. That can place them at more risk because personal care homes don't have the same medical staffing requirements as nursing homes.

"What we've seen is the people who used to be in hospitals are in nursing homes, and the people who used to be in nursing homes are in personal care homes," said Ann Torregrossa, policy manager of the governor's Office of Health Care Reform. "The staffing and training qualifications have not kept pace with the change in acuity."

Some officials point to the Serenity Personal Care Home in Midland as one example of the problem. A resident who developed severe bed sores there in September did not receive timely care, according to the state Department of Public Welfare, and ended up dying Oct. 12 after delayed transfer to a hospital and then a nursing home.

The department has called for Serenity to provide staff training to avoid similar incidents, but it's widely assumed that other nonmedical homes throughout the state also are caring for residents whose needs rise to the level of skilled nursing. Technically, they're supposed to transfer those residents to nursing homes, but that's a rarely penalized violation.

"It's a dilemma, because many times, you have families trying to keep the person in the same location," said Patricia McNamara, director of public policy and assisted living for the Pennsylvania Health Care Association, which represents about 90 providers. "The thing we've been promoting is, staff and administrator training must be increased."

Torregrossa said the Rendell administration would submit by summer proposed regulations that increase training of both administrators and their employees. The hours of course work for administrators is expected to increase from 40 to 120, and other qualifications may be required of them.

Aides will have more detailed requirements as well before they can work unsupervised. The facilities may also need to do more comprehensive assessments of residents and their care plans.

At the same time that all personal care homes could face tougher rules, which smaller facilities may object to as imposing more costs, the administration and Legislature are discussing the proposed new category of assisted living.

Scott Johnson, executive director of the Senate Public Health and Welfare Committee, said the new classification would carry enough safeguards to make it possible to accept patients who otherwise are supposed to be in nursing homes. There also may be requirements that assisted-living facilities have to offer a certain degree of independence, such as the right to private bedrooms with locks on the doors.

Legislation from committee Chairman Sen. Harold Mowery, R-Cumberland, would enable modest-income residents to obtain Medical Assistance funding for assisted-living services. That government support is now available only for care in their own home or a skilled nursing facility.

Up to now, the state has concentrated on reducing nursing home use, the most expensive form of government-funded senior housing, by increasing home care spending. Senior advocates have applauded the shift while criticizing the state for ignoring support for the transitional step of assisted living or personal care, which most people have to pay for on their own.

"This is a topic that's been discussed for five or six years, and there's been no action," said Mary Anne Kelly, executive director of the Southwestern Pennsylvania Partnership for Aging. "It's time for Pennsylvania to look at the whole gradation of senior housing."

The Serenity case, in which the home received a $320 fine and no downgrade of its license until five months after state inspectors said lax care was a factor in a resident's death, also called attention to the Welfare Department's system of penalties.

For the first time in late 2002, the department began issuing fines for violations. The amounts are based on a 1987 statute, however, and may be too small to carry much incentive.

At the same time the state began issuing fines, it sharply reduced the number of provisional licenses it issued. Such licenses alert the public to problems and put facilities on notice to improve. In February, 61 homes were on provisional licenses, less than half the number of 18 months earlier and barely a third the number of four years ago.

Teleta Nevius, the department's deputy secretary overseeing personal care homes, said policy changes would make it more likely a home with serious violations will receive a provisional license, and more promptly than in Serenity's case. Two key officials responsible for enforcement on the western and eastern ends of the state were recently reassigned. Nevius declined to explain why when questioned at an advisory group meeting of provider and consumer representatives March 11.

There may be a need for legislation, administration officials said, that would increase fines and permit still tougher penalties, such as banning new admissions to homes with serious problems.

Few facilities are ever forced out of business, and that isn't likely to change. The ultimate goal, Nevius said, is not to focus on penalties, but on incentives for homes to maintain regular licenses and assure the safety of residents. That's regardless of whether the housing is called personal care or assisted living.

"The last thing we want to do," she said, "is create a homeless situation or put personal care homes out of business."