Seventy-five-year-old Istvan Upor endured persecution from the Nazis as a boy in Hungary and from the Soviet bloc as a young man before fleeing Budapest in 1956. As ludicrous a comparison as it seems, he bears just as much contempt for the state Department of Public Welfare and a new set of regulations affecting personal care home operators such as himself.

Tony Tye, Post-Gazette Istvan Upor stands in the solarium of Easy Living Estates of New Stanton, which he owns along with two other facilities. Click photo for larger image.

"They don't kill you all at once. They make it endless," the outspoken entrepreneur said of the state officials who are implementing the biggest overhaul of the industry's rules in nearly a quarter-century.

Although they just took effect Monday, the regulations came as no shock to anyone in the field. Draft versions have been debated for at least four years. They were circulated, discussed, pulled back, languished, altered, republished and scrutinized some more before receiving final approval from the state Independent Regulatory Review Commission in February.

A providers group has filed a lawsuit seeking to block them, at least temporarily. A decision on the request for a preliminary injunction is expected within weeks.

Welfare department officials held explanatory workshops around the state over the summer for administrators of the more than 1,600 personal care homes. The homes range from eight-bed, mom-and-pop dwellings run on a shoestring to the large, assisted-living facilities that woo affluent suburbanites as they become frail.

The operators all have a new rule book that increases credentials to enter the field, expands training requirements, adds assessments of residents' needs, toughens fire safety provisions, requires medication education and makes other provisions deemed overdue by the state and consumer advocacy groups.

They will also have unannounced annual visits from DPW inspectors, whereas they previously knew in advance the specific date of an inspection.

The overhaul came from agreement that the field had changed dramatically, with the current 53,000 personal care residents in frailer condition than predecessors because they stay in their own homes longer before moving. Impetus was added from sporadic, attention-getting incidents of abuse or neglect, including two Pittsburgh-area deaths that resulted in criminal investigations last year and a Northumberland County fire in which three residents died.

Mr. Upor and many others in the field call the new regulations an overreaction that burdens them with more paperwork and costs while assuring nothing better for residents. Welfare officials counter that safeguarding residents is the principal objective.

The department's spokeswoman on the issue, Karen E. Kroh, director of adult residential licensing, was unavailable to elaborate Thursday or Friday, officials said, because she was tied up by the Commonwealth Court hearing concerning the regulations.

There's always tension between operators and the oversight agency supposed to monitor them, but industry representatives are especially resentful now. That's because they'll get the same minimal government financial assistance but may have to spend more on staff or physical alterations. The federal and state governments provide reimbursements -- about $30 a day -- for residents receiving Supplemental Security Income, but they make up just one-fifth of personal care home residents.

Mr. Upor operates three homes under the Easy Living name in Somerset, Ligonier and Hempfield and maintains that only the latter -- officially known as Easy Living Estates of New Stanton -- is making money. He makes no apologies for paying most of his staff $6 to $7 an hour, saying that's all he can afford, but he commends them for being willing to do the hard work.

"I tell my staff every day, 'We are all morons that we stay in this,' " he said, standing in a lobby of the 5-year-old, 108-bed New Stanton facility, which is only about one-third occupied. He designed it with abundant indoor plants and fountains, an exercise room and scattered games such as air hockey and pool tables. They're rarely used, but Mr. Upor said they were present as a "con game" so people feel they're part of a young and healthy environment.

From his own business perspective, he said, the advantage of the regulations is that if they drive smaller homes out of business, he will gain new residents. "But that's not fair to them," he quickly adds.

Some of the changes are being phased in gradually, some contain "grandfather" provisions so as not to harm people already in the field and some apply only to facilities with more than eight beds. Among the changes:

To become an administrator, which previously required a high school diploma, individuals will either have to be nurses, have two years of college education or already be a nursing home administrator. Their orientation before certification will consist of 100 hours of course work instead of 40 hours.

Newly hired direct-care staff must have a high school education or GED, whereas they had no minimum education requirement before.

Annual training requirements will be a minimum of 24 hours for administrators and 12 hours for staff, compared previously to six hours for administrators and none for staff.

The person listed as the administrator must be present in the home at least 20 hours a week, instead of being able to have a designee filling in at any and all times.

Residents must have detailed assessments and care plans put into writing for them upon arrival and upon changes in their conditions and abilities, which was not the case previously.

Employees assisting residents with their medications must undergo a training program, which is still to be set up by the state. Previously, staff lacking any medical license were not supposed to have anything to do with medications, but it was common practice for them to assist residents who needed prompting and support.

As a result of the changes, Mr. Upor said he would be paying much more for training of employees, plus the cost of filling in their shifts while they attend the sessions. It's an unreasonable expense, he contends, considering the high turnover in the field.

And even though he has a smoke alarm in every bedroom, which is not covered in the regulations, they will force him to put corridor smoke alarms within 45 feet of every bedroom. He had met previous fire safety standards to have them within 75 feet.

"I haven't spent a nickel yet on the regulations, because I am hoping they will stop it," he said of the court decision awaited on the challenge by the Northern Area Personal Care Home Administrators Association.