Is Assisted Living Dangerous to Elders?
Stories in the press have highlighted some frightening cases in assisted living. Neglect and abuse have hastened the deaths of at least 27 elders in CA. An entire group of frail elders was abandoned in one facility, when the state shut it down, but failed to transfer the residents elsewhere for days. It was horrible.
That could just be the tip of the iceberg.
Is it a scary thought to consider putting a loved one in assisted living?
Overall, it need not be a dangerous decision. However there are a few basic things to know that are hidden in the rhetoric between the assisted living industry and the consumer advocates who bring the horror stories to the public’s attention.
First, assisted living is in a bit of a grey area legally. It is regulated by Departments of Social Services in our states, not by Departments of Health. And yet, besides providing a pleasant, enriched social environment for the vast majority of residents, some facilities take in elders who need far more care than assisted living is qualified to deliver. They are taking in residents who need health care. When they do so, residents can languish without the care they require and some die prematurely.
Do we need more government regulation of the industry? I believe so, but that can only solve part of the problem. For example, due to budget cuts and lack of regulations, assisted living homes are only inspected every 5 years in California. That’s ridiculous! Closer government inspection will likely stop some of the neglect and poor conditions that have been highlighted in reports of nightmarish and sad assisted living stories. We need to fund that with higher licensing fees. Even the professional assisted living association in CA (CALA) agrees with that concept.
The rest of the problem is twofold. First, the facilities should never take in any resident who starts out needing skilled nursing care or 24/7 monitoring. They are not set up for it, they don’t have the staff for it, and they have never even been required to have a licensed nurse on hand to judge what care to give nor to deliver that care. Caregivers are not required to be trained to actually give health care, dementia care or anything other than basic help with such things as bathing and walking.
The other part of the problem is the families of the elders. All too often they come to assisted living looking for a pleasant place to put an aging loved one, without facing the truth of how much care that loved one needs. The owners and operators of assisted living homes want to keep the apartments full. They need to do so to make a profit. Therein lies the conflict between doing what is right and being profitable. Families of elders need to accept the hard fact that sometimes a skilled nursing facility is the right choice. And operators need to be truthful in telling prospective residents and their families that some seniors are just not a right fit for assisted living.
CA has a list of proposed new assisted living regulations being considered by the legislature in 2014. They may help, but will not solve the problem of bad facility operators, nor of families who dump elders in places where they don’t belong. Both bear responsibility for what goes wrong in these places.
If you are considering assisted living as an option for your loved one, look carefully. Get a doctor’s recommendation for the right place for your elder. Do your research.
My short eBook How to Understand the Pros and Cons of Assisted Living, will give you some very helpful information for your wiser decision making. Get yours today by clicking here.
Join the discussion 13 Comments
You have a glaring error in yiour thinking and writing about this subject: You talk about the families who have the “responsibility” for finding, researching, making decisions and then “dumping” their loved ones. Uh, if the “loved ones” are incapable of making their own decisions, they have no business being in assisted living.—My mother chose (we encouraged her) to go to assisted living and she chose where and she perked up considerable after the decision was reached (she took about 10 years getting there! lol)because as a widow with grown children, living alone in a big house was too depressing for this otherwise social butterfly. She was deaf but still allowed to drive by the state of CA and had no intention of giving up her independence nor did we want her to do so! As it was she found new friends and activities and that gave her many more years. She lived to be 92 and only died from complications due to heart surgery that was intended to help her live to be 102 since her other health was so fantastically good!….the other thing missing from your essay is discussion of what to do with/for people who need a little help w housekeeping, dressing,, bathing and walking but are on Medicare of Medicaid (MediCAL in CA) or some combination. These folks do not qualify for a full on “nursing home” but can’t afford assisted living. In CA there is a service called In Home Supportive Services (IHSS and only for those with MediCAL)that is ONLY for people who need help in order to keep them from having to go to a nursing home and even then by LAW whatever hours they qualify for MUST be cut by 8%!What about those who don’t qualify and can’t afford anything else and don’t have caring family or the family is caring but can’t afford to give full time care either? These folks (usually the working poor who have retired)deteriorate rapidly sometimes and are the folks you hear about in the news who are found dead in their homes after several days have gone by….I am generally a less is more kinda gal and against MORE regulations and NEW LAWS to fix old broken ones. So I am just not sure this essay does much to educate us. I am however grateful for the conversation starting.
I think you may be unaware that many assisted living facilities and board and care homes do in fact care quite well for elders with dementia. These people are indeed no longer capable of making competent decisions.
if the “loved ones” are incapable of making their own decisions, they have no business being in assisted living
I know there are thousands of operators and managers of assisted living communities and small homes who would vigorously disagree with you. The care and safety of vulnerable people with dementia is a fundamental purpose some facilities have. As I have personally cared for many hundreds of elderly patients in my nursing career I am speaking from experience about what care is available and what works for those who are no longer competent. As a lawyer, I can also define legal competency sufficiently to speak from experience as well.
My post addresses a problem in the industry which is poorly regulated and is in fact under scrutiny at this time by the legislature in Ca. It is the issue of what level of care (“Acuity”) is suitable for assisted living places to accept. Some assisted living communities take on elders who need 24/7 monitoring when they have no licensed persons on staff to observe changes, deal with emergencies or give nursing care.
The purpose of the post is to shed light on various topics of interest. Other topics, such as what you mention, about low income persons who need help but not a nursing home will be addressed in other posts in time. We have hundreds of topics here and on my other blog at Forbes.com, called Aging Parents. As you may be unaware of it, note that CA also has an assisted living waiver program for low income individuals with certain criteria who want to remain in the community rather than stay in or go to nursing homes. Check out California Assisted Living Waiver Program and read about it. The state subsidizes and sets the program requirements. Some other states also have these programs. Thanks for your comments. Carolyn Rosenblatt, RN, BSN, Attorney, Mediator
You make good points, but I am thinking you could just as easily title an article, “Is Staying at Home Dangerous to Elders?” and include as many or more safety concerns.
It may sound good, but I don’t believe asking a doctor, nurse or hospital discharge planner for their recommendations is a good way to choose assisted living. In my experience, most of these people do not have time to personally visit and know little or nothing about the reputation. In fact, the first question to ask anyone (even a placement agency) who recommends any assisted living is, “Have you personally visited this place?”. I know of one local doctor who sends all his patients to a local care home, which is a very nice place to look at. The problem is, this is a great place for residents with advanced dementia or bedridden hospice patients, but a sad, depressing experience for an alert, active gentleman who was sent there because he simply needed to recover from hip surgery. The point is, no place can be right for everyone.
Ironically, sometimes the places which provide the best care may do very little advertising or marketing and may not even have a website. On the other hand, some of the places with fancy websites and expensive amenities in their lobbies to impress families may in reality provide very poor quality care.
Families need to understand that if their loved one needs a very high level of care and attention, a place that has only one caregiver per 15 to 20 residents will put that person at risk, no matter what is promised on admission. Families also need to be honest and realize if they try to save money by hiding the fact their loved one has a history of wandering, sundowning behavior, mental illness, etc. they are potentially putting that resident and others in danger. It is always convenient (and newsworthy) to blame the community when something goes wrong, but there is often more to the story.
I don’t agree that discharge planners are typically unfamiliar with the reputation of local assisted living situations. It’s their job to know, though I’m sure some are unprepared to do the job well. There is an abundance of resources to help find good places for a loved one to live. To use them, one must do the research and get recommendations first. That does take time. One can’t expect it to be handed to you. Most reputable places do have websites, though there are exceptions. Further, consumer advocacy organizations in some states provide publicly reported records of citations, safety violations, etc. of which placement companies and discharge planners may be unaware. California Advocates for Nursing Home Reform (CANHR) is an example. In my booklet, How to Understand The Pros and Cons of Assisted Living, I recommend that family members ALWAYS visit a place first and get a feel for it, regardless of any recommendations on way or the other. What’s good for one person may not sit well with another. My own family has recently gone through this exercise for my brother who had a stroke. As experts in this area, we knew what to do. I have shared the journey in other blog posts. I can tell you that the discharge planners at the acute hospital and at the rehab facility were both helpful and that we found an excellent place for him in assisted living, by doing our research and checking out places in person. Thank you for your comments. Carolyn Rosenblatt, RN, BSN, Attorney, Mediator