Senate Probes the Cost of Assisted Living and Its Burden on American Families

A U.S. Senate committee on Thursday launched an examination of assisted living, holding its first hearing in two decades on the industry as leaders of both parties expressed concern about the high cost and mixed quality of the long-term care facilities.

The federal government has minimal oversight of assisted living, which is regulated by states, unlike skilled nursing homes. Both the Democratic and Republican leaders of the Senate Special Committee on Aging said their inquiry aimed to detail the financial practices and quality levels in the industry so that consumers would be better able to choose facilities. Lawmakers expressed little appetite for Congress to take a more direct role in regulating the sector, such as by setting federal standards for staffing levels and how workers are trained.

Prompted by a New York Times-KFF Health News series, Sen. Bob Casey, the Pennsylvania Democrat who chairs the panel, put out a call for residents and their families to submit their bills so the panel could assess the industry’s business practices.

“I want to know more about what people are paying for assisted living and to have people tell their stories,” Casey said. “We want to hear from you about the true cost of assisted living and understand whether families have the information — the information that they need — to make this difficult financial and health care decision for a family member and for the family.”

Sen. Mike Braun of Indiana, the ranking Republican on the committee, endorsed the inquiry while cautioning against actions that would lead to new financial burdens on the federal budget. “When you’re promoting transparency, it can bring odd partners together,” Braun said.

More than 800,000 older Americans reside in assisted living facilities, which cater to people who have dementia or trouble walking, eating, or doing other daily activities. Most residents have to pay out-of-pocket because Medicare doesn’t cover long-term care and only a fifth of facilities accept Medicaid, the federal-state insurance for people with low incomes or disabilities. The industry is quite profitable, running median operating margins around 20% and often charging residents with extensive needs $10,000 or more a month. The national median cost of assisted living is $54,000 a year, according to a survey by the insurer Genworth.

The New York Times-KFF Health News series detailed industry’s pursuit of maximum profits by charging residents extra at every opportunity. Facilities have billed residents $50 for each injection, $12 for a single blood pressure check, and $93 a month to order medications from a pharmacy.

The quality problems in assisted living have been widely exposed by national and state news organizations. At the Jan. 25 hearing, Patricia Vessenmeyer, a Virginia woman, described the poor care and overwhelmed workers she observed at a dementia care facility where her late husband, John Whitney, lived.

“I once believe I saved a man’s life,” she said, describing how she helped stop a resident who was beating another resident using the victim’s cane. “It took several minutes before a staff member finally heard me and came to help,” she testified. Vessenmeyer said the facility, which she did not name, charged her husband around $13,000 a month.

Jennifer Craft Morgan, director of the Gerontology Institute at Georgia State University, testified that state governments have inconsistent and nontransparent monitoring and enforcement of quality at facilities. She said fewer than 10 states shared information about these procedures in a manner easily accessible to the public.

She said the crux of the problem is that assisted living “is marketed to those who can afford it with a hospitality mindset. They advertise and compete on the basis of amenities, beautiful campuses, luxury food and furnishings, and concierge service.”

Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit advocacy group, testified there is “an escalating demand for federal involvement,” which he said is justified by the fact that a large amount of federal Medicaid funds are going to facility operators, some of which also get loans from the U.S. Department of Housing and Urban Development.

“While some assisted living can be wonderful places to live and to work, too many take in or retain residents for whom they are unable to provide safe care and dignified living conditions,” Mollot said. “Too many residents and families are at risk for financial exploitation and even fraud.”

Casey and other Democratic senators on Jan. 24, citing the Times-KFF Health News series, sent a letter to the Government Accountability Office requesting it study how much Medicaid and other federal agencies pay for assisted living.

A GAO report in 2018 called for improved federal oversight and found that state Medicaid agencies spent $10 billion to provide care in assisted living for 330,000 people in 2014.

In a news release, the National Center for Assisted Living, an industry trade group, said the overall quality of facilities is strong and best overseen by states. It acknowledged that the U.S.’ method of funding long-term care is “broken” and that assisted living is “out of reach for too many seniors.”

Julie Simpkins, co-president of Gardant Management Solutions, which operates senior living facilities in Illinois, Indiana, Ohio, Maryland, and West Virginia, testified that a national standard for all assisted living facilities would be “both unworkable and irresponsible for resident care,” and that injuries, neglect, and deaths are rare. She called for government and private entities to work to develop more affordable options and address the shortage of caregivers.

“These efforts could make a real difference,” she testified.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.