Assisted Living: A Crisis in Care

By McGinnis, Patricia L. | Aging Today, January 1, 2014 | Go to article overview

Assisted Living: A Crisis in Care


McGinnis, Patricia L., Aging Today


The recent Frontline-ProPublica documentary, Life and Death in Assisted Living, and their October 2013 follow-up investigation, Elderly, At Risk, and Haphazardly Protected, highlighted some of the critical issues faced by assisted living residents across the country. Over the past 20 years, assisted living has been the fastest growing component of long-term care, with approximately 31,000 assisted living communities in the United States now serving nearly 1 million residents.

This growth is due, in part, to consumer demand because consumers prefer to age in place-at home or, at the very least, in a community facility with a home-like environment, regardless of their medical condition. Another factor is the marked increase in the acquisition and development of assisted living communities by corporate chains, mirroring the market growth of the nursing home industry in the 1990s.

State Oversight Is Spotty

Unlike nursing homes, which are medical facilities that receive the bulk of their revenue from Medicare and Medicaid and are regulated by both the state and federal governments, assisted living facilities are-in theory, at least-non-medical. The majority of residents pay privately for services and, because few federal dollars are involved, the facilities receive zero federal oversight.

It has been left to individual states to set the standards for assisted living. Thus, all 50 states and the District of Columbia have different rules and regulations governing the frequency of inspections, enforcement, staffing, training, levels of care and even the definition of an assisted living facility. One state's board and care home is another state's residential care facility, and yet another state's assisted living facility.

While most states require facility inspections once every year or every two years, California is one of only two states that require such inspections once every five years. Few states devote adequate resources to enforcement and oversight of assisted living facilities, and nearly all states have inadequate staffing and staff training requirements.

Assisted Living Facility or Healthcare Provider?

Assisted living facilities are usually described as an alternative to institutionalized, impersonal nursing home care and pride themselves on being non-medical models that provide a home-like environment and promote consumer choice. However, too many of these facilities have become healthcare providers trying-and failing-to care for residents with the same acute medical conditionspeople who just years ago were being cared for in nursing homes.

Most states, including California, have failed to keep pace with changes in the care provided by assisted living facilities and the type of high-risk residents they serve. Residents now are sicker, older (older than age 85 on average), needing assistance with three or more activities of daily living, taking multiple, complex medications and dealing with many more chronic diseases. Despite this radical change in the acuity levels of assisted living residents, these facilities are rarely required to have medical personnel on staff.

This failure has led to many of the problems in assisted living today. …

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