A person with Alzheimer’s or another type of dementia walks away from assisted living or memory care facilities nearly every day in America. Many die, according to a Washington Post investigation that combines state inspection reports and media accounts.
After a year of determined reporting, Arizona Republic journalists Sahana Jayaraman and Caitlin McGlade have uncovered widespread neglect and abuse in assisted living.
The Industry’s Inadequate Training
The aging population in the United States is growing fast, and many of them will need care at some point – services that provide a safe and comfortable living environment. Some will need assisted living, where they can be given medication and help with daily activities like bathing and dressing. Others will need nursing home care, where they will get specialized medical services. Unfortunately, many of these facilities have been criticized for neglect and abuse.
One of the biggest reasons that assisted living fails to live up to its promise is a lack of adequate supervision and training for staff. Seniors with dementia can become confused or disoriented, and they may wander from their rooms. This often happens when they are experiencing discomfort or fear, and it can lead to serious injuries if they get lost.
A recent Post investigation found that at least three in five seniors who die after leaving their assisted living homes did so because they got lost or were left outside unattended. The Post searched state inspection records, media reports and lawsuits to find cases of residents who eloped or died while outside their facilities. It also surveyed experts to find out why such incidents occur.
In some cases, facility employees tried to cover up what happened to a resident. In the case of Hazel Place, who died at Cappella of Grand Junction in Colorado, staff falsely wrote that she had wandered away and had been found sitting alone in a car. In other cases, family members say that staff never told them what happened to their loved ones.
Some experts blame the industry for this problem. Some have suggested that the industry should be regulated more heavily, much like nursing homes are, which are heavily regulated because they are paid for by Medicare and Medicaid. However, the industry argues that it is different from nursing homes because assisted living primarily provides housing and meals while nursing homes provide a full range of specialized care for their residents.
Despite these issues, some states are making efforts to improve the quality of care in assisted living. New York, for example, is requiring more detailed information from facilities about their operations. But many other states have not stepped up to regulate the industry. Lawmakers should consider legislation that would increase staffing levels and require better training for caretakers in assisted living, as well as set higher standards for oversight and reporting.
The Industry’s Lack of Regulation
As the $34 billion senior assisted living industry has grown in recent years, private equity companies and ownership groups including real estate investment trusts have poured in capital. This has helped fuel rapid growth. But it has also likely contributed to cost-cutting that could leave communities understaffed as these companies seek bigger returns, according to a Washington Post investigation.
As part of the investigation, The Post reviewed state inspection reports and media accounts of walkaway deaths at assisted living and memory care facilities. It found that in these incidents, residents with Alzheimer’s disease and other cognitive impairments often get outside, where they can be injured or killed by cars, falls, cold temperatures or other factors. Often, the elopements are caused by staff neglect and negligence: inadequately locked doors, skipped bed checks, workers sleeping on the job and failure to heed door alarms. Despite these tragedies, senior living managers and front-line caregivers rarely face consequences. Regulatory fines are generally $10,000 or less. In one case, after a resident was found dead in 104-degree heat in a Arizona irrigation ditch, authorities fined the facility and chain owned Silver Creek Inn the maximum amount permitted by law: $500.
A GAO study reported that many assisted-living facilities, which typically are privately funded but can use Medicaid funds, have contracts with prospective residents that limit their liability for a variety of accidents. That limits the ability of regulators to impose fines or take other action against a home that has repeatedly failed to meet minimum standards.
To examine the nation’s oversight of assisted living, The Post analyzed training and staffing requirements in each state. It categorized each state into tiers based on benchmarks suggested by experts.
Assisted living is not subject to as rigorous regulatory oversight as nursing homes, because federal authorities have limited authority in these settings. This lack of oversight may explain why some states have more problems than others, and why the industry has fought efforts to increase state scrutiny and consumer protections.
In fact, the senior assisted living industry has spent more than $51 million since 2017 on lobbying state officials, according to OpenSecrets, a nonprofit that tracks campaign spending. The industry’s influence has thwarted attempts to raise standards in Kansas, Delaware and Massachusetts, and to expand oversight of small, privately funded assisted-living facilities.
The Industry’s Lack of Standards
The federal government does not oversee the nation’s 30,000 assisted living facilities. Instead, a patchwork of state rules governs the industry. And some of those state regulations are woefully inadequate, a Washington Post investigation has found. Some are just a few years old; others have been around for decades. These rules often fall far short of expert recommendations and have failed to address a critical concern: the wandering deaths of elderly people with dementia.
In many cases, these seniors wander from their care homes and end up dying of exposure to extreme heat or cold or getting hit by cars as they try to find a way home. The Post’s investigation shows that these tragic events are preventable. But the problems uncovered are a clear indication that many assisted living providers are ill-equipped to provide the safe and high-quality care needed.
One of the most effective ways to ensure the quality of a care facility is to seek accreditation from an independent, nonprofit organization. These organizations set standards for healthcare institutions, work to improve their services, and publish their findings. Accreditation is a key step for many medical professionals and families when choosing a care facility for their loved ones.
But a quick look at the 18 measures that claim to measure assisted living quality on the Joint Commission’s website shows that none of them address wandering or other safety issues. Most of the measures with perfect scores are trivial on their face, such as a facility’s enrollment of care coordination agencies or its record of keeping home health agency licenses.
The largest industry lobbying group, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), says it supports collaboration and transparency among policymakers and providers to ensure that “safety is at the forefront of every conversation.” And it has pledged to support a national safety program and to advocate for higher staffing levels and more oversight for assisted living facilities. But for the residents of these facilities, and their families, this is not enough. They need more accountability, and they need to demand it.
The Industry’s Lack of Supervision
While the assisted living industry has blossomed in recent decades and offers seniors a safe, home-like alternative to traditional nursing care, senior neglect and abuse still occur at a staggering rate. In fact, a national study found that elders are subjected to physical and emotional abuse in their communities at an alarmingly high rate.
A startling number of assisted living residents wander away from their homes, sometimes to tragic results. Some die of exposure to extreme heat or cold, and others get hit by cars. Others are drugged, deprived of water and food, physically or emotionally abused, or left unsupervised for long periods of time. This type of neglect and abuse is not only common but also illegal.
In many cases, families do not even realize a loved one is being neglected until it is too late. But when it is discovered, the facility may be fined or sued for not upholding its legal obligations to provide a safe and secure environment.
To prevent this type of neglect and abuse, accredited assisted living facilities have rigorous standards in place to ensure the safety of residents. For example, staff members must be properly trained and regularly reassessed for competency. Medication management and infection control are another area where accreditation is critical. This is because both of these areas can affect a resident’s health and well-being.
The Joint Commission’s Assisted Living Accreditation offers independent living communities a path to achieve and maintain compliance with quality and safety standards. The process also helps to streamline processes and improve communication within the community. It requires the community to create and implement quality improvement initiatives, engage staff and residents, and seek external support from consultants or accreditation experts.
In addition, the accreditation process can help to attract potential residents and increase the community’s reputation and competitiveness in the market. It can also reduce risk and liability by ensuring that the community is operating in accordance with applicable laws, regulations, and industry best practices. As a result, the community can protect itself from unnecessary complaints, fines, lawsuits, and other negative outcomes that can jeopardize its business and reputation.
