PBS' Powerful Assisted Living Exposé
'Life and Death in Assisted Living,' a 'Frontline' investigation, finds disturbing problems. Watch it – and learn what to look for.
Richard Eisenberg is the senior Web editor of the Money & Security and Work & Purpose channels of Next Avenue and Assistant Managing Editor for the site. Follow him on Twitter @richeis315.
Billy Howard Photography
Frontline will also be holding a chat about the program today, Wednesday, July 31, at 2 p.m. Eastern time; below, you can submit questions and attend the chat.
And Next Avenue has compiled a resources guide, "A Starter Guide for Assisted Living," with assisted living basics and advice on finding a topnotch facility.
The result of a yearlong inquiry with the investigative journalism nonprofit ProPublica (which is publishing a related series online), the program reveals serious problems with the way elderly residents – many with dementia – are cared for and supervised in some of the nation’s roughly 30,000 assisted living facilities.
A brief definition: Assisted living facilities are designed for elderly people who want to maintain their independence, need help with daily activities like showering, dressing and cooking, but don’t require the intense level of medical care provided in nursing homes. The facilities are often composed of apartments and common areas meant to look like someone’s home.
(MORE: What Is an Assisted Living Facility?)
The Big Operator Under Scrutiny
Much of the Frontline program focuses on troubling cases at Emeritus, parent company of the nation’s largest assisted-living chain. The producers spoke to more than a dozen former Emeritus employees as well as current executives.
“Big, sophisticated national chains have the tools to provide the highest quality care, the acumen and the infrastructure to minimize these tragic incidents — that’s one reason we focused on Emeritus,” A.C. Thompson, the show’s correspondent, co-producer and co-writer, told me.
Among the disturbing tales, all at Emeritus facilities:
- Former pro football hall of famer George McAfee, who died after ingesting industrial strength dishwashing liquid that the Georgia assisted living facility’s staff failed to lock away. (The state fine: $601.)
- Joan Boice, whose family was awarded $23 million after a jury determined her assisted living facility was responsible for elder abuse and neglect. Boice, who had advanced dementia, developed several deep wounds during her three-month stay there. (Emeritus is appealing the jury award.)
- Mabel Austin, who also suffered from dementia, wandered out of her assisted living facility and froze to death.
Emeritus chief executive Granger Cobb wouldn’t talk to Frontline about those particular incidents but did offer this response to the problems the program found: “We are 27,000 human beings caring for 40,000 residents and human beings make mistakes. We devote as much time and attention to training and orienting and giving guidance and making sure that they feel comfortable in the decisions that they make, but on occasion there will be mistakes.”
Pros and Cons of Assisted Living
Health care analysts and lawyers interviewed by Frontline had a different view on what’s happening in the assisted living world.
(MORE: 8 Tips for Finding a Home for Your Elderly Parents)
“The head of a state licensing agency told me assisted living is the rock we don’t want to look under,” Catherine Hawes, director of the Texas A&M Program on Aging and Long-Term Care Policy, says in the show.
Assisted living isn’t a bad idea. Far from it. “Assisted living is a great option for a lot of people and was created to fill a real need,” says Thompson, winner of the 2011 I.F. Stone Medal for Journalistic Independence.
And these facilities, while hardly inexpensive, are much less pricey than nursing homes. The median annual cost is $41,400 vs. a nursing home’s $75,405, according to the Genworth 2013 Cost of Care Survey.
The trouble, as the program points out repeatedly, is the huge gulf between the concept of assisted living and the reality. Specifically:
Understaffed facilities where residents aren’t well supervised By law, assisted living buildings often need to have only “sufficient” staff to meet the needs of residents, Thompson says. “That doesn’t really mean a lot,” he adds.
Inadequate training for staffers and administrators Walking Thompson through one of Emeritus’s “memory care neighborhoods" for dementia patients during the program, executive Kelly Scott says its employees there get eight hours of training.
“I could be a licensed administrator of an assisted living facility in California if I pass a 40-hour class,” Thompson says. “And if I was running a small one, I wouldn’t need a college education.”
A hard sell to fill the rooms One former head of an Emeritus memory care unit told Frontline she felt pressure to get residents in “at any cost.” Thompson says: “There’s incredible pressure on people working for the big chains to move in as many people as possible. And that can lead to decisions to move in seniors who shouldn’t be there. They may have psychiatric problems or serious behavioral problems and should be in a nursing home or a hospital.”
A lack of regulation Unlike nursing homes, assisted living facilities aren’t overseen by the federal government and state regulation is spotty. California’s 7,500 assisted living facilities are inspected on a regular basis every five years, for example, Thompson says.
“In many places, regulations are not sufficient to prevent seniors from being hurt over and over and over again,” he adds.
A lack of comparable data for families trying to select a facility “There’s an information vortex,” Thompson says. “The federal government tracks, monitors and analyzes nursing homes with the Medicare website’s Nursing Home Compare, but we have no clue what’s going on in the assisted living industry.”
(MORE: Shaky Finances of Continuing Care Communities)
You may be wondering: Why does the federal government regulate nursing homes but not their assisted living cousins?
One reason, Thompson says, is that the assisted living pioneers felt nursing homes were overregulated, so they turned to the states. Another is that nursing homes get money from Medicare and Medicaid, which means the federal government has an obligation to monitor them; few assisted living facilities get similar financing.
Assisted Living and Your Wallet
And that brings me back to the financial concerns for families deciding the best place for their parents or grandparents to live.
Assisted living looks much less expensive than a nursing home, but Medicare doesn’t reimburse any of its costs, unlike the way the federal health insurance program does for up to 100 days of nursing home stays. And Medicaid – the health insurance program primarily for the poor – covers some nursing home residents’ costs, but typically pays for assisted living stays of only 90 days or less.
So you or your parents may be on the hook for the substantial charges of an assisted living facility. Here are a few tips to find one that’s worth the money and will provide the proper care:
Start your research before you’re in emergency mode. “The best scenario is to prepare ahead of time by investigating the options in the area your parent wants to live,” says Sherri Snelling, a Next Avenue contributor and founder and chief executive of the Caregiving Club. “Some facilities fill up fast, so when your loved one needs a bed, there may be no room at the inn" if he or she hasn't been put on a waiting list.
Understand the basics of assisted living facilities and how to compare them. The free online “Guide to Choosing an Assisted Living Residence” from the industry trade group, the Assisted Living Federation of America, is useful as is the Senior Housing Help Guide from the nonprofit site, Helpguide.org. Also, the MetLife Mature Market Institute’s guide, Choosing Assisted Living, has smart advice.
Next Avenue has also published three articles worth reading: "8 Tips for Finding a Home for Your Elderly Parents," "What Is an Assisted Living Facility?" and "How to Find the Best Residential Care."
Look for reliable information about particular facilities. The Alzheimer’s Association, Caring.com and LeadingAge.org have state-by-state directories. Your local Area Agency on Aging can also tell you about nearby choices.
Become your own investigative reporter. Do a Google search to see if there have been any troublesome news reports about a facility you’re considering.
Also, check the property’s regulatory history and complaint record for the past five years. Generally your state’s health department or long-term care ombudsman will have that data. You can find the appropriate agency at the website of the Assisted Living Federation of America.
Ask the facility’s administrator key questions about how the place is run. Don’t be taken in by the beautiful grounds or social activities, Snelling says. You’ll want to get answers to such essential questions as:
- What’s the ratio of caregivers to residents? (Thompson says that in a dementia setting, you’ll want a ratio far below 1 caregiver to 20 residents.)
- How many staffers are on duty overnight? Serious incidents, like falls, often happen at night.
- What type of nursing care is provided? Thompson says “24-hour nursing care” sometimes means there’s a nurse on duty weekdays from 9 a.m. to 5 p.m. and the facility will call a nurse if something happens during other hours. Also, he says, nurses frequently spend little time caring for residents because they’re mostly doing marketing, sales and administrative work.
- How do costs vary depending on the level of service required? There’s generally a base cost and then a variety of services offered a la carte. Medication management runs $347 a month, on average, and dressing assistance costs $236, according to the 2012 MetLife Market Survey of Long-Term Care Costs. Most facilities that provide Alzheimer’s and dementia care also charge an extra fee.
Consider hiring a geriatric care manager to help you select the most appropriate facility. Member firms of the National Association of Professional Geriatric Care Managers typically charge $80 to $150 an hour, according to Next Avenue consumer blogger Caroline Mayer.
You might check to see if your employer offers the services of such a pro, as companies like GE, Wells Fargo and Disney do, Snelling says.
Time for the Nation to Assess Assisted Living
I hope you’ll do these things, but I hope even more that the Frontline/ProPublica work will lead the federal and state governments to take a hard look at the way assisted living works (or doesn’t work) today.
As Thompson told me: “We’ve got three-quarters of a million people in this type of facility and 5 million with dementia. We need to think of better ways to care for them going forward and what we can do to ensure they live out their lives with as much diginity as possible.”
Participate in a live Web chat (below) about Frontline's 'Life and Death in Assisted Living' at 2 p.m. Eastern time on Wednesday, July 31. You can submit your questions now or during the chat.