Life and Death in Assisted Living

A new documentary/expose of the same name just began airing on PBS July 30, highlighting the pitfalls and perils that can come with assisted-living facilities. Co-produced by Frontline and ProPublica, it chronicles the experiences of residents at Emeritus Senior Living, the largest for-profit assisted-living chain in the country.

Your clients, like many Americans, may look to assisted-living facilities to be the “goldilocks solution” to their housing needs: daily living that’s not too independent or too dependent, but just right. And for many seniors, this intermediate offering between living in one’s own home and in a nursing home may be exactly what they need — at least for some period of time. But deciding to go the assisted-living route, and then selecting a good one, is not without risk.
To help educate your clients about this residential option, you may wish to point them to this 1-hour documentary, on PBS TV stations or online here. Or to Seven Questions to Ask When Searching for Assisted Living, also prepared by Frontline. Or to this article in Forbes, which aims to temper the documentary’s findings a bit. You might also share this Wall Street Journal/Marketwatch article on the same theme from a few months ago. As it’s a decent example of many articles on this subject, I’ve summarized its ten points here:

1. Assisted-living is not right for everyone, and all homes are not the same. Investigate whether a facility can actually provide the level of services that your potential resident needs. Also realize that people often want to stay in these facilities longer than they should, even with deteriorating health; in these instances, an assisted-living home can be more dangerous than a nursing home, as it may not be able to meet the increasing medical needs of the resident.
2. Arbitrary evictions happen
   These facilities decide themselves whether residents meet their qualifications for continuing to live there. As such, evictions can be (or seem) arbitrary, and there is no industry-standard process for appeal. Local landlord tenant laws and the ADA can help fight eviction decisions.
3. Beware of a la carte charges
   Most facilities charge extra for supplemental services, such as administering medication, bringing meals, etc. To avoid surprises, be sure to read the contract to know which services are not included in the base rate.
4. Negotiate rent and fees
   Depending on the market, potential residents may be able to negotiate a decrease of the base rent, rent guarantees for a few years, discounts on the first few months’ rent, or even discounts or elimination of the community fee or other supplemental charges (see #3).
5. Distinguish hype from reality
   Folks with Alzheimer’s and other dementias make up more than 40% of assisted-living residents (blogger’s note: other research puts this figure at over 60%). Investigate whether the home really provides the services and supervision needed by the potential resident. The same for any other specific medical need.
6. Don’t be wooed by looks
   A lovely atmosphere can be cheap to create and can generate a strong emotional tug on families, blinding them to the important qualities of care they need in an assisted-living facility. To gauge the qualities that really matter, eat several meals in the dining hall and look for competitive staff to patient ratios.
7. Homes are in the business of making money
   Over 80% of assisted-living facilities are for-profit (68% of nursing homes.). Some of them are large national chains. Staffing cutbacks are the quickest way to increase profits. (PBS study’s focuses on largest assisted-living chain country.)
8. Beware of biased referral services
   Free referral services can help guide you to living facilities. But: they are usually for-profit businesses receiving a finders’ fee from the assisted-living facility (usually about one month’s rent). You can get independent, unbiased guidance from a geriatric care manager or other senior professional, though you’ll likely pay a fee. (blogger’s note: you can also get free guidance from your local Area Agency on Aging. Click here to find your local AAA.)
9. State quality ratings are lacking
   State information about the quality of care in assisted-living homes is usually very hard to find, if it exists at all. One shortcut: ask the facility for its record of fines and violations, which should be on-site and publicly available.
10. What is the home’s Medicaid policy?
    Ask about the facility’s policy if the potential resident were to run out of money and go on Medicaid while living there. Not all homes allow this (i.e. they might have to move out).

Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directives registry in the U.S., which ensures that the emergency information and healthcare directives of its 200,000 enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Center for Advocacy for the Rights and Interests of the Elderly, the International Society of Advance Care Planning, and the Coalition to Transform Advanced Care, she is active in health education and public engagement related to advance care planning and advance directives and serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative. Randi is an ongoing contributor to the Academy blog.

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