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To survive, some facilities are taking in or holding on to sicker residents and increasing the fees they charge to serve them. Sunrise Assisted Living, one of the few companies whose stock price has remained steady, told its investors it is now marketing to "the frailest of the frail." This is welcome news for many residents and their families who believe that the ability to "age in place" is a blessing, even if their care needs are changing. Carrie Cyphert, 89, who suffers from advanced Alzheimer's disease, has been in an Alterra memory-care facility in Portage, Mich., since September 1999 at a cost of $42,300 a year. In July 2000 state health inspectors cited the Portage facility for several violations, including medication errors and insufficient staff. The state tried to force Cyphert and nine other residents to move to higher-care facilities, contending that if they didn't move, Alterra would in essence be operating a nursing home without a license. Several of the families sued. Says Cyphert's daughter Judy Petrick, who was pleased with the care her mother was getting, regardless of the regulatory violations: "I didn't think the state had the right to tell me or anybody else where my mother could live if I'm paying for it."
Therein lies the dilemma for those who wish to regulate assisted living. The vast majority of residents pay for their own care, and according to industry surveys, most are satisfied. Even at the height of turmoil at the Eagan center, several families wrote thank-you letters for the "wonderful" and "tender" care and for providing a place "just like home." So how to justify government intrusion? Michigan decided it couldn't, and the state swiftly passed a law that allowed Cyphert and all other assisted-living residents to stay as long as they wish if the family, the doctor and the provider all agree to it. "Isn't that wonderful?" beams Alterra president Vick. "Free choice has risks, but as long as the operators and residents agree, I think it's a win-win for America."
As states across the U.S. rewrite their rules governing assisted living, most, like Michigan, have deferred to the wishes of the industry. Many of Kentucky's new regulations apply only to facilities that have yet to be built. Alabama has just six inspectors to oversee more than 300 assisted-living centers. In Minnesota attorney general Hatch proposed a consumer-rights bill that would require facilities to disclose fully such key information as staff training and treatment protocol. But even that bill was watered down so much--it includes no required training or inspection--that Hatch now admits that "it won't do much."
Consumer advocates say their best hope for enhanced regulation may be Medicaid, the government assistance for poor elderly that is widely used to pay for nursing homes. Forty states now allow Medicaid to be used for assisted living, but providers have been reluctant so far to accept the money. Their need to fill beds, however, has made them more receptive--and the change has caught the eye of federal lawmakers. Last week the Senate Special Committee on Aging brought together representatives from both the industry and consumer groups and asked them to agree on ways to improve care.