Assisted Living Facilities Must Adapt to Meet the Needs of Their Changing Population

As the baby boomers come of age, more and more Americans are choosing assisted living facilities as their retirement homes. As these facilities seek to admit higher acuity residents, including demented residents, the risk of harm to these patients can increase drastically when they are admitted into facilities that are not well staffed.

Because the nation’s roughly 28,900 assisted living communities are regulated by states without federal standards, practices vary widely.  State regulations provide fewer protections for residents than are found in nursing homes. Some assisted living facilities are small homes housing as few as four to six seniors; some are large housing complexes with nearly 600 older adults. Nearly 919,000 individuals live in these communities.

According to data from the National Center for Health Statistics, assisted living patients are older and with more impairments than before.  Over 40% of these residents have dementia.  Some 55% of these patients are 85 or older and 77% require assistance with bathing.  In addition, more than half of the residents have high blood pressure and about one-third have heart disease.

According to a panel of experts, assisted living facilities often fail to meet the needs of their older patients and need more of a focus on residents’ medical and mental health issues.

Dr. Kenneth Covinsky, a geriatrician and professor of medicine at the University of California-San Francisco, witnessed staffing-related problems when his mother moved to assisted living at age 79. At one point, she fell and had to wait about 25 minutes for someone to help her get up. On another occasion, she waited for 30 minutes on the toilet as overworked staffers responded to pagers buzzing nonstop. “The nighttime scene was crazy: There would be one person for 30 to 40 residents,” said Covinsky, the author of an editorial accompanying the consensus recommendations. Eventually, he moved his mother to another facility.

The Panel has recommended ratios of health aides to residents be established and that a registered nurse or LPN be available on site. The panel also recommended staffers get training on handling dementia and mental health problems, on medication side effects, on end-of-life care, on tailoring care to individual residents’ needs, and on infection control — a weakness highlighted during the height of the pandemic, when an estimated 17% more people died in assisted living in 2020 compared with previous years.

“If I were placing my parent in assisted living, I certainly would be looking not just at staffing ratios but the actual training of staff,” said Robyn Stone, senior vice president of research at LeadingAge and co-director of its long-term services and supports center at the University of Massachusetts-Boston. Stone said the organization generally supports the panel’s work.

The better-trained staff are, the more likely they are to provide high-quality care to residents and the less likely they are to feel frustrated and burned out, said Dr. Helen Kales, chair of the Department of Psychiatry and Behavioral Sciences at UC Davis Health.

Lack of staffing and staff training is frequently an issue addressed in long-term care litigation, explains assisted living attorney Jeffrey Downey.  Mr. Downey prosecutes assisted living facilities for the neglect and abuse of the elderly.   He typically handles cases involving elopements, pressure wounds (bed sores), falls, medication errors, and physical and sexual abuse. While most states like Virginia and Maryland mandate some training of nurses and nurse aides, the training requirements are minimal.  Often aides are put on the floor after a few days of basic orientation and lack the knowledge necessary to properly assess the residents. I’ve seen cases where aides drop the resident and put them back to bed without calling a nurse to evaluate the patient.  This is nothing short of resident abuse, explains Downey.

Proper training is especially important for memory care delivered in stand-alone assisted living facilities or a wing of a larger community. “We have seen places where a memory care unit charges upwards of $10,000 a month for ‘dementia care’ yet is little more than a locked door to prevent residents from leaving the unit and not the sensitive and personalized care advertised,” wrote Covinsky and his University of California-San Francisco colleague Dr. Kenneth Lam in their editorial.  Because dementia is such a pervasive concern in assisted living, the panel recommended that residents get formal cognitive assessments and that policies be established to address aggression or other worrisome behaviors.

Further recommendations from the panel emphasized the importance of regularly assessing residents’ needs, developing care plans, and including residents in this process. “The resident should really be directing what their goals are and how they want care provided, but this doesn’t always happen,” said Lori Smetanka, a panel member and executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy organization.  “We agree with many of these recommendations” and many assisted living communities are already following these practices, said LaShuan Bethea, executive director of the National Center for Assisted Living, an industry organization. Nonetheless, she said her organization has concerns, especially about the practicality and cost of the recommendations. “We need to understand what the feasibility would be,” she said and suggested that a broad study looks at those issues. In the meantime, states should examine how they regulate assisted living, taking into account the increased needs of the residents, Bethea said.

About The Law Office Jeffrey J. Downey, P.C:

Attorney Jeffrey Downey has over 30 years of litigation experience and started his career as a defense attorney.  If you have questions about an assisted living facility or nursing home matter, call our office for a free consultation.

Contact Information:

The Law Office of Jeffrey J. Downey, P.C.

8300 Greensboro Drive, Suite 500

McLean, VA 22102

Phone: 703-564-7318

Fax: 571-765-7200