Washington Post Series Examines Assisted Living Industry

An estimated one million Americans reside in assisted living facilities, the "most popular innovation in long term care since the advent of nursing homes," but these centers are facing increasing scrutiny amid reports of patient neglect, medication errors and inadequately trained workers, the Washington Post reports in the first of a two-part series. Developed to provide a place for "elderly people who weren't sick enough for nursing homes, but were no longer comfortable on their own," assisted living facilities operate "entirely without federal standards," and U.S. health officials only inspect the "few" centers that accept Medicaid funds. States are left to oversee the industry, which operates between 11,500 and 30,000 facilities nationwide, through a "quilt of separate rules." While most states issue some sort of operating license, assisted living facility regulations "tend to be vague and provide consumers with fewer rights than federal law ensures every nursing home patient," the Post reports. Only half of states require yearly inspections and most do not dictate the number of caretakers a facility must have or the extent of their training. According to the Post, "such loose oversight may jeopardize adequate care." A 1999 study of assisted living facilities in four states found that more than one in four facilities had "at least five quality or consumer-protection problems," ranging from poor care to inadequate staff. Medication errors appear "especially common." The "first major national survey" of the facilities, commissioned by HHS, found that a quarter of all people who left assisted living facilities were "dissatisfied with the care or the cost."

No Help from Feds?
Because of the lack of regulatory oversight, problems with assisted living facilities are "emerging as a result of families' frustrations and occasional legal challenges," not federal action. In 1999, Sen. Charles Grassley (R-Iowa) held the only congressional hearing addressing the industry's problems. Despite "exposing many of the industry's flaws," no action was taken, and Grassley is opposed to federal regulation of assisted living facilities. Rep. Pete Stark (D.-Calif.) recently called for a White House conference on the issue but has not introduced any legislation to regulate the industry. Meanwhile, 17 states recently have rewritten assisted living rules and other states are "rethinking" theirs, but any attempt to increase regulation will face "strong industry opposition," according to the Post. The industry instead favors a "private system of voluntary accreditation" (Goldstein, Washington Post, 2/19).

The Price of Assisted Living
The second part of the series, featured in the Feb. 20 Post, examines the cost of assisted living facilities, and finds a "pattern of financial practices" in the industry "that confuse -- and sometimes mislead -- consumers." While assisted living costs on average $2,000 per month, many facilities include extra charges for services, such as laundry or transportation, that seniors or their relatives may not be aware of when they sign a contract. And while seniors living in nursing homes have an "automatic safety net" in the form of Medicaid should their savings run out, many assisted living facilities do not accept Medicaid. According to one survey, two-thirds of assisted living residents do not have large enough incomes to pay for a "typical" year's stay, leading to a loss of savings. The high, and often unanticipated costs of assisted living have forced many seniors to leave facilities, the Post reports. With criticism and scrutiny of the industry and its pricing practices growing, the Assisted Living Federation of America has begun to offer a "voluntary certification program for sales and marketing staff, emphasizing the importance of disclosing [services and prices]" (Goldstein, Washington Post, 2/20).