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Report Card: Assisted-Living Facilities

Room for Improvement: How to Identify the Best Providers

A lack of federal oversight and a wide divergence in state regulations raise concerns about the consistency of guidelines for assisted-living facilities and create potential confusion for consumers.

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When Kathy DeBoer moved in 2014, she entrusted the care of her 81-year-old mother to an assisted-living facility that wasn’t far from the home that the two shared in Connecticut. The experience quickly was marred by a series of blunders, including room mix-ups, confusion over care requirements—the staff was instructed that her mother needed a walker and assistance with feeding; neither was true—and uncertainty about whether her mother received the correct medications.

DeBoer moved her mother out of that facility and eventually was reimbursed the $15,000 that she paid.

Although DeBoer had a positive outcome, unfortunately, that isn’t always the case.

Richard Mollot, who is the executive director of national advocacy organization Long Term Care Community Coalition, says stories of missteps at assisted-living facilities aren’t uncommon. An extreme example is Prospect Park Residence in Brooklyn, N.Y., which has been the subject of numerous media reports and at least eight wrongful-death lawsuits since 2012 because of alleged mistreatment of residents. The facility, which once had at least 120 seniors as residents, billed itself as an assisted-living facility but wasn’t licensed as such, according to Mollot and published reports.

However, even when an assisted-living facility is licensed, you can’t be sure of what sort of care that you’ll receive, Mollot says. That’s largely because no federal regulations exist for assisted-living facilities. Such facilities are licensed by individual states and governed by state laws, which vary widely. Supporters of assisted-living facilities say state regulation allows for closer oversight than what federal rules achieve. However, Mollot says the need for federal regulation is increasing as the demand for assisted living increases from an aging population that’s choosing assisted living over skilled-nursing facilities, which typically are referred to as nursing homes and are regulated federally.

STANDARD CONFUSION. The state-to-state differences start with what assisted-living facilities are called: Although they commonly are marketed as “assisted living,” the names under which these institutions operate and their licensing requirements differ by state. For example, California calls them “residential-care facilities”; Illinois calls them “supportive-living facilities”; Michigan dubs them “homes for the aged.”

Advocates say the absence of standard definitions and regulations can lead to confusion for those who live in one state and seek care for a loved one who lives in a different state, where requirements might differ. In other words, what constitutes “assisted living” in one state might not in another, Mollot says, and the lack of federal regulation leaves residents at risk of mistreatment and even abuse.

States’ differing regulations also result in disparate staffing levels at assisted-living facilities. According to an October 2013 report by ProPublica, which is an independent, investigative journalism source, assisted-living facilities typically are free to decide the number of staff members that’s suitable. Only 14 states set staffing ratios, and even those vary widely. For example, in Mississippi, facilities must have at least 1 per employee on duty for every 15 residents during daytime hours and 1 per 25 at night. In California, facilities that have as many as 200 senior residents require no more than two workers on the overnight shift, or 1 per 100 residents. Further, California doesn’t require either of those overnight workers to have any medical training, and one is allowed to be asleep. Consequently, if an emergency arises, a resident might not receive timely assistance.

Furthermore, inspection requirements vary widely, according to the report. Most states require inspections from once yearly to once every 3 years. However, six states—Alabama, Minnesota, New Mexico, South Carolina, Utah and Vermont—have no requirements for periodic inspections, which means that violations of state regulations regarding safety and staffing have the potential to be overlooked. (We found no evidence that violations were overlooked.)

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