This week, the PBS program Frontline investigated care at the nation’s largest assisted living company—Emeritus Corp. The program’s message was powerful—and highly controversial: Residents of some Emeritus facilities are dying as a result of poor care by insufficient and poorly trained staff and a lack of government regulation.
I can’t speak to what’s happening at Emeritus, a for-profit company that has 50,000 beds in 480 facilities in 45 states. But I spend a lot of time in assisted living facilities and wrote in May about what consumers need to know about choosing one.
After watching this show, I’d like to share some important take-aways:
Understand what services assisted living does, and does not, provide. No-one even agrees on what assisted living is. In general, it is residential care that provides some services but is not licensed as a skilled nursing facility. That covers a lot of ground. It could be a large corporate facility such as those operated by Emeritus, a mid-sized non-profit facility, a board-and-care home where one or two people live in spare bedrooms of private home, or professionally managed small group homes.
Assisted Living is generally less expensive and less structured than skilled nursing, but also less likely to provide medical care. It may have fewer aides per resident, though some have more. When making a choice, think about the level of assistance you or your loved one will need. If your mom needs full-time help from a private duty aide, for instance, independent living might be more cost effective. After all, why pay for facility care mom is not going to use?
Dementia. Half to two-thirds of assisted living residents have some cognitive impairment. But that represents a wide range of care needs. The Frontline show argued that many dementia patients in assisted living should be in nursing homes. I disagree.
While some dementia patients may need skilled care, the vast majority do not and can do very well with the help of high-quality aides. These aides need special training and time to get to know their residents, but they can do an excellent job in a residential care setting. People with dementia need to be in good care settings. They don’t need to be in nursing homes.
Regulatory trade-offs. Assisted living is far less regulated than skilled nursing and the rules vary widely from state to state. That can be a problem. But there is a trade-off: More regulation does not mean better care. States need to balance the health and safety needs of residents with their autonomy. I can imagine a facility where no one ever falls. I wouldn’t want to live there. On the other hand, neither would I want to live in a place where the staff is poorly trained or overworked.
Keep in mind that many of the most creative senior service solutions over the past few decades have come in less regulated settings. As the operators of the cutting–edge Green House nursing homes will tell you, it is not easy to be creative if you are running a highly-regulated skilled nursing facility.
What alternatives do you have? Can your parent be cared for at home with help from you, your family, and perhaps a private duty aide. It might be more cost effective and the care might be better. On the other hand, what do you do when the aide doesn’t show up and you need to get to work? Is skilled nursing really a better choice? Assisted living may be your best option.
If you have a bad feeling about a place, leave. Watching the Frontline program, I was struck by the number of adult children who were concerned about the quality of their parent’s care well before their tragic deaths. But every time, the family members rationalized these fears and did nothing. The message is: If a place doesn’t feel right or you have concerns that you feel are not being addressed, leave.
I understand moving may be hard. There may be cost issues, and people often want their parents physically close to them. But nothing is more important than the well-being of your loved one.
There are bad assisted living facilities. But assisted living is not a bad concept. Run well, these facilities fill an important niche. But to get the most out of them, consumers must be discerning shoppers and strong advocates.