PBS shines a bright light on Assisted Living – will change follow?

I've spoken with CNAs that work in ALF. They are required in most cases to care for 10 or more persons. All have said that caring for so many is impossible. ALF make no bones about the fact that they are just running a hotel type facility. Since that is the case, workers at ALF, inmates (yes it is a good word to use), and family members who interact with the inmates should establish a site like Trip Advisor. The only way the ALF industry can profit is by reducing either facility maintenance costs and/or labor costs. Given that Wall Street (and the CEOs themselves) want increased profits each year to justify CEO outrageous salaries and stock prices, the For profit ALF have few ways to increase profits. The continued decline in the number of Nursing Home providers points to that fact. I think that Boomers have already seen those issues with ALF for their parents and will not follow that path. Aging in the Home will be the default with services brought into the house. In many case, this is the financial savvy way to go since the person gets one on one care, can be directly hired, and can be paid more than the $8-$9 typically paid to CNAs. I've seen this model work well in a number of cases. As one CNA told me, I get paid well by not having an agency rake off half of what they charge to find a caregiver. I personally think that this will become the default way for the Boomers.

In the 1980's, I worked in and completed my dissertation in the first assisted living facility in the country. My research showed that within six months of move-in, most residents declined significantly and needed more care than expected. State aging service policy makers admitted, during interviews, that staffing was not sufficient to provide care unless residents remained quite healthy and independent. I even had a resident ask me if she could move somewhere where there was more attention from staff. She was afraid and felt completely isolated. Administration told me this was "crazy" and to keep filling the beds. So, from the beginning the model was flawed.

Let's face it, families and older adults do not make this move until absolutely needed, a result of an injury, illness or other crises. Residents are frail at move-in, may be in decline, and the move itself is another stress. Fast forward to today, when the age at move in is even older and residents in need of more care. Yet, 25 years later we still do not have policies requiring adequately trained staff and a adequate numbered of staff. I have a hard time explaining this lag in policy response to my graduate level gerontology students.

While I agree, Laurie, that technology could be better used to improve safety, and involved families and staff can enhance care, we must revisit this model. Twenty-five years is too long for a more creative approach.

Laurie...I love your analogy of hotels and TripAdvisor.

I truly believe the only way we will see advancement in elder care is to re-evaluate the need from the beginning and start searching for new solutions beyond what is available today, particularly in the Assisted Living space. Trying to fix existing industries(like Assisted Living) or companies(like Emeritus) is not going to work. It is so hard for an incumbent or existing company to do anything beyond incremental changes. They have "drank the Kool-Aid". This is true in all industries.

I don't think there is a silver bullet either. This is a complex space. On one hand, Wall Street has its eye on just the short-term and rewards for short-term, but investors themselves could be voting with their own purchases and vote for companies that are doing the right things. Until we have more transparency (a TripAdvisor), we will not see more companies doing the right things. Wall Street is really hurting the economy at the moment, but slowing I'm beginning to feel investors are rewarding companies for doing the right thing, not just for the almighty dollar.

Culturally we also seem to have many different mindsets around the world to address these issues. Here in the U.S. we need to get families to address these issues sooner rather than waiting for a crisis, which is what happens today.

I have always enjoyed your perspectives and candor on this blog...keep it up!

As a health professional with more 25 years consulting experience to both SNFs and ALFs, I was quite surprised when I was asked to review the medications of a g-tube resident recently admitted to an ALF. I was told an outside agency had been contracted for care and administration. My biggest question was why would the family put their loved one in an assisted living building and not a nursing home. One answer is the stigma that still exists of putting a loved one in a "Nursing Home." Emotionally, a nursing home means we failed to take care of mom. Now she lives in an institution where she will wither and die and it's all our fault. ALFs have become the antithesis of SNFs, beautiful surroundings, beautiful rooms, great cuisine. And that's why most families accept the inevitable breakdowns in facility care, because their mom is not in a nursing home. There is much less guilt.

The answer? Certainly requiring similar regulatory standards to SNFs is a start, along with strict, enforceable guidelines on eligibility to ALFs. But one additional important factor is for the family to be able to objectively assess the needs of their loved ones before placement. Understand what ADLs are, understand what a mini mental state exam is (MMSE). Talk to professionals who understand them as well. By totally understanding the acuity level of your loved one can you make a more informed decision about their future care.

Thanks Laurie,

A much needed retrospect of the current "crisis" in long term care. Better forethought and education on where families place their loved-ones is needed as well as good communication from the provider to family members is essential. New technology is not the answer...just the ability to provide better care using current technologies.

Although Emeritus was targeted in this report the problem exists throughout the industry. Families need to be overly cognitive of the the care they will require of their loved ones and hold them, the provider, to the fire for timely updates, reporting and most important...simple communication.

Hi Laurie, thanks for sharing your thoughts on the PBS Frontline expose. Part of our mission at SeniorAdvisor.com is to help raise the level of care in the industry, as well as encourage dialogue between community managers and the residents and families they serve. We believe online reviews of senior communities can be a great resource to families during their search for senior care, and can help people feel more confident in the decision making process.