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Fueled by Wall Street speculation and the rapidly aging U.S. population, assisted-living residences in the past few years have popped up in nearly every suburb and city. Today there are at least 10,000 facilities, 90% of which have been built in the past decade, according to the American Seniors Housing Association. They house nearly 800,000 elderly Americans. But the boom has been accompanied by widespread allegations of substandard care, neglect and even preventable death. Year after year, Washington politicians take aim at problems in nursing homes, often proposing scores of new guidelines for an industry that is already heavily regulated. Yet Congress has thus far largely ignored assisted living, which receives no federal oversight whatsoever.
Last week a special government investigation disclosed that the number of nursing homes cited for abuse violations has doubled in just the past five years, prompting Congressman Henry Waxman, a California Democrat, to propose tougher staffing and disclosure rules. These may indeed be necessary. But the soon-to-be-released findings of the first national study of assisted living suggest that staffing problems and neglect in these facilities may be just as acute as in nursing homes. The Department of Health and Human Services (HHS) report will show that 32% of assisted-living residents (who are typically much healthier than their nursing-home counterparts) had been hospitalized in the previous year, a rate higher than for residents of nursing homes. And according to the report, most assisted-living staff do not have a basic understanding of the aging process: the vast majority thought, for example, that incontinence, confusion and depression were normal signs of aging rather than potentially reversible conditions. "There's absolutely no doubt that these facilities are more dangerous than nursing homes," says Karen Love, executive director of the Consumer Consortium on Assisted Living.
Underlying the problems is the very freedom from regulation that makes assisted living so attractive. This has allowed operators to cater to the aesthetic desires of their customers--to sport plush carpeting where nursing homes have only linoleum--and still keep costs down. The average nursing home, funded largely by Medicaid, costs nearly $4,000 a month. The average assisted-living facility, where residents typically pay out of their own pocket, costs about $1,800 a month. Disparities in regulation, though, leave seniors vulnerable to huge variations in everything from the quality of food to the number of registered nurses available. Most assisted-living centers do not even have a full-time nurse on staff; nursing homes of comparable size have four or five, which is the major reason they cost so much. Yet studies show that nationwide, on average, people in assisted living actually receive more medication than do patients in nursing homes. They may not be sicker, but they still need plenty of attention.