HB2285- As a mental health clinician and a parent of neurodivergent children, I urge you not to sign the bill. It is a violation of HIPAA and human rights. While I understand the intention is to increase funding, it puts providers in the position to report otherwise private information. It is possible that disclosure can be used against children that are unable to consent to providing their information to a public database. It also creates a conflict of interest for many neuro-affirming clinicians, who believe in their clients' rights to privacy. Please imagine that your private medical information was shared without your consent; how would you feel? As a parent, it is my hope that all parents allow their neurodivergent children the decency to decide if they choose to disclose their neurotype. In creating this, you are robbing children of the opportunity to make decisions for themselves later in life. Please take note of the current political climate; marginalized people (race, gender, etc) are being othered; please do not create a database that offers a space for disabled people to be outed and othered in the future.

We support the autism commission as recommended by the BHC and the autism advisory committee

Please support the bill to advance the autism council to an autism commission. This will benefit directly our adult autism population, which struggles from a lack of resources and therapy professionals. The commission can hire staff to show the gaps in services, and then work to fill those gaps. This bill directly impacts many families in the Commonwealth. Thank you.

As a current member of the Autism Advisory Council, I support this bill that will replace the Council with an Autism Commission. The Council unanimously approved this bill at its last meeting. The commission is necessary for several reasons. The two most important reasons are (i) the needs of the autism community are unique and they are growing and require a focus that, to date, has not been fulfilled by any other commission; and (ii) this will require staff to really make a difference. On behalf of The Faison Center, were we serve children and adults of all ages all along the autism spectrum in our Behavioral Health Clinic, Schools and Adult residential and day programs, we strongly support this bill and respectfully request your support, as well.

Dear Members of the House Rules Committee, On behalf of Commonwealth Autism, I am writing to express our strong support for House Bill 1772 and the creation of the Autism Commission in Virginia. As the President and CEO of Commonwealth Autism, I see firsthand the urgent need for focused leadership and dedicated resources to address the challenges faced by individuals with autism and their families. Autism prevalence continues to rise at an unprecedented rate. According to the CDC, autism now affects 1 in 36 children, and the need for autism-specific resources within the larger developmental disability community has never been greater. Despite progress in services and support, families and providers still face significant gaps in access to care, early intervention, education, employment, and long-term services. An Autism Commission will ensure that Virginia remains proactive in addressing these needs. Unlike other broad disability initiatives, a commission dedicated to autism will bring specialized expertise, legislative focus, and sustainable funding strategies to the table. The challenges facing autistic individuals—including early diagnosis, access to evidence-based therapies, workforce development, and adult transition services—require targeted solutions that a commission can help shape and implement. Furthermore, autism is a lifelong condition. Many supports currently focus on children, but as autistic individuals grow into adulthood, the need for employment opportunities, independent living supports, and community-based services expands. Without a structured and coordinated effort, Virginia risks falling behind in ensuring that autistic individuals have the opportunities and resources needed to thrive. By establishing an Autism Commission, the General Assembly would be taking a critical step in prioritizing the needs of one of the fastest-growing disability populations in the Commonwealth. This commission will provide focus, attention, and resources to the pressing work ahead and will help ensure that Virginia is well-positioned to support autistic individuals at every stage of life. We urge you to support HB 1772 and take this important step toward a more inclusive and supportive future for individuals with autism and their families. Thank you for your time and consideration. Sincerely, Tyler Hart President & CEO Commonwealth Autism

Greetings, I write today in support of HB1772/SB1232. I am Director of State Government Affairs for Autism Speaks, a national nonprofit dedicated to creating an inclusive world for all individuals with autism throughout their lifespan. From my perspective as someone who advocates for the autism community across many states, and who studies national public policy trends on autism-related initiatives, HB1772/ SB1232 would well position Virginia lawmakers to respond to the growing needs of the autism community. A new study of electronic health records and insurance claims data from over 12.2 million people from 2011-22 shows that the number of individuals diagnosed with autism spectrum disorder (ASD) has increased by 175% over a decade. This study offers insights into trends in autism diagnosis over time, and when paired with prevalence data from the CDC, offers valuable insight that can be used to better understand the demographics of the autism community and plan for their myriad of needs. Some of the most significant details from the study: * The increase in ASD diagnoses among young adults suggests that people may be going undiagnosed in childhood, only receiving a diagnosis in early adulthood when challenges in daily life become too difficult to manage. This trend highlights the importance of accessible diagnostic services across the lifespan and the need for age-appropriate interventions and supports for adults on the spectrum. * The results also showed that males are about three times more likely than females to get an autism diagnosis. However, the gap seems to be narrowing. Diagnosis rates rose by 305% among girls and 315% among women, compared to 185% among boys and 215% among men. This trend may reflect greater awareness of ASD signs in females, who may present differently from males. * Among racial and ethnic groups, ASD diagnosis rates rose significantly for minority children, though not for adults. For example, diagnosis rates among Hispanic children increased by 315%, compared to a 146% increase for non-Hispanic children. Rates among Black and Asian children also saw significant increases. These findings may reflect better access to diagnostic services within historically underserved communities. * Results showed that ASD prevalence was highest among children aged 5-8, reaching 30.3 per 1,000 children in 2022—about the same as the most recent CDC prevalence rate. Among adults, prevalence was notably low, particularly in those aged 45 and older. However, young adults aged 26-34 saw the sharpest rise in diagnoses, with rates increasing by 450% over the study period. I highlight this new information because it underscores the need for -- and importance of -- HB1772/ SB1232. The elevation of the Autism Advisory Council to an Autism Commission signals a commitment from Virginia lawmakers to improving public policy for the growing needs of the autism community. A commission's additional infrastructure, including dedicated staff would provide focused resources to address autism-specific challenges without diverting resources from other disability groups. This targeted approach is needed to ensure the complex needs of the autism population are effectively met and gaps in existing services are addressed. I encourage the members of the Rules Committee to support the creation of the Autism Commission as recommended by both the Behavioral Health Commission and the Autism Advisory Council. Thank you.

Comments Document

Please vote YES for HB1772 Autism Spectrum Disorder (ASD) encompasses a wide range of abilities, challenges, and co-occurring conditions that require targeted, nuanced support. Existing services for individuals with autism in Virginia are fragmented, requiring families to navigate a complex maze of systems with little coordination. A commission would focus on creating policies specifically designed to address these unique needs, ensuring resources and support systems are appropriately aligned. The numbers are only increasing along with the complexity of needs. Please support the Autism Commission and HB1772.

Please vote yes on HB1772. I am the father of a son who is autistic. We are very grateful to the Behavioral Health Commission and the Autism Advisory Council for recommending an Autism Commission. This bill is important to me because we have struggled with disproportionate responsibility on families and significant financial, emotional, and logistical burdens due to the high cost of therapies, inadequate public support, and limited respite care options. Becoming a Commission means there will be staff to assist with research on complex issues and look for data-driven answers. • Virginia's rates of autism are increasing rapidly and the population has complex and diverse needs. • Existing services do not adequately support many individuals with autism and their families • A Commission will allow for research of proven and effective methods to address autism-specific challenges. • Adult autistics often require job support, communication support, or more intensive levels of care in the community and the home. The needed support is non-existent and families are unable to access the services. Please vote yes

We are very grateful to the Behavioral Health Commission and the Autism Advisory Council for recommending an Autism Commission. I am a service provider to a wonderful group of adults who have Autism. While these people are "faceless" to you, I see their faces daily. I also see the faces of their caregivers that are trying to make sense of the current systems we have in place. This bill is important to me because I have witnessed the disproportionate responsibility on families and significant financial, emotional, and logistical burdens due to the high cost of therapies, inadequate public support, and limited respite care options. Virginia's rates of autism are increasing rapidly and the population has complex and diverse needs. Adult autistics often require job support, communication support, or more intensive levels of care in the community and the home. The needed support is non-existent and families are unable to access the services. Families with a Medicaid Waiver are having services cut because the funds have not been allocated for providers. Becoming a Commission means there will be staff to assist with research on complex issues and look for data-driven answers. Please Vote YES on HB1772 Thank you

The Autism Commission would enable dedicated attention to autism, which currently is addressed frequently under the behavioral health commission A distinct commission would allow state dollars to better serve not only those with autism, who present with unique complexities and support needs often above and beyond other forms of developmental disabilities, but also those with behavioral health concerns. It would additionally support increased efforts across the state to support all individuals with developmental disabilities.

Persons with autism have complex and diverse needs which current Commonwealth legislation, policies and DD waiver services have made little progress in addressing. Autism is a spectrum disorder that ranges from very high functioning individuals who are capable of attending college, participating in the workforce and leading relatively normal lives with minor accommodations to individuals who are nonverbal, intellectually disabled, engage in self-injurious behavior and have major behavioral issues. I am the parent of a 30 year old son with profound autism who is functionally nonverbal, incapable of engaging in competitive employment and has significant behavioral challenges. He has a Community Living (CL) Waiver, but current services and DBHDS policies do not adequately address his needs or allow him to lead a safe and productive life. But as badly as the Commonwealth is failing my son, there are many persons with autism who are in far worse condition, especially those on the DD waiver waitlist. A Commission will ensure that state of the art research is available that informs legislators and executive branch agencies with the basis for developing evidence based, proven and effective methodologies to address autism-specific challenges. It will also enhance the overall coordination and cooperation among the various autism and developmental disability advocate organizations. Most importantly, it will ensure that parent/guardian/caregiver concerns are heard and incorporated in the development of future legislation and executive agency policies.

Please support the establishment of the Autism Commission as it would provide the additional infrastructure needed to actually make meaningful changes for the autistic community. With a dedicated staff to do research and analysis and gather input and stakeholder feedback, the commission could help legislators make evidence-based decisions. A commission would also create more diverse representation through subcommittees with additional legislators, self-advocates, family members, clinicians, autism advocacy organizations, school representatives, and many more. This commission was also a recommendation from both the Behavioral Health Commission and the Autism Advisory Council. Please support HB1772!

Dear Committee, This commission is vitally important to provide the Autism Community the ability to most effectively address our needs. As an Autistic Adult it is vitally important to me that we have people who are dedicated to our community to provide guidance on the best course of action. Thank you for your time.

Please vote for our Autism Advisory Council to become a Commission with paid staff. The staff will be able to work full time to fill those gaps and needs for us that continue to grow. To include education, healthcare, employment, housing and independent living supports. I feel the Autism Advisory Commission can be that added support that we need so all of our needs can be met as best as possible, and we can all be whatever is the best of who we can be.

As a non-profit provider of services to individuals across the autism spectrum of all ages; in particular, to a number of individuals profoundly impacted by their autism diagnosis, I am in touch to ask that you all vote YES on HB 1772. I am grateful to the Behavioral Health Commission and the Autism Advisory Council for recommending an Autism Commission. This bill is important for a variety of reasons, some of which include the increasing prevalence of autism, discoordination of various initiatives across the Commonwealth, and the lack of efforts geared towards better supporting those with profound autism. Becoming a Commission means there will be staff to assist with research on complex issues and look for data-driven answers. Thank you for voting YES on HB 1772.

Please vote yes on HB1772 (https://lis.virginia.gov/bill-details/20251/HB1772) We are very grateful to the Behavioral Health Commission and the Autism Advisory Council for recommending an Autism Commission. A Commission without staff cannot address these complex issues. Becoming a Commission means there will be staff to assist with research on complex issues and look for data-driven answers. Virginia's rates of autism are increasing rapidly and the population has complex and diverse needs. Existing services do not adequately support many individuals with autism and their families A Commission will allow for research of proven and effective methods to address autism-specific challenges. Collaboration with others in the Developmental Disabilities community will ensure everyone has input. Adult autistics often require job support, communication support, or more intensive levels of care in the community and the home. The needed support is non-existent and families are unable to access the services. Families with a Medicaid Waiver are having services cut because the funds have not been allocated for providers. Families support their loved ones at home for as long as they can without calling for help because the current system is abusive and causes lifelong trauma. Please vote yes on HB1772

Please vote yes on HB1772 (Link for the language of the bill) We are very grateful to the Behavioral Health Commission and the Autism Advisory Council for recommending an Autism Commission. IMPORTANT to tell them to KEEP Staff for the Commission. A Commission without staff cannot address these complex issues. Becoming a Commission means there will be staff to assist with research on complex issues and look for data-driven answers. Expanded Comment Ideas Virginia's rates of autism are increasing rapidly and the population has complex and diverse needs. Existing services do not adequately support many individuals with autism and their families A Commission will allow for research of proven and effective methods to address autism-specific challenges. Collaboration with others in the Developmental Disabilities community will ensure everyone has input. Families support their loved ones at home for as long as they can without calling for help because the current system is abusive and causes lifelong trauma. Adult autistics often require job support, communication support, or more intensive levels of care in the community and the home. The needed support is non-existent and families are unable to access the services. Families with a Medicaid Waiver are having services cut because the funds have not been allocated for providers.

I support HB1949 because I live at sea level. Beyond my personal stake in coastal protection, the threat of major coastal flooding will badly hurt the state economy. Insurers are beginning to pull out of other coastal areas. WE need realistic, data-driven planning for coastal Virginia. Please support HB1949.

Response to House Bill 1978 – Concerns and Recommendations from a Senior Housing Professional Dear Delegate, I am writing to share my perspective on House Bill 1978 as a Registered Nurse and Licensed Long-Term Care Administrator with 17 years of experience in the senior housing industry. While I understand and appreciate the intent behind making the process of establishing small licensed homes more accessible, I have concerns about the potential consequences of loosening regulatory requirements without ensuring appropriate oversight. One of the most significant issues with the current system is the complexity of obtaining licensure for a small residential home in Virginia. While I believe some streamlining could benefit prospective providers, it is also essential that a well-defined process remains in place to ensure that only qualified individuals operate these facilities. If regulations are significantly relaxed, there is a risk of an influx of new homes opening without the proper staffing, training, and safeguards in place—potentially compromising the safety and well-being of vulnerable residents. That said, I also recognize the financial and operational challenges that smaller facilities face compared to larger communities. Currently, small homes, such as my own 8-bed facility, are subject to many of the same regulations as large-scale assisted living communities, despite having significantly fewer resources. I strongly advocate for regulatory adjustments that consider occupancy size while maintaining a high standard of care. For example, compliance measures should be proportionate to facility size, allowing smaller providers to meet essential standards without undue financial burden. Another critical concern is the growing demand for senior housing. With an increasing number of aging individuals in need of care, small residential homes play a vital role in providing safe and personalized environments for seniors. However, maintaining quality should not come at the expense of accessibility. Striking the right balance between regulatory oversight and operational feasibility is crucial in ensuring that these facilities remain a viable option for seniors and their families. I urge lawmakers to consider a tiered regulatory framework that ensures safety and accountability while acknowledging the financial and operational differences between large and small senior housing providers. I welcome the opportunity to further discuss this issue and provide insight into how we can create a more effective and sustainable model for small licensed homes in Virginia. Thank you for your time and consideration. I appreciate your commitment to improving senior housing options in our state and look forward to seeing how this legislation develops. Sincerely, Shauna Toussaint MSN, RN Liscensed Long Term Care Administrator CEO of Pivotal Senior Services CEO of Pivotal Assisted Living shauna@pivotalseniorservices.com

I have been a Licensed Administrator and a Nurse In Assisted Living since mid 2000. Keeping the older people safe and secured is a BIG JOB and 24 hour responsibilities. You need to have the talent, education and experience . I truly believe that we need to have a HIGHER Standards in VA to protect our seniors in VA. Assisted Living nowadays is similar to a NURSING HOME. We take care of People that needs a lot of medical needs. DONT ALLOWED LOWER STANDARDS. WE NEED AN OPERATOR WITH ADVANCE DEGREE and TRAINING. ASSISTED LIVING IS LIKE A NURSING HOME NOW

I have been a Licensed Administrator and a Nurse In Assisted Living since mid 2000. Keeping the older people safe and secured is a BIG JOB and 24 hour responsibilities. You need to have the talent, education and experience . I truly believe that we need to have a HIGHER Standards in VA to protect our seniors in VA. Assisted Living nowadays is similar to a NURSING HOME. We take care of People that needs a lot of medical needs. DONT ALLOWED LOWER STANDARDS. WE NEED AN OPERATOR WITH ADVANCE DEGREE and TRAINING. ASSISTED LIVING IS LIKE A NURSING HOME NOW

I have been in this business since 1980 and we have worked hard and deligently on taking care of seniors, mental health people, on a 24 hr basis and I should NOT be asked to take a test to become an Licensed Administrator when I have did this job for over 30 years. The Administrators today cannot operate the facility because they don’t have patience and it’s to stressful so they quit!!! I want to be Grand-fathered in as an Administrator anyone who has been in this business since 1980 should be given a pass to operate without being required to go to school to be a license Administrator you will never find dedicated people like me again and who are willing to hang in there and keep taking care of the people for they have no family members or any where else to go and we become like family to them. Taking us away will only hurt the facility and the residents who have become to look at the facility as home and love the management. They should be given a choice and not the state making that for them. If you mandate 45 years of dedication to be taken away some Residents could be harmed by taking away the very people who have cared for them and who they respect and love. Also state regulations should be for Assisted Living not Nursing Home for most of them are privately owned by big corporations who never see the Residents and it’s only a money game with them . We should be credited for our love and dedication because no one could stay in business by the rate the State pays to take care of people 24 hours seven days per week, but we have hung in there and managed because we care and these people had no where else to go. It’s really bad now because you cannot find dedicated staff to work in no department but especially Management and Nursing. So i ask you with a heavy heart DONOT MANDATE anyone in business since 1980 to go to College and earn a degree to become a License State Administrator for and Assisted Living in order to keep there business and continue to take care of the Residents that are in their facility and it’s there home. We / me should be grand-fathered in and continue to operate And find some great dependable staff that have some education and experience in working with the Elderly. This business is the only business left for people to feel like they are at home because it’s affordable Nursing Homes are extremely expensive and a lot of low income people do not qualify or sex offenders so they become homeless or a person of the streets. We must do better when we are thinking about people And their lives. Yes we are accountable but you Put people in harms way when we don’t allow people to live their lives to the best of their ability. So again if you have been in business like I have over 45 years I DONOT need to be a license Administrator please Consider this please.

Support HB 1978

In support of passing this bill. VA is in great need of evaluating (1) the state requirements to become an administrator (2) the over-regulation of ALFs in the state and the (3) lack of distinction between small ALF communities and large ones. They are all evaluated by the same list of hundreds of standards that do not make working sense. (4) Inspection regulations hold facilities to standards far past excellent care of the residents and a good loving environment for our elders - read all 200+ pages of the regulations from VDSS. Further - The NAB exam does not evaluate the tester's knowledge of Virginia regulations, as it tests an individual’s knowledge of nationally accepted practices in long-term and post-acute healthcare industries, which sometimes conflict with Virginia’s regulations for assisted living facilities. The pass rate of the exam is less that 50% and the supply and demand for ALFs must be revaluated. There is a significant shortage of licensed preceptors available to train AITs and there have been recent barriers to entry imposed by even more regulations around the rules of being a preceptor in VA. It is very clear there is a shortage of administrators in VA for this industry but there is no shortage of facilities. This is the first time in US history there is more aging population than young people. People are moving out of state to work in this industry because it is easier to carve out a career path in other states.

The study for licensure for Assisted Living is greatly needed! I sat for my exam in October of 2020. Prior to sitting for the exam I had built a 15 year career at that point in skilled nursing and nursing homes. I had completed the AIT track after completing my Bachelor's in Healthcare Management. During the time leading up to sitting for the exam I was very suprised to find out that the exam did not really center on Assisted Living, but senior living in general coupling our sector in with skilled nursing. With the experience I had gained in Skilled Nursing and Nursing homes I was able to pass with ease and was fortunate to have had that foundation. I currently have been a preceptor for a few years now attempting to help the next generation of healthcare executives, because we can not wait another 15 years for a new generation of executives. I find it frustrating as a preceptor that I am having to help teach knowledge on policy, procedures, and regulations that lay outside the Assisted Living sector of healthcare to those who are the next to sit for the exam. Our level of care is different, it is not cookie cutter, should we not have a professional licensure track that mirrors the educational and skill needs of our specific industry?

Hello , my name is TaKeia Davidson . I want to take the time to advocate for the AIt students . I had an extremely hard time finding a preceptor In my area . I searched and was in contact with different preceptors for years. I had experienced in NC . I feel as if a solution would be to have more support through the process, schools work force development centers , help paying for administrator in training programs. Most people have never heard of the program. Market the program in colleges and work force development opportunities so that the demand in Communities will be met . Thank you so much for your time .

From July 2014 through July 2016, I was a Sales and Marketing Director for an Assisted Living Community in Danville VA. While in that position, I learned a lot about Assisted Living and the VA Regulations. When my Administrator transferred to another community, it was recommended that I go through the AIT program to become licensed as an assisted living administrator to take over my community. I had been a professional real estate agent for 15 years prior to senior living, but did not have any education higher than a high school diploma other than the many real estate coursed that I had taken. I was deemed "unqualified" to apply to participate in the administrator-in-training program due to not enough education. A couple months later, I was offered a position in a NC community. In NC, I could serve as the Administrator with another administrators license in the community. I worked full time for 2 years while taking classes at the community college year round. I tried to take classes that I felt would help me as an administrator, but many I took to acquire the highest number of credits needed to apply quickly. It was such a waste of my time and money to have to complete courses simply to have the required number to apply. Then went through the AIT program. The five years that I worked in NC, I could have been a VA administrator had the regulations for VA not been so excessive. In 2021, I finally made it back to VA, took the administrators exam and became a VA Long Term Care Administrator. I have been working for Commonwealth Senior Living since that time. If you do any continuing Education for AL, you know that soon the state is going to be bombarded with baby boomers who will require senior living. How are we going to meet that need if the licensure process is so difficult and their is a shortage of Administrators. I urge you to please pass HB1978 so that the JCHC can conduct the study on the licensure process for assisted living facility administrators. In conducting the study, the JCHC will be able to determine any potential barriers to licensure as an assisted living facility administrator and make recommendations on policies to increase the accessibility of licensure. We will all benefit from this study whether we are seeking to be licensed administrator or those in need of senior living in the future.

Our industry needs dedicated men and women with a heart for service who are willing to commit to the time and stress of the job. Barriers currently in place prohibit those who may have the life experience to operate communities and provide for excellence in the care of residents and the mentoring of others on the team. I would ask the current requirements be reevaluated such that we do not eliminate those who may contribute to our industry and society.

Opportunities:  Virginia can serve as a leader in recruiting, training, and retaining highly qualified assisted living administrators by reducing barriers to licensure and by expanding pathways to licensure to fulfill workforce needs.  By expanding credentialing options, Virginia strengthens its career options and workforce expansion opportunities by developing and maintaining a continual pipeline of talent  Fulfilling the goal to remove barriers to licensure could create viable pathways to licensure allowing ALFA candidates to decide which options works best for them and their career goals.  HB1978 supports a thorough analysis of any barriers to licensure and creates an opportunity to make recommendations on policies to increase the accessibility of licensure. Support HB 1978.

As many of know, there is a shortage of healthcare workers. Most times we only think of clinical team members, but there is also a shortage in healthcare administrations. There are many reasons why we have the shortage, but the one that we can reduce is the ability of administrators to be qualified to practice in a community. We are requesting that their be data collected to look at the regulations set out by DSS and other state codes to see if anything can be revised to support more people to become eligible to be administrators. Caring for residents is something that is not going away and we need leaders that help manage the day to day. We would love a round table or opportunities to share more feedback on the barriers that prevent people from joining this workforce.

I support HB1978! The state of Virginia is one of the difficult state to operate assisted living. Having worked in multiple states for other companies, I find VA to be one of the most challenging states to operated. The over regulatory environment makes it impossible for provide quality care and services. The requirement for adminsitrator licensure is over burdensome in the following ways: * The regulatory requirement for a preceptor is burdensome. Hours requires and lack of qualified preceptors makes it impossible to get folks licensed. * The testing is extremely difficult and the pass rate in the state is dismal. * The test is a standardize test that doesn't have anything to do with VA and assisted living. The state is nursing home test. * Significant amount of AIT hours in addition to working a full-time job, balancing school, and/or balancing home life is a real barrier for younger people who want to begin a career in senior living in VA.

As someone who is responsible for 25 assisted living communities in VA, supporting thousands of seniors and employing thousands of VA residents, I strongly encourage passage of this bill. Thank you, Earl Parker

Comments Document

The Virginia Assisted Living Association (VALA) represents nearly 200 licensed assisted living communities (ALF) throughout the Commonwealth of Virginia of varying capacities and operational structures. We receive many calls for assistance in understanding the process of becoming a licensed assisted living facility administrator (ALFA) from individuals currently working in Virginia as well as individuals wanting to move to Virginia. We often hear the desperation and disappointment in their voices when they review the prerequisites to even enter the required administrator-in-training (AIT) program and the requirements of participating in the AIT program such as the requirement to complete 320-640 hours of precepted training and a national examination. We are often told Virginia has some of the most restrictive requirements resulting in loss opportunities for recruitment and a significant shortage of licensed administrators to fill the industry’s need. A review of other states and their respective AIT programs resulted in a competitive average training requirement of 180 hours, the allowance of knowledge exams based on state regulations, and varying eligibility requirements to enter their respective AIT program. Virginia’s requirements create barriers to entry for becoming a licensed administrator, barriers to operation for assisted living communities, and a reduction in long-term care housing options for seniors as assisted living communities are required to have a licensed administrator. VALA often hears from assisted living providers that are struggling to recruit administrators due to the shortage. These calls expressing concerns about administrator vacancies were exacerbated throughout the COVID-19 pandemic. During the COVID-19 pandemic, many administrators were overworked and burned out resulting in many leaving the profession. Virginia has a deficit of available licensed administrators to meet the needs of the industry, as some individuals have retained their license but are not actively practicing in the industry. According to the VA Healthcare Workforce Data Center (HWDC), the percentage of licensed ALFAS working in an ALF as their primary location has been steadily decreasing from 84% in 2013 to 64% in 2024. According to HWDC, the percentage of ALFA licenses not renewed each year is generally greater than the percentage of new licenses highlighting the labor shortage of ALFAs. HWDC also reports that 30% of the currently licensed administrators plan to retire within 10 years and 21% plan to either leave the profession, leave Virginia, decrease their patient care hours, or decrease the teaching hours within 2 years. Virginia can serve as a leader in recruiting, training, and retaining highly qualified assisted living administrators by reducing barriers to licensure and by expanding pathways to licensure to fulfill workforce needs. By expanding credentialing options, Virginia strengthens its career options and workforce expansion opportunities by developing and maintaining a continual pipeline of talent. HB1978 supports a thorough analysis of any barriers to licensure and creates an opportunity to make recommendations on policies to increase the accessibility of licensure. We encourage and ask you to support HB1978.

I strongly support HB 1978. It has been very difficult for us to find a preceptor able to train an AIT.

It is imperative HB 1978 is approved. It is necessary to ensure the leadership solvency of assisted living communities for years to come. It is very difficult to find and train licensed administrators. This study would allow for a thorough review of barriers and opportunities to improve the licensure process.

It is imperative HB 1978 is approved. It is necessary to ensure the leadership solvency of assisted living communities for years to come. It is very difficult to find and train licensed administrators. This study would allow for a thorough review of barriers and opportunities to improve the licensure process.

Requirements for an AIT are restricting many from becoming licensed. The educational requirements are restrictive, as there are many candidates who would be exceptional but do not have the college credits, but do have life experience. Field experience should equal college credits. Second, the number of hours required is excessive for a person with field experience, especially as they have most likely already performed many of the duties suggested in the training. The extensive hours should only be required for someone with education but no experience. Third, the reason preceptors are difficult to find is that this is restricted to two people at a time. As a consultant, I would be a preceptor full-time and help many AITs get trained, since I have 30 years of experience, but with the limit of only two AIT at a time I would not be able to make enough money to do this. Since only 8 hours a week is required to spend with each person, a preceptor should be able to have at least 5 AIT at a time. Also, the rule should be removed that a preceptor must have served as an Administrator within the past 2 years. As a consultant, I work IN and FOR communities but not always in the role of Administrator. A preceptor who is a licensed administrator, and has served as an Administrator for a total of over 5 years OR in the past 2 years should be allowed. Thank you for the opportunity to express my views.

Good evening, As a lifelong human services professional seeking credentials to start my encore career as an assisted living facility administrator (ALFA) in Virginia, my efforts are greatly impacted by the number of obstacles and challenges that I must overcome to do so. I am a graduate student in the Master’s of Gerontology program at VCU, slated to graduate in December 2025. However, I already possess an M. Ed in Leadership, Policy, and Organizational Management, a Post-Baccalaureate Certificate in Disability Leadership, and my work experience includes serving as a training coordinator for a healthcare company, a social worker for nearly 20 years in the City of Richmond, and a stint managing a public guardianship program. I also serve on several boards and committees that address and focus on senior related issues and concerns, such as the Aging and Disability Advisory Board (ADAB) for the City of Richmond and the Chesterfield Council on Aging (CAA). Yet, according to the guidelines for ALFA licensure in Virginia, I still need 320-640 hours of an administrator-in-training (AIT) program, which will have to be done along with working my full-time job that I need to take care of my family. This means I will have to craft a schedule that my current employer will hopefully support while trying to figure out how to manage 70-hour weeks of work and AIT responsibilities along with completing the remaining academic coursework. I have looked at ALFA licensing requirements for other states and considered relocation just because I would be able to achieve my goal much more quickly and reasonably, in a state such as North Carolina, which offers a state-based exam and will recognize and would acknowledge what I currently possess academically and professionally. Virginia has always been my home, and it is my desire to have it remain so, to utilize my time and talent for the benefit of the residents of the state I love. I respectfully ask your support for HB 1978 to ensure that others seeking to become ALFAs in Virginia have pathways to do so that fit their individual goals and circumstances. Thank you, Glynis Boyd Hughes

My name is Ruby Cherian, and I am an attorney at Legal Aid Justice Center. I serve as part of plaintiff’s counsel at Fluvanna Correctional Center for Women, where I represent incarcerated people in their lawsuit for constitutionally adequate medical care. I have had both pregnant and nursing clients as part of this case. I urge you to support HB 2325. There is a significant lack of information on the experiences of incarcerated women, particularly pregnant and nursing mothers, who are often overlooked in criminal legal discourse. This workgroup will gather data on lactation policies (or the lack thereof) across jails in the Commonwealth and recommend standards. Since breast milk provides essential nutrition and antibodies for infants, this bill will better protect the health and wellbeing of children in the Commonwealth. For these reasons, I support HB 2325. Thank you!

The League of Women Voters supports HB2617 which would establish the Commission on Women’s Health. The proposed scope of work takes a wholistic approach to women’s health and takes into account the social determinants of health that affect equitable access and outcomes of health care for so many women. The Commission on Women’s Heath could draw much needed legislative attention to women’s health. Its charge to recommend legislation or budget changes to improve women’s health could result in more meaningful and substantive actions than piecemeal legislation. For these reasons, the League supports the establishment of the Commission and urges that adequate funding be appropriated so it may have the impact intended.

It makes sense to reestablish the Joint Subcommittee on Recurrent Flooding because the flooding has not gone away. Please support HJ437.

The Virginia Education Association supports this bill.

I support HJ440

HJ440 Should be passed. We need a study on the removal of books in schools because it is crucial to be known the extent of this occurring in Virginia. It has happened at my kids school. However you have some who would say that book bans are a hoax. This is absolutely not true. Have this study get the information so that we can have something definitive to work from.

Hello, Please prioritize this initiative. This data will be invaluable for Virginia education and libraries. In addition, it will create jobs for the community. Thank you for your time

I urge passage of HJ440. This would enable a valuable study into the effects of removing books from the school libraries students use. Are certain subjects and viewpoints unsafe for children and teenagers? Or does the lack of information about those subjects create a risky ignorance? What happens to students who identify with the contents of removed books? A study would give us facts instead of assumptions to guide school policies.

The Virginia Education Association supports this bill.

Dear Delegates: As an entity (Clean Fairfax, Fairfax County) that receives a portion of the proceeds of "The Litter Tax" I write to urge you to support HJ448 which would ask the Department of Environmental Quality to study ways to reform and update the Litter Tax. As you may be aware the litter analyzed in the original study from 1979, has little relevance to the litter that we encounter across Virginia communities in 2025. For example, 46 years ago, aluminum cans were the most common type of litter found, comprising 38% of all litter found in the outdated study. Over the past several years of monitoring and cleaning up litter in Fairfax County's streams, however, we have found that food and beverage plastic detritus account for more than 75% of litter floating in area waterways. Those aluminum cans of the late 70s have been replaced by an overwhelming avalanche of plastic--bottles, food containers, wraps, bags, polystyrene (foam--let's hope we get that foam ban in place) and other single use plastic litter. We rarely find aluminum cans now. In addition, we believe there are opportunities to increase the fees that retail outlets pay to have the fund keep up with inflation and help mitigate the litter problem in the commonwealth, and offer opportunities for creative problem-solving on the front end of the problem, as well as the cleanups on the back end. This fund has an excellent return on investment as it is used across the commonwealth generally by localities and nonprofits to support volunteer led community cleanups,--thousands of volunteers each year, putting in tens of thousands of volunteer hours in their communities, picking up tons of mismanaged mismanaged solid waste (aka litter) that has flown out of the backs of trucks, out of dumpsters and trash cans and recycling bins. We hope you will move this bill along and we look forward to assisting DEQ with this important work, just as we have for the last 40 years since we were established in Fairfax County to work on this exact issue. Very truly yours-- Jen Cole, Director, Clean Fairfax

Comments Document

The Virginia Assisted Living Association (VALA) represents nearly 200 licensed assisted living communities (ALF) throughout the Commonwealth of Virginia of varying capacities and operational structures. VALA supports HJ463. Data provided by the Census Bureau shows a net out-migration from Virginia of individuals aged 60 and older between 2010 through 2022. For the first time in U.S. history, adults aged 65 and older are projected to outnumber children by 2034 because of the aging “Baby Boomer” population. Should the baby boomers continue the recent trend of migration out of Virginia, this will negatively impact Virginia in multiple areas including, but not limited to: demographic shifts in workforce, healthcare systems, economic impacts, real estate markets, and even political and social influences. By understanding why older Virginians are migrating out of the Commonwealth, Virginia’s agencies and community stakeholders can help to stabilize migration influencers. With this study, existing policies and regulations may be identified that are unintentionally contributing to this trend. Study findings and recommendations will allow the Commonwealth to consider changes that could reverse the migration of older Virginians. VALA requests the passage of HJ 463 and would welcome the opportunity to work with JLARC and the Virginia General Assembly to improve the quality of life for and the retention of older Virginians.

Support for HJ463.

Good evening, Recently, Governor Youngkin gave remarks on Legislative Day, January 21, where he shared how Virginia has been seeing a steady growth in people moving into the state over the past several years. However, HJ463 points to an area that we may not have been fully aware of and that warrants attention: Virginians 60 and older have been leaving the Commonwealth for the past decade. HJ463 is asking JLARC to study the causation and resulting impact of this migration. The consequences of this migration range from decreased tax revenue, loss of workforce and historical knowledge base (which is needed to adequately train those coming into positions) and most of all, people possibly leaving the home they love for reasons we need to be aware of to ensure the state is maintaining a "do no harm" stance as it pertains to its elder citizens. As a gerontologist in training, this issue is of great concern to me and my colleagues in the gerontology field, as we do the work that contributes to the quality of life for Virginia’s seniors. This issue raises the quite reasonable question of why many of Virginian’s older citizens are choosing to relocate outside of Virginia, possibly people who were born here and spent their lives working and raising families in the Commonwealth, contributing in numerous ways and measures to the state's growth and development. I respectfully encourage and urge that the committee support passage of HJ463 to JLARC study. Thank you, Glynis Boyd Hughes

January 29, 2025 Delegate Don Scott Chair, Rules Committee House Committee Room B – 205 Richmond, Virginia The Honorable Chair Scott, Vice Chair Helmer and Members of the Rules Committee: RE: HJ 466 – Designating May, in 2025 and in each succeeding year, as Amyotrophic Lateral Sclerosis Awareness Month in Virginia Position: SUPPORT My name is Lindsay Jack, and I am the Managing Director of Advocacy at the ALS Association. I am writing today in support of HJ 466: Designating May, in 2025 and in each succeeding year, as Amyotrophic Lateral Sclerosis (ALS) Awareness Month in Virginia. ALS is a fatal progressive neurodegenerative disease that that affects nerve cells in the brain and spinal cord, It slowly robs a person’s ability to walk, talk, eat, and eventually breathe. There is no cure for ALS (also commonly known as Lou Gehrig’s disease), every diagnosis is lethal. Every 90 minutes, someone is diagnosed with the disease, and someone passes away from it. The rate at which ALS progresses can vary, although the mean survival time with ALS is two to five years, some people live five years, 10 years, or even longer. Most people who develop ALS are between the ages of 40 and 70, with an average age of 55 at the time of diagnosis. However, cases of the disease do occur in people in their twenties and thirties. ALS is more common in men than women, and for unknown reasons, military veterans are more likely to be diagnosed with the disease than the general public. Life changes after an ALS diagnosis. Being diagnosed with ALS is devastating and overwhelming. At the ALS Association we assist people with ALS and their families throughout Virginia and the rest of the country through our care services team and certified clinical care centers. The ALS Association is the largest philanthropic funder of ALS research in the world, funding global research collaborations, and advocating for better public policies for people with ALS. The ALS Association builds hope and enhances quality of life while urgently searching for new treatments and a cure. For all these reasons, I respectfully request your support for House Joint Resolution 466. Thank you to Delegate McClure for introducing this resolution and to the members of the House Rules Committee for your time and consideration. Sincerely, Lindsay Jack Lindsay Jack Managing Director, Advocacy The ALS Association Lindsay.Jack@als.org