Assisted Living Facilities Largely Unregulated

An increasing number of seniors wishing to escape the "stigma" of nursing home care are turning to assisted living facilities -- adult homes that give residents degrees of independence but that are also costly and largely unregulated, the New York Times reports. Assisted living facilities fall somewhere between nursing homes and retirement communities, offering "a mix of independence and help" with everyday tasks, such as meals, housekeeping and some "basic medical attention." Many seniors view these homes as "a dignified alternative to nursing home care," and are willing to pay large out-of-pocket costs to live there. While nursing home fees, paid largely by Medicaid, run about $5,000 per month, assisted living center residents and their families pay anywhere from $2,500 to $6,000 per month largely out-of-pocket.

Since there is no official definition of assisted living facilities, regulation of the industry is very difficult and is often "patchwork" at best, the Times reports. While 29 stateshave passed laws regulating certain aspects of assisted living facilities' operations, other states provide little or no oversight of the homes. Many facilities do not fall into any categories in existing state laws, meaning that they do not have to tell state health officials they exist. Many family members have complained that facilities have not fulfilled their promises of 24-hour care for residents, and some have criticized the facilities for evicting residents with deteriorating health. Other families have pointed to "inflated or unexpected" charges for care, and questioned whether the homes retain residents in need of increased medical attention "longer than appropriate."

Discharge policy has become a "major battleground" in assisted living care issues, since many companies boost their revenues by retaining "the most frail and dependent residents," who are typically charged for extra medical care. Conversely, residents in declining health who wish to remain at an assisted living center can find themselves evicted "with little notice if their condition deteriorates," the Times reports. Health officials, however, are often "confounded" in their attempts to investigate these complaints because assisted living facilities have "no consistent rules" governing issues such as staff ratios and qualifications, billing practices or discharge policies. Facility operators are opposing attempts to regulate the industry, fearing that close oversight would "stifl[e]" expansion and cause facilities to "become mirror images of nursing homes." Consumer advocates and several lawmakers, however, are pushing for legislation that would tighten regulation of the homes. Fred Griesbach, manager of governmental affairs for the New York branch of AARP, said, "If we are going to let an industry like this grow, we have to make sure that people are protected and quality care is being provided." Rep. Pete Stark (D-Calif.) last week called for a White House conference to discuss quality standards for the assisted living facility industry (Steinhauer, New York Times, 2/12).