The Rendell administration is following up a rocky, undermanned overhaul of personal care home regulations with plans to devise a new long-term care category.

Representatives of the Governor's Office of Health Care Reform have invited long-term care industry and advocacy groups to a meeting tomorrow in Harrisburg to unveil proposed legislation.

The proposal is designed to divert aging, increasingly frail individuals away from nursing homes by keeping them in more homelike assisted-living settings. A new government funding stream would be created for such care, funneling money to facilities able to provide more resident amenities and medical care than what most personal care homes offer.

In essence, the state would be giving a subset of the existing 1,600 personal care homes a chance to be part of a new licensing category, with higher standards than what they've had but less stringent requirements than those faced by the 700-plus nursing homes in the state.

Although many facilities in the state already market themselves as "assisted living" centers, offering group meals and an array of nonmedical services to support older adults, Pennsylvania, unlike most states, lacks any assisted-living definitions, regulations or funding.

"We know there is great interest among people to have assisted living as one of the options when someone would like to stay in the community, but staying in their own home might not be the right answer for them," said Michael Hall, the state's deputy secretary of long-term living.

"One of the major themes of assisted living is aging in place. If you set one of these up correctly, an individual ought to be able to stay much longer than in a private apartment or home. In many cases, you might be able to stay in assisted living with medical support services, completely avoiding the need to get into a nursing home."

Other legislative proposals concerning assisted living have languished for years, and the long-term care industry itself has mixed views on whether it's useful or necessary to create a new category. Many providers remain critical of the process that led to adoption of more stringent personal care home regulations in 2005.

The Department of Public Welfare has acknowledged that it had insufficient staff to enforce the new regulations, with nearly three of four personal care homes carrying expired licenses this year because inspectors couldn't meet mandates for annual visits.

A bipartisan legislative committee also issued a report this month contending the Rendell administration underestimated the impact and cost of the new regulations on smaller facilities, suggesting a vulnerable population with financial or mental health problems could be at risk if too many homes close.

One industry group, PANPHA, representing nonprofit homes, said there are so many unanswered questions about the future housing and funding of Pennsylvania's senior population that a commission studying the various needs and options would be preferable to creating new legislation and categories now.

"What other states call assisted living is what Pennsylvania has now as personal care," said PANPHA President Ron Barth. "We're saying whatever you call it, you've got to figure out how to fund it."

Finances are a major factor in the new proposal because Pennsylvania and the federal government are spending $3 billion a year -- the state's share of that is 46 percent -- on nursing home care of people who qualify for Medicaid reimbursement. That type of skilled, 24-hour care often costs twice as much as what an assisted-living facility might charge.

Under the administration's plan, the state would obtain federal approval to use Medicaid funds to support people in assisted living.

Presently, personal care homes rely mostly on private-pay residents. Willing providers receive about $1,000 monthly from the government to care for low-income Supplemental Security Income recipients, but many places refuse such clients because they contend they can't cover costs of care on that income.

The Medicaid waivers sought for assisted living are already available for home care, costing up to $55 a day, of individuals frail enough to be eligible for nursing home admission. Consumers with incomes of less than $1,870 a month qualify.

The governor has budgeted $328 million for such home care in 2007-08 but nothing yet for assisted living, because of the uncertainty over its approval. Mr. Hall said no cost estimates have been prepared on what would be spent to support assisted living.

The goal of adding an assisted-living category with government financial support has backing from both Pennsylvania AARP and the Pennsylvania Health Care Association, a providers group. Ray Landis, advocacy manager for AARP, noted there's a wide difference between a "mom-and-pop" personal care home providing meals and laundry service for six or eight residents, and a 100-bed facility that gives people the privacy equivalent of their own apartments.

"It doesn't make sense for us that those two facilities are under the same set of laws," Mr. Landis said.

Personal care homes that lack any medical care ought to continue as an option, agreed PHCA President Stuart Shapiro, "but we need something between that and a nursing home that's also well-regulated, that allows people who need some health care services, but not 24/7, like in a nursing home."

Mr. Hall said the new category would be regulated by the state Department of Health, like nursing homes, rather than by the welfare department. To qualify in the new category, a facility would have to give each resident a private bathroom and kitchenette with some capacity for making meals. Those criteria would eliminate many personal care homes from consideration unless they remodel.

New standards also would have to be developed relating to staffing levels, the medical training of personnel and the extent of medical problems that can be handled by assisted-living centers.

Separate assisted-living legislation passed by a Senate committee last week, for instance, would bar such facilities from handling more serious cases such as people dependent on ventilators. Some industry representatives object that additional restrictions in the bill go too far, eliminating care they already provide.

The sponsor of that legislation, Sen. Patricia Vance, R-Cumberland, said that up to now, the administration has not conferred with her about its measure any more than it has with interest groups.

Ed Corbeil, president of the Pennsylvania Assisted Living Association and an executive with Sunrise Senior Living in Montgomery County, suggested that the administration has inspired little confidence it can handle a new licensing category, when so many objections have arisen to its implementation of the new personal care home regulations.

The state has changed its interpretation of the new rules multiple times, he said, in addition to falling sorely behind in inspections. Sunrise has two dozen assisted living centers across the state, with many whose licenses expired six months or more ago.

Public Welfare Secretary Estelle Richman has acknowledged the department was unable to keep up with inspection requirements at the same time it was trying to crack down on poor-performing homes by increasing penalties and closures.

The department is in the process of hiring 15 more permanent inspectors, plus bringing out of retirement 30 temporary inspectors to reduce the backlog, a welfare spokeswoman said.

"It's unacceptable that a department charged with protecting health, safety and welfare has fallen so far behind," said Cheryl Nemerovsky, co-owner of Sycamore Estates home in Duquesne and president of NAPCHAA, a group of mostly small providers.

"They should have had their ducks in a row beforehand, so they could have their jobs done when required, just as we're required to do."