The Empty Promise of Assisted Living

So Mom’s not getting any younger and she’s really tired of dealing with all the upkeep on the house, not to mention hiring people to help out who either don’t know what they’re doing or don’t show up. Then one day she notices an ad in the paper. There’s a nice new community opening up on the other side of town. It’s an assisted living facility, so she can take her own furniture, park her car in the gated garage, and come and go as she pleases. There’s no yard to take care of, the cleaning people visit as often as she wants and she can cook for herself or have meals in the community room. They’ll even deliver meals to her apartment, like room service! How perfect is that?

For this person, who is basically healthy and fully functioning, assisted living is ideal. But more and more often, managers of assisted living facilities accept patients they are not equipped to handle and make promises that cannot be kept.

Exhibit A: Lifehouse Properties, which owns a number of assisted living facilities in the Midwest. According to the website, Alzheimer’s patients are welcomed by a staff specially trained in Montessori techniques for dealing with dementia issues. Plus, they offer a wellness program, spa therapies, a diet and exercise program, planned life enrichment opportunities, “compassionate care” and “personalized services.” Who would pass up an opportunity like that?

My father moved into a Lifehouse Property in February, 2006. And in the six months that followed, we (my sister and I) discovered that few of the promises made were going to be kept. To this day, we have seen no evidence of a wellness program. As for diet, our father’s file contains an evaluation sheet on which someone scrawled “likes sweets.” Spa therapies? Sorry, don’t think so. Life enrichment opportunities? Sure, if you consider Bingo an opportunity to enrich your life. I could go on, but I’m sure by now the point is clear. People can post anything on a website. They can create a brochure reminiscent of a resort. That doesn’t mean it actually exists.

No doubt there are some wonderful assisted living facilities out there, and I don’t mean to suggest that they all are disappointments -- or worse. But the problem is this: assisted living operations do not have to live up to the same standards as nursing homes, which are highly regulated. Actually, there are very few standards for assisted living operations in most states. That fact alone makes them appealing to certain business people. And it’s no coincidence that assisted living facilities are the fastest growing segment of the elder care market.

Here’s why: Most parents of Baby Boomers grew up in the Depression. Unlike the Boomers, they knew how to live frugally and they saved their money. In fact, elderly Americans have accumulated enormous wealth. Getting these people into assisted living situations is one way to tap that wealth. Not surprisingly, assisted living facilities offer rates that are considerably lower than those of nursing homes. Plus, they sound much less "end stage" than nursing homes, which are often viewed as God's waiting room. So not only are kids relieved that they aren’t putting a parent into a dreaded “home,” but there’s also the possibility that the savings accounts won’t be drained. Because there is so little oversight, though, an assisted living company can promise that Mom or Dad will be treated with dignity and respect, etc., and then pretty much do as they please. Most children are not able to visit very often and have no idea what is actually happening.

If you’re up for an in-depth read on the subject, here’s a long (20-some pages) report from Michigan State University, documenting some of these problems.

Here are a few tidbits from the report (italics added)–

"ALFs [assisted living facilities] also have significant advantage for providers. These include:
-- freedom from the burdens and expense of extensive regulatory requirements;
-- the absence of governmental involvement in facility development and operations, and,
-- the opportunity to respond to individual needs and to create innovative programs....
The lack of regulation also enables providers far greater flexibility in the development and operation of their facilities, although further study is required to determine if ALF facilities actually routinely offer flexible services to suit individual needs and preferences."

The entire report is easy to skim. And you’ll see that for people who are unhappy with an assisted living facility or who have had a bad experience, there is very little recourse. This is exactly what we found out when our father was given an emergency, 24-hour discharge, and asked to leave ASAP. The reason: “Continual combative and non-compliant episodes.” That’s right -- an 88-year-old, disabled World War II veteran who uses a walker and still can barely get around was too much for staff to handle. What could we do about it? Nothing. As we discovered, the typical assisted living contract gives management the option of removing any resident at will. So much for “compassionate care.”

Before too long, I’ll be adding links to several series of articles on assisted living that depict some of the more serious consequences this lack of oversight has caused, including abuse and fatalities. Over the years, there have been attempts to pass legislation that would require assisted living facilities to meet higher standards, but only a few states have actually passed these kinds of laws. Bottom line: Don’t believe everything the staff people tell you, and by all means, don’t assume that whatever’s on the website or in a glossy brochure bears any resemblance to reality.