Hearing Focuses On Spotty Oversight Of Assisted Living

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By Robert A. Rosenblatt

Not quite strong enough to live with full independence and autonomy but too healthy to enter a nursing home--this is the dilemma faced by many older Americans and by the family members who worry about them. The answer for many has become assisted living, a fast-growing type of housing attractive to older people looking for safety and security. In addition, it appeals to their adult children, who want to be sure that mom and dad are comfortable and safe.

Because the industry is growing so rapidly, and because regulation is spotty, Congress has taken an unusually close look at assisted living by holding two full-scale hearings in only two years. "With hundreds of thousands of Americans now living in such facilities nationwide, it's important that we continually evaluate the quality of care the facilities are providing," said Sen. Larry Craig, R-Idaho, the new chair of the Senate Special Committee on Aging, which held its most recent hearing in April. Craig and the other committee members are worried that many facilities may not be giving prospective residents enough information to make informed choice. The assisted living industry says it is working to improve facilities and doesn't want any federal regulation.

Assisted living options have many labels, such as residential care facilities, homes for adults, community residences, personal care homes, catered living facilities and adult congregate living facilities, according to the major industry trade group, the Assisted Living Federation of America (alfa), Fairfax, Va. Typically, an assisted living facility provides an individual apartment for each resident. There is a common dining room where the residents get at least one meal a day. Assistance varies widely depending on the facility, the needs of the residents and the nature of the contracts people sign when they enter the assisted living facility. Some residents only need help cleaning the apartment regularly and doing laundry. Others may need more help, such as telephoned reminders twice daily to take their medications or assistance with bathing and dressing. The danger for consumers, said those testifying at the hearing, is in misunderstandings. Elders and their families have to keep in mind that they only get what is in their contracts. Promises ("Don't worry, we'll take care of your mom and give her whatever she needs") are worthless unless they are spelled out in writing.

Consumers "have no easy way to compare different facilities," warned Sen. Hillary Rodham Clinton, D-N.Y., who testified before the committee. "They have to operate on a good deal of faith. But when it comes to protecting our elderly family members, I don't think that kind of 'faith-based' program is what families need," she said.

Clinton told the story of a woman who came to New York and placed her mother in what she thought was a first-class facility. It was an unlicensed assisted living home, with a licensed homecare agency on site. Within six weeks the mother was hospitalized with rapid atrial fibrillation and died. Records showed that she had missed taking her heart medications 15 times. The daughter told the facility staff that her mother would take the heart pills only if they were crushed. Apparently, though, no one transmitted this vital information to the homecare agency, which provided the personnel who gave residents their medications. Clinton cautioned that this sort of confusion can be all too common in the complicated regulatory structure that has emerged over the years.

A SPECIAL REPORT

The Congressional Research Service (CRS) presented its special report on assisted living at the hearing. CRS, a department of the Library of Congress, is a nonpartisan research and reference service for Congress. It used a broad range of descriptions that generally include room and board, some personal care and limited health-related care, to reach a national estimate of 800,000 assisted living units or beds in 33,000 facilities. "They range from tony, hotel-like buildings to small group homes providing services to people with low incomes," according to the report. More than 35% of the beds are located in just three states: California, Florida and Pennsylvania.

Each state establishes what a facility must provide, usually based on standards of staffing and safety. The oversight of assisted living is very different from that of nursing homes, which must operate within detailed rules and regulations in order to receive federal funds. Because most people in assisted living facilities pay as private individuals, they and their family members are responsible for their own financial and personal welfare. This means they must carefully scrutinize the facility--and the contract.

aarp (formerly the American Association of Retired Persons), in Washington, D.C., tells consumers to seek answers to key questions: Does the assisted living contract specify what kinds of help residents will receive? Does this include personal grooming, such as help with shaving, brushing teeth and brushing hair? Is bathing assistance available? Is there help for people who are incontinent?

Members of the Special Committee on Aging want the assisted living industry to give consumers more information, and they want the states to do a better job of oversight. Sen. Craig said, "We must ask whether the states and the industry are doing enough to protect the elderly who rely on assisted living facilities." He shared his personal interest in the issue: "My in-laws are currently living in an assisted living community. I am grateful that they live in a good environment and receive quality care. The goal for this hearing is to make sure that all residents receive high levels of care."

Although Congress has expressed concern and interest, federal legislation seems highly unlikely. Therefore, families have to be their own advocates, inspectors and careful shoppers to be sure they get the most out of assisted living.

Robert A. Rosenblatt is a veteran Washington economics correspondent for the Los Angeles Times. He regularly contributes "Potomac Sources" to Aging Today.

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