Elevating the Standards of Assisted Living: An Urgent Call for Reform - Part 4

With a growing recognition of mistreatment in assisted living facilities, it's important to address the issue of elder abuse. My Response to Granger Cobb and the ALFA and ASHA As a nurse that has almost 50 years experience, I welcomed the Frontline story. It is a long time in coming. The stories shared were not new ones, and do not happen in just the corporate facilities.

There has been a growing recognition of the mistreatment of residents living in an assisted living community over the past few years. It is a serious issue that needs to be addressed. There are actually studies out there that estimate the frequency of elder abuse in nursing homes and assisted living is between four to five percent. For every case that is reported there are 5 cases that go unreported.

Assisted Living Facility offers Supportive Living

We have a serious health care crisis on our hands. As I was investigating the statistics for abuse reported in Assisted Living, I was shocked. There is no official system in place to report the abuse. And the information that is available is very limited. This may be for several reasons. Many individuals in Assisted Living do not report any abuse because of fear or embarrassment.

Some have a fear that they may have to move to a nursing home. It is noted that two thirds of the residents in Assisted Living have some form of dementia. they may not have the capability to report any abuse, do not have the physical means to report the abuse (lack of a phone). I know from personal experience that the administration in many of the buildings does not want to hear or take time to listen to concerns or issues that residents raise.

I recently had a client that had ants in her room. Now, she was an impeccably clean person. She was in a wheelchair and did have a home care nurse come three times a week to dress her wounds. I heard my client tell the staff multiple times about her ant problem, The staff even came in and checked out her drawers and refrigerator to look for a cause.

They saw the ants, but nothing was done. It took her home care nurse to find her in bed with ants crawling all over her for the facility to take action. The threat of the ombudsman being called was what the facility needed to take action. The Frontline story has taken the first step to make the public aware of how dangerous assisted living can be. There are drastic and dramatic changes that need to occur. Assisted Living needs to have rules and regulations to monitor this growing industry.

Addressing Elder Abuse in Assisted Living Facilities

In the concluding installment of our series, we focus on the critical issues in assisted living facilities, emphasizing elder abuse's severity. Drawing from nearly 40 years of nursing experience, the author sheds light on the widespread mistreatment in these facilities, highlighting a healthcare crisis that demands immediate action. The disturbing reality of elder abuse, with estimates suggesting that only a fraction of cases are reported, underscores the need for a systemic overhaul in how we care for our elderly in assisted living communities.

High-Risk Incidents in Assisted Living Communities

The Department of Health and Human Services has reported that a significant 20% of high-risk emergency cases involving Medicare recipients are attributed to either abuse or neglect in assisted living facilities. These facilities, integral to the senior housing industry, are tasked with providing essential services such as meals, safe environments, and necessary medical and other personal care services. However, neglect and abuse lawyers have observed a troubling link between insufficient supervision by staff members and the majority of neglect cases in these communities.

Legal Recourse for Injuries in Assisted Living Facilities

Families of residents injured in accidents within an assisted living setting may have legal grounds to seek compensation. These accidents can range from medication errors to neglectful supervision, often resulting in costly medical treatments and other expenses. Skilled nursing care, a crucial component of most assisted living facilities, demands vigilance and professionalism to prevent such incidents.

Medication Management: A Crucial Aspect of Elderly Care

Proper medication management is vital in residential setting and assisted living facilities, especially since many elderly residents are already on multiple medications. It's the responsibility of the prescribing doctors to ensure that new prescriptions do not adversely interact with existing medications, a task crucial for maintaining the residents' health and well-being.

The Perils of Malnutrition and Neglect

Understaffing in assisted living facilities often leads to diminished care levels, including inadequate nutrition and hydration. Malnutrition can have severe medical consequences for residents, potentially leading to the development of bedsores and other health complications. Assisted living costs should account for the dietary needs of residents, ensuring that meals provided are not only nutritious but also cater to the specific health requirements of each individual.

Supervisory Failures Leading to Accidents

Despite the greater independence afforded in assisted living compared to nursing homes, supervision remains crucial. Failing to provide adequate oversight is a common cause of injuries in these settings, with residents requiring constant monitoring to ensure their safety and well-being.

The Tragic Reality of Wrongful Deaths

In the most severe cases, neglect and abuse in assisted living can lead to wrongful deaths. Families of deceased residents may pursue wrongful death claims against the facility, seeking compensation for their emotional and financial losses. This highlights the need for stringent enforcement of residential care facility standards to prevent such tragedies.

Elder Abuse: A Multi-Faceted Issue

Elder abuse in assisted living facilities can take various forms, including physical, emotional, and sexual abuse, as well as financial exploitation and neglect. Signs of abuse can be subtle, such as changes in behavior or mood swings, and require vigilance from family members and caregivers. Facilities are legally obligated to report any instances of abuse to law enforcement and Adult Protective Services.

Neglect in Assisted Living: A Critical Concern

Neglect remains a significant issue in assisted living communities. Despite the value placed on independence, residents must receive regular medical care, be kept clean, fed, and have their mobility needs adequately addressed. There is no justification for neglect in any form, whether it be in personal care, medical attention, or basic daily living needs.

This comprehensive overview of health statistics underscores the need for continuous quality improvement in assisted living facilities. Ensuring the safety and well-being of residents requires a collective effort from facility staff, family members, and regulatory bodies, making it crucial for these facilities to adhere to the highest standards of care and supervision.

The Critical Lack of Reporting Systems in Assisted Living

The absence of a formal system to report abuse in assisted living settings is alarming. Many residents, especially those with dementia, who make up a significant portion of many assisted living communities' populations, cannot report abuse due to physical limitations or fear of repercussions. This issue is exemplified by a case where a client's complaints about an ant infestation were ignored until it escalated to a severe level, indicating a systemic failure in addressing residents' concerns.

Addressing the Gap in Reporting Systems in Assisted Living Facilities

The lack of a robust reporting system for abuse in assisted living facilities represents a significant gap in safeguarding the well-being of assisted living residents. In many assisted living communities, especially those catering to older adults with cognitive health issues such as dementia, the ability to communicate grievances or mistreatment is severely hindered. These residents, who often require comprehensive personal care and skilled nursing care, are particularly vulnerable due to their physical limitations and potential fear of retaliation or negative consequences.

This issue is further exacerbated by the fact that most assisted living facilities lack a standardized process for reporting and addressing complaints. In the case of a client suffering from an ant infestation in private apartment, for instance, the grievance was initially overlooked, reflecting a broader systemic failure. This incident not only highlights the importance of maintaining a clean and safe residential setting but also the need for responsive and effective channels of communication within assisted living communities.

The challenge is more acute in facilities where residents have limited personal resources and rely heavily on the facility's staff for daily living assistance, medication management, and other forms of medical care. In such environments, the power dynamics can discourage residents from reporting issues, as they might depend entirely on the caregivers for their most basic needs.

Medicaid Cover Assisted Living Facility

Furthermore, the financial constraints faced by many assisted living facilities, particularly those that cater to residents paying through Medicaid or those operating under tight budgets, may lead to understaffing or inadequate training. These factors can result in a lack of sufficient supervision and attention to residents' needs, allowing issues like neglect or abuse to go unnoticed or unaddressed.

It's crucial for family members and other advocates to be vigilant and involved in the care of their loved ones in these settings. Regular visits, active participation in care planning, and maintaining open lines of communication with care providers can help in identifying and addressing potential issues. Additionally, advocating for the implementation of formal complaint and reporting mechanisms in assisted living communities is essential. These systems should be accessible and safe for residents to use without fear of retribution.

To ensure the safety and well-being of residents, assisted living communities must prioritize establishing clear and effective reporting protocols. This includes training staff to recognize signs of abuse or neglect, encouraging a culture of transparency and responsiveness, and providing residents with easy access to reporting tools. By doing so, assisted living facilities can foster a more secure and caring environment, ensuring that residents receive the respectful, dignified care they deserve in their daily living.

Tragic Incidents Highlighting Industry Neglect

The Washington Post’s investigation into seniors wandering from assisted living facilities or left unattended has raised major concerns about memory care alone. The report documents at least 98 deaths under such circumstances since 2018, with the overwhelming majority of resulting from exposure to extreme temperatures. This investigation has revealed a harrowing pattern of neglect, particularly towards residents with Alzheimer’s disease or other mental impairments, showcasing the urgent need for reform in the assisted living sector.

Understaffing and Negligence: The Root Causes

Understaffing in assisted living facilities is a significant contributor to these incidents. This lack of adequate supervision, often a result of cost-cutting measures approved by senior leadership, leads to tragic consequences. Furthermore, the nature of cognitive decline in seniors, such as those with Alzheimer’s, exacerbates the risk of wandering, making supervision in adult care facilities even more critical.

Expanding on Understaffing and Acuity Levels in Assisted Living Facilities

Defining Acuity Levels in Assisted Living

The term "acuity level" refers to the degree of nursing care and medical attention required by a resident in an assisted living community. It is an assessment of the intensity and complexity of the care needed, usually influenced by factors such as cognitive health, physical therapy needs, and the management of chronic medical conditions. Residents with high acuity levels require more intensive medical care and personal care services, as they may be dealing with advanced stages of diseases like Alzheimer's or have more demanding physical needs.

The Impact of Understaffing on High Acuity Level Residents

In many assisted living facilities, particularly those serving older adults with significant medical and personal care needs, there is a critical issue of understaffing. This is often the result of cost-cutting measures, which lead to a reduced number of skilled nursing staff and caregivers available to attend to the daily living and health care needs of residents. This scarcity of staff becomes particularly problematic in facilities with residents who have high acuity levels, as these individuals require more frequent and specialized care, including medication management, constant supervision, and assistance with everyday tasks.

State Regulations and Staffing Requirements

The regulations regarding staffing in assisted living communities vary significantly from state to state. Some states have established minimum staffing requirements, while others have no specific mandates. However, there is a growing recognition of the need for staffing standards that are aligned with the acuity levels of residents. Such requirements would ensure that community living facilities are staffed adequately to provide the necessary level of care, especially in communities where most residents have high medical and personal care needs.

Consequences of Inadequate Staffing

The lack of adequate staffing in facilities, particularly those housing residents with higher acuity levels, can lead to neglect and increased risk of incidents such as wandering, falls, or medical emergencies. For example, residents with cognitive impairments like Alzheimer's disease may require constant supervision to prevent wandering, a task that becomes challenging with insufficient staff. Additionally, the inadequacy in staffing can lead to delayed responses in emergency situations, improper medication management, and overall reduced quality of care.

The Need for Acuity-Based Staffing Models

To address these challenges, there is a pressing need for assisted living facilities to adopt acuity-based staffing models. Such models would ensure that the staffing levels are not just based on the number of residents but also on the intensity of care each resident requires. This approach would help in allocating sufficient skilled nursing care and personal care resources, thereby improving the quality of life and safety of residents, especially those in high acuity living settings.

Enhancing Assisted Living Care: The Critical Role of Family Members and Advocacy Groups

Family members and advocacy groups are indispensable in the movement towards reforming assisted living facilities. Their involvement is vital in bridging the gap between what families expect from these facilities and what is realistically provided under the current assisted living model.

The Disconnect Between Social and Medical Models in Assisted Living

The assisted living sector primarily operates under a social model, focusing on providing a community-like setting for older adults. This model emphasizes independence, social and recreational activities, and a home-like environment, including private apartments and amenities like dining rooms. However, as the aging population's needs evolve, particularly for those with increasing medical conditions and cognitive health challenges, there is a growing need to shift towards a more medical model.

This medical model would incorporate more comprehensive skilled nursing care, medication management, speech therapy and physical therapy services. It addresses the higher acuity levels of residents, ensuring that their complex medical and personal care needs are met. The current disconnect lies in the expectation of families who often anticipate a higher level of medical care than what most assisted living facilities, operating under a social model, can provide.

The Role of Home Care and Hospice in Assisted Living

To bridge this gap, the integration of home care and hospice services within assisted living settings is becoming increasingly important. Home care services provide additional support for daily living tasks own meals, personal care services, and medication management, complementing the care provided by the assisted living staff. Hospice care, on the other hand, plays a crucial role for residents with terminal illnesses, ensuring they receive compassionate end-of-life care that focuses on comfort and quality of life.

Advocacy for Acuity-Based Staffing Models

Family members and advocacy groups are instrumental in advocating for acuity-based staffing models in assisted living communities. These models ensure that staffing levels and skills are directly correlated to the residents' care needs, considering factors like cognitive and physical health, medical care requirements, and the level of personal care services needed. By actively lobbying for policy changes at both national and state levels, these groups can influence the implementation of regulations that mandate appropriate staffing based on acuity levels, potentially reducing the assisted living costs while enhancing the quality of care.

Implementing Solutions for Safer Assisted Living

To combat these issues, enhanced supervision and staffing are essential. Regular reassessment of residents’ needs, especially those with progressive conditions like dementia, is crucial. Additionally, improving facility design to prevent wandering and implementing safety measures are necessary steps towards creating a safer environment for assisted living residents. Legislation mandating higher standards of care and specific safety protocols in assisted living facilities is also crucial.

The Need for Systemic Change and Advocacy

This series underlines the urgent need for comprehensive reform in the assisted living industry. Ensuring the safety and well-being of residents in independent living community requires not only internal changes within facilities but also external advocacy and legislative action. It is the collective responsibility of healthcare professionals, policymakers, and family members to champion these changes, ensuring that assisted living becomes a safe, dignified, and nurturing setting for our seniors.

It is time to create and establish enforcement systems in assisted living and board and care  facilities. It is also time for  government controls and systems be put into place to periodically evaluate facilities. CQI ( Continuous Quality Improvement)  needs to initiated to not only  be preventing abuse, but prioritizing  family and resident issues and satisfaction, and promote accountability of the facility to meet and exceed the regulations set by the state or federal government. It is also time to put the necessary policies in place that would allow facilities to close to new admissions until improvement or completely closing facilities that fail to meet the required standards. I think it is also important to put a system in place that would not allow an organization that has closed to be permitted to reorganize and change it name, to operate again.

Incorporating these measures and reforms is imperative to transform the current state of assisted living. By addressing the critical issues outlined in this series, we can work towards an assisted living system that truly honors and protects its residents.

Advocating for Enhanced Care and Support in Assisted Living Facilities

Now more than ever, it's crucial for consumers and families involved in assisted living communities to actively support and elect policymakers who advocate for increased wages and benefits for the long-term care workforce. The dedicated staff in these facilities, from nursing homes to residential care facilities, deserve advancement opportunities and comprehensive ongoing training. It's startling to learn that staff in memory care units, such as those at Emeritus, receive only 8 hours of training, which is grossly inadequate given the complexities of dementia care.

Understanding dementia, including the various types and how it affects different parts of the brain, is essential for staff in assisted living settings. This knowledge significantly impacts how they interact with residents and respond to their unique needs. Person-Centered Dementia Care, alongside habilitation training and behavioral approaches, is vital to mitigate challenging behaviors effectively.

Assisted living facilities, especially those providing memory care, often charge higher fees but may not offer services proportional to this increased monthly cost alone. It's imperative that these facilities provide activities and routines during evenings and weekends, essential for successful memory care. Furthermore, the compensation for staff in these roles should reflect the hard work and responsibility they shoulder. Acknowledgment and reward programs are critical in creating an environment where staff are motivated to remain and excel in their roles. Reducing staff turnover not only saves costs but also results in better care for residents and higher satisfaction levels among both residents and employees.

For residents and their families, active involvement is key to preventing abuse in assisted living communities. This means listening attentively to family members in care, participating in resident councils, and insisting on regular family member council meetings with facility administration to discuss any concerns or issues. Additionally, in cases where a resident might be experiencing neglect or mistreatment, family members should not hesitate to report these incidents to their Ombudsman. Should the situation not be resolved satisfactorily, consulting a nursing home attorney specializing in abuse cases is a recommended step to explore legal options.

In conclusion, we invite everyone involved in assisted living - residents, family members, and staff - to share their experiences. Whether they are positive, challenging, or distressing, these stories are invaluable in understanding and improving the state of assisted living facilities. By working together and advocating for change, we can ensure that assisted living communities are safe, support

Assisted Living -Dangerous, Deceiving and Dysfunctional Part

Critical Insights into Assisted Living: Care, Cost, and Quality - Part 2 of 4

Emeritus Senior Living Response to Frontline Story

Addressing Elder Abuse in Memory Care Facilities A Critical Issue for Vulnerable Seniors