At Committee Hearing, Senators Say Assisted Living Industry Needs More Oversight, Better Consumer Information

The Senate Special Committee on Aging met on April 26 to take a second look at the adequacy of consumer protections in assisted living facilities and evaluate industry efforts to provide quality care to consumers. The panel held an initial hearing on the issue two years ago after a 1999 General Accounting Office report revealed that assisted living facilities did not "consistently" provide consumers with "sufficient information" to "determine whether a particular facility meets their needs," committee Chair Larry Craig (R-Idaho) said. He added, "With hundreds of thousands of Americans living in such facilities nationwide, it's important that we continually evaluate the quality of care [assisted living facilities] are providing." Committee ranking member John Breaux (D-La.) pointed out that Americans have "more information about ... toasters ... in our society" than assisted living facilities, and said, "With nearly 33,000 facilities nationwide, and the number and variety of assisted living facilities on the rise, we must ensure [their] viability." Testifying before the panel, Sen. Hillary Clinton (D-N.Y.) urged the assisted living industry to provide consumers with a "usable form" of information, pointing out that the "myriad of different state-based regulations, often with multiple regulatory frameworks coexisting uneasily even within a single state," can lead to "a lot of confusion." She said, "[There are] a lot of worried families who don't know what it is they're buying," adding that consumers have "no easy way to compare facilities." Committee member Sen. Jean Carnahan (D-Mo.) also warned that a "lack of oversight" of the industry has placed the "health and safety of residents at risk" (Josh Kotzman, Kaiser Daily Health Policy Report, 4/26).

Then...
The 1999 GAO report, which surveyed assisted living facilities in California, Oregon, Florida and Ohio, found "evidence of inadequate marketing materials." Only half of the surveyed facilities informed prospective residents about "help they would receive in taking medications, or when they might face higher costs or discharge because of worsening health problems" (American Health Line, 4/26/99). The GAO also reported that quality of care and "adequacy" of consumer protections in assisted living facilities "differs significantly" among states, with "some offering more safeguards than others," Breaux said.

... and Now
Karen Love, co-chair of the Consumer Consortium on Assisted Living, said at the hearing that the "uneven and patchwork approach to state regulation and oversight" has painted an "increasingly alarming picture of the assisted living industry." For example, she said, in California, assisted living facility residents who become incontinent may have to leave the facility, while New Mexico has no provisions for admission criteria, contracts or "grievance procedures," and New York has "no specific guidelines" for treating residents with dementia. Sen. Ron Wyden (D-Ore.) suggested a "model statute" that would outline a set of "baseline" consumer protections but still provide the assisted living industry with the "flexibility" to expand could help alleviate concerns. Wyden said that states would have to enact the statute within a set time frame, or face "consequences" for failing to comply. He added that the statute could serve as a "tool" that would allow states that have inadequate regulations "to get up to speed" but would not affect states that have adequate rules.

Industry Resists Federal Control
Margaret Thompson, who testified on behalf of the Assisted Living Federation of America, said that the industry backs state regulation of assisted living facilities that does not "restrict seniors' choices." She said, "The industry is very supportive of helping the states help us," but said it opposes "uniform" federal rules, which could restrict choices for seniors. However, Breaux said that the federal government, which provides funding to assisted living facilities in 38 states through Medicaid waivers, should have oversight of the industry. "Wouldn't it be better to have a national standard with enforcement at the local level?" he asked, adding, "I am particularly disturbed that [the federal government] could [provide funding to] a facility where there are no [uniform] standards." During her testimony, Clinton also said that she favored a national standard for assisted living facilities that "sets a framework" for quality of care and consumer protection, adding that most facilities, hoping "to be separated out from those few bad apples," would "welcome that." According to Thompson, however, enforcement of existing state rules, not "implementing another set of regulations," would improve the quality of care in assisted living facilities.

'Dire' Staffing Shortage
The committee also discussed how health care worker shortages were affecting care in assisted living facilities. Wyden said that assisted living facilities nationwide face a "dire shortage" of "qualified" employees. Citing a recent study of more than 300 assisted living facilities, Love said that 25% of those surveyed had only one caregiver per every 20 residents between 3 p.m. and 11 p.m., and one for every 34 at night. To address the problem, Wyden suggested that the industry and governments should offer college scholarships to low-income high school students to attract them to the "aging field." Testifying before the committee, Bill Southerland, managing partner of Bill Southerland's Residential Care Homes in Eagle, Idaho, said, "We need to put a great deal of importance on these positions. They need to be like electrical engineers." Southerland also said that the federal government should provide funding for assisted living facilities to allow them to boost salaries for employees. "They need more reimbursements. They need more dollars per hour," he said. However, Wyden called higher reimbursement rates only a "short term solution" that would not "really develop the care of people" (Kotzman, Kaiser Daily Health Policy Report, 4/26). To view a Healthcast of this hearing, click here.