Some Assisted-Living Residents Don’t Get Promised Care, Suit Charges

Court decisions in California may shed light on how large chains make staffing decisions.

Comments: 115

  1. This is the tip of a very big iceberg, and the American Titanic is heading straight for it. Demand for assistance with activities of daily living is going to grow tremendously as the Baby Boomers age, and Gen X (the oldest of whom are now in their 50's) follows them. Several changes in American society are converging to create a massive problem; among them are high divorce rates among the Baby Boomers and subsequent generations, fewer adult children to provide care, the need for women to work outside the home and not be available to help Mom and Dad, geographic distance or estrangement, depleted savings thanks to several recessions and lack of wage growth, fewer people covered by defined-benefit pensions, and rising numbers with chronic conditions like diabetes and cardiovascular disease. The reality is that we will have a large number of people who need assistance with ADL, but not skilled nursing care, and who have fewer resources, both financial and of family members' time, to secure that care. Nursing homes are a very expensive solution, assisted living facilities are not much cheaper. How can we provide this care to people in their own homes and communities in a cost effective manner that does not segregate them from the rest of society? How would that be paid for in the case of those who don't have the income or savings to afford $4000 a month? Either we solve that dilemma, or we see "deaths of despair" or deaths from neglect increase. The re

  2. Yes, I second everything you said. It’s just getting worse. The boomers at least still have pensions and benefited from the stock market boom in the late nineties. The Gen Xers, not so much. They are the ones with no pension, out of control college tuition for their kids and sometimes big mortgages that may not even be paid off by the time they retire. Assisted living? Dream on.

  3. @Karen B. : BOOMERS DO NOT HAVE PENSIONS -- not unless they are public employees, like police or school teachers! Something like 95% of us DO NOT HAVE PENSIONS! Some have 401K plans ,but not all. Many boomers had to liquidate their 401K plans in the Great Recession, just to survive. The idea that "all boomers" have anything is nuts -- there are 55 million of us! ranging in age from 54 to 73!!! I am a boomer, and I did not benefit one dime from the stock market in the late 90s -- when I still had kids at home and in college! not one dime! I know many folks my age who are still paying on big mortgages, in their 60s.

  4. Not only are assisted living facilities staffed inadequately but the medication management of patients is being performed by unlicensed, unskilled workers. In the state of California there are no requirements for Licensed nursing staff to oversee medication that is given to the residents. They can basically hire people off the street, label them as med techs, and they're allowed to dispense medications. Working as an emergency room RN for many years. I have seen residents requiring hospitalization due to medication overdose and errors. I don't believe many families are made where this.

  5. @Lynn S. Unlicensed yes! Unskilled, that is too broad a statement. I would ask who is going to pay to make sure that nurses do this. Most of the comments here already complain about the high cost. Adding a nurse to do all the meds would likely add a couple hundred a month per resident, maybe more.

  6. This is the most important take-a-way of the entire article: "Families can find it difficult to make informed decisions about assisted living; there’s no equivalent of the federal inspection findings and quality rankings at Nursing Home Compare. State websites are inadequate substitutes, a recent study found." As we face our own futures, let us now, while we are able to,fix our past mistakes.

  7. @Chris The idea that federal oversight would make things better is simply wrong. We have that in the nursing home industry and the result is higher costs to we the tax payers and still mostly terrible nursing homes. The right answer is for families, to do their due diligence in picking an assisted living community. Don't pick only based on the posh interior and exterior. Go in the evenings, talk to families and residents, look at consumer review sites.

  8. @Steve Moran What about people without family?

  9. In the Los Angeles area, assisted living at a Sunrise facility is nothing like $4500 a month. It is more like $13,000. Other places may be less money, or perhaps half that amount with less fancy, older facilities, or less in places with cheaper underlying real estate. But the main scam is always the same: squeeze as much money as possible out of the affluent children who are making the decisions for aging parents but don’t want the actual physical burden of caring for them personally. So, a coat of paint, a couple of chandeliers, the promise of a resort-like utopia, and the kids can feel less bad about not being able, one way or another, to shoulder their responsibilities. It’s about assuaging guilt with one hand and grabbing the money with the other. Of course, this is not always the case, but it is often enough that this is the basic business model, especially of the notorious Sunrise.

  10. @Pottree Aegis is the culprit in Seattle. We paid over 30K in fees for our father (we're all from LA) and thankfully I had a flexible job because I spent tons of my day there every day and they'd call me to help with my dad. Tons of class action suits...and yes, tons of chandeliers in their new facilities.

  11. @Pottree The children "don’t want the actual physical burden of caring for them personally"? How about the children simply cannot manage that burden (while working full-time, while dealing with their own physical and/or emotional illnesses, and so on)? I'm in my 70s. No way do I assume that providing eventual assisted living or nursing home care for me is my kids' responsibility. Elder care is a community responsibility, a state and national responsibility! Would you expect families to provide hospital-based care for their loved ones? Caring for elders is just as technical, just as full of the potential for bleeding, fractures, and other medical disasters.

  12. @Pottree : I wondered about that too. LA is so much more costly than the Midwest, and I can tell you that AL costs START at $4500 a month here. Most are closer to $5500 or $6000 a month. And this is the Rustbelt Midwest, where you can buy a pretty nice house for $100,000. So I can't see how LA, with such costly housing and real estate, could cost the same as (say) Akron, Ohio.

  13. Mexico has high quality assisted living facilities at an affordable price, and in a culture that respects the elderly.

  14. @Smokey I've read about those mainly in a community called Ajijic in the state of Jalisco. My assisted living plan is in place: my best friend Lolita in Michoacan who is a trained nurse. I will certainly pay her but at a fraction of the cost in the US. I will die happy.

  15. My sisters and I are in the midst of moving our mother into such a facility. We are VERY lucky she can afford a high quality place but they are nonetheless grim, even with new construction, granite countertops and a day full of activities. There is nothing that says getting old than sitting at a table for a meal with people whose hygiene resembles that of a toddler. And, no, we are avoiding caring for an elderly parent (as a comment below suggests), all three of us are fully employed, with families and can not assume the burden of caring for someone who needs daily assistance. This is an incredibly difficult time and made all the more difficult knowing the promises of any assisted living center are just that - promises.

  16. @North Dakota First this is in no way meant to insult you, but one of the biggest reasons senior living is so expensive is that fancy buildings is what consumers are willing to pay for. It is likely that if you focused mostly on quality of life and care, you would find yourself moving your mom into a less fancy place, but with higher quality of life. My theory is that families tend to feel huge amounts of guilt placing mom or dad in an assisted living home and mitigate guilt by picking the most opulent, when it may not really be the very best choice.

  17. Class actions only benefit the attorneys who bring them. The awards are, as the author says, paltry. This has always been true, since the beginning of class actions back in the 1960's. Class actions are a scam.

  18. @James Ribe True that the lawyers profit & they should. The clients may not receive much cash, but their lives are frequently improved by what is accomplished if the suits are successful. I don't call that a 'scam'.

  19. @Jenifer Wolf They're not clients. They're "class plaintiffs." None of these class plaintiffs has ever met or even heard of the law firm that "represents" them.

  20. @James Ribe So true. Reading this, along with the very real and serious issues raised, also reminded me of the early seasons of "Better Call Saul," when Saul/Jimmy McGill was plying his trade at the nursing home.

  21. A move to an assisted living facility, given the often scanty hygiene of helpers and other residents, devolves rapidly into a stay at a hospital for some virus or another. From there, the merry-go-round of hospital to nursing home to hospital, hospital back to nursing home, and back to hospital begins. Having elderly friends go that route, and having studiously avoided that fate, as best as we could, for our relatives, we hope that we can summon the strength to allow ourselves to sicken and die at home.

  22. Prepare now for $5000 a month for as long as your relative survives in assisted living. My mother is in a very nice facility. She absolutely needs a local relative to make sure things are going right. Like bills are accurate, Sheets are changed, clothing is appropriate, medical conditions are attended to. There are many residents with no visitors who never leave the facility. I shudder to think of their bills and what is being neglected.

  23. @M Woodbury : absolutely! but it is very hard. With my own relative, I was able to monitor these things. But I started visiting an old family friend in such place. With each visit, I got suspicious that the bedding was always the same. So I secretly tagged the bedding, so I could tell if it was changed weekly. It was not -- it went unchanged for months! -- and suspiciously, the lady's own (fancy) sheets and bedspreads "disappeared" in the laundry and her bed was made with sad, torn & stained bed linens. After SIX WEEKS of the sheets not being changed or washed, I reported this to management. I also called my state ombudsman, who did nothing (likely, they were paid off by the facility!). My reward? I was thrown out of the facility and "banned for life" and they threatened to call the police on me!

  24. The majority of staff responsible for assisting residents are not full time employees, even in "luxury" facilities. They come from outside agencies and do not go through any screening process which opens the door to negligence and abuse. My 91 year-old mother suffered a broken leg and subsequently died as a result of an aide from an agency (who did not know my mother) cranking up her bed to a dangerous height. Until assisted living facilities are required by law to screen and train full time staff, these horror stories will continue.

  25. Ugh. This is a phenomenon that happens across the board at these places especially ever since the real estate developers figured out what great margins these places have. We had a horrible experience with the Aegis institution (out of Seattle) - only after we had our experience (30k+ a month for memory care which still was terrible) - noted multiple class action lawsuits against the chain. Not only do the residents suffer, but the poor (usually) immigrant laborers are so overworked it is awful. I spent so much time there to supplement the care (they'd call me in to help and yes, already paying over 30K a month) - watching these overworked people... A new perspective on the whole sham of assisted living. Republicans - don't cut Medicare and Social Security - these seniors depend on it so much (who worked all of their lives like our father and saved his $) and the burden will be borne by everyone else (family members, etc.)

  26. @Ms Nina G : $30,000 a MONTH? Even the best skilled nursing homes do not charge this much! You were paying $360,000 a year for care? For $360,000 a year, you could have had 3 rotating shifts of actual RNs! in a private home or apartment! That makes no sense. I do agree the facilities that exist are too expensive, provide substandard care -- and are there to make huge profits for corporations.

  27. This suit is on target. Absolutely no correlation between an assessment that results in higher charges and better care. The funds are more likely to go towards appearance of the facility and less about care or the staff who provides it. It is a sham industry that hides behind fancy decor.

  28. I think most of us would rather decline in our later years at home. If this isn't possible, entering one of these facilities seems to be, and should be, a last resort. The stories making their way to the media are frightening and prohibitive. Who would want to live somewhere where no one really cares about your well-being and only sees you as an impediment to their job? As long as there's a financial incentive, seniors will always find themselves in an exploited position. It's just too easy to take advantage of and abuse seniors.

  29. The big chains are businesses and must show a profit. Risk management to reduce bad publicity and lawsuits (bad for business) is the priority in all decisions and protocols. Staff are usually underpaid, overworked, subject to conflicting demands of residents and management. Verbal abuse of caregivers by patients, families, and managers can be very common. The fine print in that contract you sign is full of details that seem unimportant when you are fairly healthy and independent. Facilities may require you to hire a 1:1 aide (at your expense) to provide safety supervision. Facility rules prohibit this person from actually providing care - but staff stop providing care as 'they have a caregiver." As the silver tsunami continues to build, there are no good options.

  30. @mary I was a volunteer in a nursing home & overheard quite a bit of verbal abuse, some of it quite threatening, of residents by 'caregivers' - never the other way around. The residents were to weak & frightened to complain.

  31. @Jenifer Wolf Report such behavior.

  32. @m : I reported this behavior and WORSE -- abuse, neglect, dirt, lack of bathing, lack of feeding -- you name it -- with the result that I was BANNED from the Assisted Living facility and threatened with them calling the police on me for "interfering with a patient's care".

  33. For the cost of one year at one of these facilities, my sister added a spacious studio apartment to her house for our mother. Even if some hired help is needed as her faculties decrease in her later days, the net outlay will still be less than what we would spend for several years of glorified warehousing (and the equity will be in my sister's pocket). More importantly, Mom is surrounded by loving family members who will pay monitor her condition. It used to be taken for granted that family would care for family. I realize that most women stayed home then, and I also realize that many families can't afford to build (but if you can afford the monthly fees for assisted living, you can afford this option). Think it through.

  34. @Terry This sounds like a lovely solution to a family challenge, but it's temporary. If your mother slips into dementia, or if she breaks a hip, she isn't going to need "some hired help". She's going to need someone in the house at all times. She's going to need someone to take her to the bathroom several times every night, to keep her from wandering, to bathe her, and possibly to feed her. This could go on for years, with the need increasing every year. Family members cannot provide this level of care without sacrificing their health, their sleep, their jobs, and their other familial relationships. The reason it used to be taken for granted that family would care for family is that people died before they reached the point that they needed 24/7 full time care.

  35. @Candace Kalish Everything you are saying is correct. I adore my father, he is 92 years old and has multiple ailments. My husband and I are in our mid sixties, My brother is older and has his own ailments, my sister lives out of town. Taking care of my father at my home would be near impossible. I know many people my age or older who have had to take care of elderly parents while sacrificing their own lives and health. Our society has made it so we almost require people to live longer by overmedicating them. If we let them die then we are liable. What kind of HEALTH care is this?

  36. @Terry. Although your solution will hopefully see your mom through to the end, most of us aren’t so lucky. My mother-in-law had Alzheimer’s. In short order, family care and aides weren’t adequate for her needs. We were lucky to find a non-profit Alzheimer’s facility (not part of a chain) where she received excellent care for the last three years of her life. But, it came at a very high cost that is out of reach for most Americans.

  37. Assisted living facilities (ALF) are not federally regulated like nursing homes which require national standards for staffing, quality, and safety. It's up to each individual state to provide licensing and oversight regulations. This can result in uneven care such as bare bones staffing, untrained staff, and little or no official oversight. Some families are desperate and feel guilty about placing a loved one in a nursing home and look to these facilities as an alternative. But the real danger is an ALF accepting a person who has higher medical needs than the facility can manage resulting in injury or death. And some unscrupulous facilities may have a financial incentive to accept these unqualified residents who really require skilled nursing care. We need national federal regulations and standards and not the hit and miss state patchwork standards that are in place now.

  38. @MSS I agree that ALFs need greater oversight. Unfortunately, so do some nursing homes... Vigilance is needed by families.

  39. "But she added, 'These group settings cannot individualize everything for every person.' Being forced to add staff members could make assisted living even more expensive, unreachable for many older adults, she said." That is ridiculous. The only harm would be to corporate profits. My son is a CNA. It was him and one LPN on a floor with 42 patients from 10pm to 6am. One patients wanders and needs 1:1 observation 24/7. Another needs two people to use the toilet. Call ligts go unanswered for an hour. It's horrific. There is one shower aide, during the day. Some residents can only shower once every week to ten days. A single aide often has as many as 15 residents to get out of bed, dress, wash, and ready for the day in 45 minutes. Just one aide.

  40. Often times federal regulation comes up as the obvious answer to improve quality of care and oversight of ALFs. But look at Nursing Homes and the 5-star rating system and you’ll see how they often don’t line up. One important piece of this complicated puzzle is the lack of adequate pay and required training for those who take care of our loved ones. At the root of this is the lack of value our society holds for direct care workers (e.g., CNAs and personal care aides). The minimum wage should be raised in all states to $15 per hour so we can at least attract people into these positions and not lose them to fast food giants who often compete for them. More rigorous education and training could follow. Meanwhile our government needs to also make headway on incentivizing family caregivers who want to stay at home and who could be the answer to the shortage of direct care workers we are facing. Our loved ones deserve staff who are adequately compensated and trained to provide quality care.

  41. @Kristie Porter $15 is not adequate in many states...especially when some fast-food places pay just that. Shouldn't care of vulnerable patients be worth more than that? Our society has misplaced values. Consider the value placed on celebrities and contrast it with the lack of value placed on the healthcare workers that care for our most vulnerable...and also the lack of values on our most vulnerable people, as well. It is a shame.

  42. It's a free maket and it can be argued that people choose what they want, but a simple analysis using a pencil and the back of an old envelope appears to show these are simply money-making machines for the investors and management companies. If X people are paying $$ that needs to cover staff, managers, facilities upkeep, food, mortgaging/debt service, etc and we know the staff is not well paid and/or not fully staffed - especially on weekends and holidays - the money is flowing where it isn't benefitting those people. And, frankly, 1 staff member for 15 people is NOT a good ratio; that needs to be much lower. This is where regulations need to be strengthened because the people who "choose" these facilities are vulnerable and have little to give them an appropriate advantage due to their limited life expectancy. Nobody wants to have to move their parent or create an atmosphere of (justifiable) mistrust or even some manipulated neglect for them as the consequence of a complaint. That's the very powerful implied threat that keeps these companies going. The Atlanta Journal-Constitution has been publishing some analysis recently on the need for more inspections, that would be a good start, but the follow up of tightening regulations (although unlikely) can't come soon enough.

  43. Have the government buy them out and turn over the operations to not for profit organizations. There’s way too much abuse and overcharging which prevents so many elderly Americans from getting the long term care they need.

  44. I retired, sold my home and moved back to the farm to care for my mom. "Assisted" living costs about 6K a month here, and not sure what you really get for that. A neighbor was relating her mother was in one of the "chain" facilities located in the nearby small city. They would often come and find her sitting in a chair naked from the waist down. the lady had severe arthritis and had trouble getting her clothes up and down to go to the toilet - so she would just take them off and the staff would just throw a towel over her lap. When the family complained the said they weren't paying "for the level of care to make sure she could go to the toilet and get dressed". ARE YOU KIDDING M???? Caring for my mother is not fun and my retirement is nothing like I envisioned. I have no help and do hire a lady to come once in a while so I can get away for a bit. But putting her into a facility will be a last resort. These "for profit" companies hire as few people as possible and provide the least amount of care and services they can get away with. Unfortunately I am age wise right in the middle of the Baby Boomers. Looking down the road isn't a very pleasant prospect as the numbers of elderly needing help balloons. The costs are astronomical and the help to staff them isn't available.

  45. In third world countries, when a loved one goes to the hospital the family must come daily, practically live there, to make sure they get proper treatment with the appropriate type of care. They make sure there are enough syringes, clean bedding, and so on, and that their loved one is bathed. That is precisely what Americans must do when a loved one needs assisted living or nursing home care. Is that really how we want to be and do as a culture, as a nation? This problem cannot be solved at the family level. It must be solved at the national level (and obviously not by the profit-oriented GOP).

  46. So, Paula Span, sometime in the future you also may be a resident of assisted living. What are your plans to make sure you will be treated fairly.

  47. @Jerry Davenport This is an excellent question.

  48. I think the resident yelling “PLEASE KILL ME” had a plan but nobody to execute it or him. SAD beyond words. This is what has become common in America where you are lucky to get any kind of care even if you are living in lush surroundings and paying $8,000 a month. I know as we watch my poor sister in law rapidly decline in assisted living where the common phrase is “oh, we don’t do that” and she can’t or won’t and her quality of life declines faster than she does.

  49. We have a friend at sunrise in los angeles its 9200... and everyone is super nice there...nicer than the other homes , its not utopia but its quiet and pretty ...we've had friends in other skilled nursing facilities -they have you in wheelchairs in the hallway with your glasses hanging off your face at an odd angle and no activities..all staff so overworked and stressed out doing paperwork noone looks at any of the patients..let alone smiles.A warehouse of lonely souls...with someone occasionally shouting out PLEASE KILL ME....at least sunrise is pretty and people are unbelievably kind...skilled nursing in los angeles is 450 a day and they let you get UTI and say its dementia, when its really just a UTI...beware of skilled nursing.... The drs fill you up with painkillers so you are nice and quiet like a good vegetable.

  50. THERE ARE NOT ENOUGH PEOPLE FOR THE NUMBER OF PATIENTS OR RESIDENTS. No matter which part of the country you live in, no matter how deluxe or basic the facility, no matter if you find yourself in a hospital, assisted living facility, or skilled nursing home, there are not enough people to do to the work required. Staffing at all levels in our healthcare systems is completely inadequate. Additionally, there are serious gaps in training at all levels. Every administrator, every CEO, every sales and marketing director of a hospital, assisted living facility, or skilled nursing home, and every elected state official regulating the insurance industry should be required to spend 24 hours anonymously admitted to a bed in a facility they oversee. They should be strapped to the bed to simulate the infirmities of old age and its limitations. Then they should be made to drink a couple of glasses of water and forced to drink a cup of Miralax. Ring the buzzer and see how you feel when nobody comes and you are unattended for 20 minutes or longer. The staff EVERYWHERE in our healthcare system are overworked and underpaid, and the staffing levels are completely inadequate. Class action law suits that mostly benefit personal injury law firms looking for a new market to tap are not the answer. A complete overhaul of our healthcare system is. And the patient, the person, not profits, should be the starting point.

  51. @Native Pittsburgher Excellent post. Assisted Living will kill you. Yes, I know of those who say their "loved ones" get excellent care. Then they are just plain lucky. It is madness to put people in these places. People wouldn't leave their pets in such places. And I DO know of what I speak.

  52. @suzanne : I agree, but many people have absolutely no choice. If you have to work at a job, how do you take care of a frail parent who needs round-the-clock supervision? and can't be left alone in a house or apartment, because they can't safely come & go, turn on lights, use a toilet, etc.?

  53. My mother has lived in 4 assisted living homes in the last 8 years. She was evicted without notice last year and I had to have the Oregon Ombudsman get involved. The ALH literally locked her out of her paid for apartment and left her sitting in her wheelchair in the lobby. The stated reason--they didn't want to readmit her back from a short stay at a nursing home. The real reason, she had told them she would be going on Medicaid soon. She is still paying out of her own savings, having exhausted her long term health insurance, but at $7250 a month, she will be broke in a few months. This is a crisis for most families. Everyone works, the elderly require large amounts of care including lifting and the prices keep going up.

  54. @Betsey Ross : many AL homes will not take Medicaid patients. The reason is Medicaid pays about $1700 a month -- so on top of the resident's SS check (average is about $1400 a month) -- you can see the Medicaid nursing home is only getting a bit over $3000 a month. That is a tiny fraction of what they normally charge. So they cut corners. Most Medicaid nursing homes are 3rd or 4th rate at best. If you run out of money at an Assisted Living home, there is about a 90% chance THEY WILL THROW YOU OUT and force you to move to a 3rd rate Medicaid home. That means…you lose your private apartment and instead must share a tiny room with 1-2 OTHER Medicaid patients! the food and facilities are much worse and drearier, and the location will be either in a rural area OR an inner city slum.

  55. @Betsey Ross You're right, this is a crisis for everyone. You're certainly doing all you can for your mom. Hope you know that. Your comment about 'exhausting LTC' caught my eye also. I know many/most of those policies have more holes than Swiss cheese, but can you say anything about if it was helpful while it was available, how long before it was used up, etc.?

  56. @Betsey Ross In fairness, 4 assisted living communities in 8 years? Is it possible your had unrealistic expectations?

  57. At least a third of assisted living residents don't belong there in the first place; they belong in skilled nursing homes. But the stench in many nursing homes drive away the children. So instead they drop off mom at the local assisted living, where they are happy to visit once a week. Nothing will change these facts.

  58. @Joseph Many are now "graduated care" facilities that have independent, assisted, and skilled nursing sections. My mother went from independent to skilled, skipping assisted after she had two strokes. And as for dropping off and visiting once a week - you've obviously never visited and seen the exhausted daughters who are still working and trying to take care of their elderly mothers, and being told "find some time for yourself." Just go to the parking lots and watch the women sitting in their cars, sobbing.

  59. @Joseph I agree. Many families choose AL for parents who either already need or will soon need more support than is offered with the monthly fee (and for which the family either isn't able or willing to privately pay for). The choice is made because of the challenging emotions that often surround the placing of a loved one is a nursing home. I have a family member currently living in an AL and on top of the monthly fee to the AL we currently pay for 24/7 care that is needed due to strokes. If our family member lives long enough, the money that was saved for her care will run out and nursing home care, paid for Medicaid, will be our only option. If that transition is necessary, that will not be the fault of the AL. We are grateful that the option of AL exists for this time in her life.

  60. I will make my own exit before I get stuck in such a place. I want whatever money I have to go to other purposes and I am making arrangements with friends to make sure my plans are executed. Otherwise, you are in a living hell....

  61. @sfdphd We all need to share how to off ourselves if we don't want to be here anymore. I have asked a few of my docs to provide an Rx for a seconal cocktail, so I can end my life when I would like to and they all laugh it off. I have written to my NY state legislators, to no effect. Help!

  62. @SG Absolutely! There needs to be Right to Die / Death with Dignity legislation nationwide. Failing that, doctors absolutely need to 'help' their patients.

  63. My mother spent the average amount of time (3 years, almost to the day) in a luxury assisted living facility. It was great when she didn't need much direct care. It took me 6 months to determine that she didn't need extra morning care but was being charged for it. Staff will not notify the director or the family that your loved one is actually bathing and dressing themselves. They aren't part of the billing, and if your loved one is independent it frees them up for more demanding clients. I had to repeatedly bring it to the attention of the director to save that extra fee. When she deteriorated, so did the care. When she returned from a hospitalization, I had to pay for outside private aides to demonstrate that she was safe enough, at a cost of 200+/day, for a minimum of 2 weeks. They were going to suggest she go to their 10K/day nursing home on private pay. Her large nest egg started to shrink immediately with no ability to see what she was getting for her $$. Those promises you get in the fancy lobby about care continuing as your loved one declines? Those are true until the facility decides it is not. Then you get 30 days to find another home. All legal, all true.

  64. @Cathy We had essentially the same experience and I wrote essentially the same comment before reading yours. It reinforced our decision to stay in our own home and die on our own terms and at a time of our choosing.

  65. 10k/day?! Surely that is a typo, right? 3.6 million a year?!

  66. Receipts for cleaning supplies should be reviewed for all assisted living facilities across the country. The findings will show not too much is being used. Also, information as to how often individual apartments are being cleaned, and how often the (bucket) water that's used to clean the floors should be provided. How cleaning staff is timed should also be provided.

  67. Surely this basic greed can’t be surprising? We are all about gouging and being gouged. Morality is for other people, you know, the stupid people so beloved by our criminal in chief.

  68. Went thru this when my mother had to move from independent to "extended care." Got an assessment that put her in the highest price category. Claimed she needed help with everything, when actually she only needed help with bathing and using the toilet. And the staffing was abysmally low, especially on weekends. One day I went to visit and heard her yelling for help but she wasn't in her room. I found her in another resident's room, parked in a wheelchair. She'd been left there for over an hour, was cold, needed a blanket, and no aide anywhere to be found in the small, 14-bed unit. Don't be fooled by the hotel-like lobbies. These facilities are not honest and are just out to bilk you; you have to watch out for your family member every single day. This particular facility was Brightview.

  69. @Wasting Time If your mom was parked in a wheelchair and unable to wheel herself or get up and walk, I would say she needs help with much more than just bathing and using the toilet. It still doesn't justify ALFs taking patients that really are not appropriate for them. Check out the Frontline episode on Assisted Living.

  70. @m She could feed herself, dress herself (except for her socks), brush her teeth, etc. According to them, she couldn't do any of those things. She not only could do them but she was proud that she could still do them. At this stage, she wasn't in the ALF. She went right from the independent to the skilled nursing care unit, bypassing the ALF.

  71. I have an assisted living success story - with a twist. My chain smoking, alcoholic Mom had a series of falls at the same time she was diagnosed with an early stage of an incurable cancer. During the second rehab we discovered she had stopped taking her thyroid medicine. She was angry and difficult to be around and I lived 3 hours away. With the help of moms sibling we got her into assisted living. She weighed 80pounds on admission and we brought palliative in to help. It was a chain AL. 15 months later she is a normal weight somewhat cheerful person. A Non-smoker by choice (non drinker cause those are the rules). The only thing that has worsened is her dementia (which was in the early stages before the falls).palliative said she is doing so well they don’t need to be on her service. At the recommendation of numerous physicians we chose not to treat the cancer (too many side effects) but it will eventually kill her and she is, ironically, in better physical shape. Her medications aid her quality of life but they are also possibly keeping her from a natural death from pneumonia or a heart attack. I like that I got back a cheerful Mom, that there is quality to her life, but hate that she might experience a cancer death after the dementia has worsened. It’s the catch 22 of modern life.

  72. The question is why should these assisted living facilities be "for profit"? America seems to accept that everything is for profit - child care, elder care, schools, health care the list goes on. If you have any service, where the recipient is not in a position to assess the service being provided, be it because they do not have the cognitive ability (children and frail elderly), be it because they cannot shop around when they are ill and prices not posted upfront in clinics and hospitals (patients), be it because the local school is all that is available, in such situations to allow profit making entities to take over is unfair and retrogressive. Buying clothes, eating in restaurants, buying fancy foods in specialty stores, taking fancy vacations can all be done by entities that can charge whatever the market will bear. But elder care, child care, assisted living, schools, health care, should never be given to for-profit entities. The only way these entities will make profit is by cutting back on necessities and the recipients will be in no position to complain.

  73. What about how government bureaucracies work, gives you any hope that their care will be better than private care? I imagine they would be even more severely understaffed as the government slowly squeezed them financially. But now, there would be no choice.

  74. @William Feldman Who said government? Who said bureaucracies? You.

  75. @Meenal Mamdani Hear! Hear! you hit the nail on the head. The only alternative that I can think of is government taking responsibility.

  76. My father passed about a year ago. For his last 6 months he was in and out of hospitals and nursing homes. What that experience has taught me is that health care is this generation's version of a factory. The people in a hospital are no longer people that are a "Product" and are treated as such. Hospitals and especially nursing homes are understaffed both in numbers of people and the quality of those people. Procedures take priority over patient care in many hospitals and nursing homes. If you want good care for your loved one, you have to be there and double check almost everything done. As an example, my father was allergic to certain common medicines. When he was admitted particularly through the emergency room we would tell them of the allergy. When he was sent upstairs to a room I would ask to see the chart and on two occasions at different hospitals, that allergic reaction was not noted. In nursing homes you have to check your loved one for bed sores, look at the chart, check for signs that what is on the chart has actually been done. You have to get to know the head nurse at the nurses station (goodies dropped off help) and demonstrate that while you will try to be nice, you will be involved and will check their work. Unless you are wealthy and can afford home health care, your loved one with be in an institution at some point. You must be involved if you want good care for them.

  77. @Bruce1253 So true, so sad. How do we change. Are we making money for profit or making money to be able to care for the health of our community and family?

  78. @Jerry Bruns Part of the issue is transparency & accountability. This is the only area in my life where I buy something without knowing the cost. We have the most expensive healthcare in the world and get 6th or 7th level results, and people say "Oh Well.*

  79. @Bruce1253 My father was in a nursing/rehab home temporarily following surgery. They had given him Vit K prior to surgery to counteract his cumidiun, but had never taken him off it. He was showing signs of potassium OD, but I couldn't get a doctor to look at him. One told me on phone, "so take him to an Emergency Dept." I did, had him transferred by ambulance at 2 am. His level was so high I was told it would very shortly be fatal. Also the rehab place complained that he wouldn't participate well in PT, I saw he was being given sedatives right before. Read the chart!

  80. My mom lived in a nursing home for the last 6 years of her life. I would receive calls from the nursing home that I had to do something about my mom's behaviour. When I would check out what the issue was I was astounded at the lack of intelligence that went into staffing decisions. I supported my mom not accept baths so long as the staff insisted on having a man in the the same bathing room at the same time - which was not the time that she preferred. The staff could not offer a reasonable explanation for why it was okay to have my mom forced to take a bath with a man in the room. It was a shortage of time and staff to accommodate scheduling that would have encouraged more contentment and less fuss by residents. Families need to be directly involved in encouraging better staffing, support staff who are overwhelmed, and hold accountable the companies that put profits over decency for their residents.

  81. To the greedmongers who advocate that increased staffing increases costs: NO! Cut the profits going to the company management who believe that it's OK to lie to seniors and theor families then financially rape them.

  82. @Barb : it is an insanely, obscenely profitable FOR PROFIT business. Don't feel sorry for these greed heads. They are milking seniors dry nationally -- bribing politicians! -- and getting away with murder (sometimes, literally).

  83. I have a great deal of experience with Assisted Living (AL) facilities both personally and professionally. Two family members lived in one at different times and we had excellent experiences both times. My professional experience helped me understand that they were private housing options and that most people's frustrations with them were due to unrealistic expectations. Complaints to State offices led to MA mandating that a disclosure form - clearly written - be reviewed with residents and family prior to contract signing. Every statement in the form has to be discussed and then initialed. The form clearly states what support will be provided and what happens if a resident needs more assistance then is provided for by the monthly fee. Too many families were using AL for individuals who needed significant care that the families were not able or willing to pay for on-top of the monthly fee. Both of my family members who lived in an AL facility ended needing more assistance and fortunately they had the resources to bring in private aides. It was very expensive and therefore out of reach for most. The problem is that AL has been an option that family's elect to avoid the emotions attached to placing a loved one in a nursing home. Please note that this is not to suggest that there aren't Assisted Livings that are poorly managed or that do not provide promised care. But this article painted a very broad picture that in my experience is not accurate.

  84. @Lisa : it's nice to be rich. So your family could afford BOTH the outrageous monthly charge for Assisted Livng -- AND the $25 or more an hour costs of a private aide? If you have to pay for an aide….what's the AL facility for at all? why not just keep your relative in their own home with rotating shifts of aides? It would be very costly but avoid many of the abuses and neglect of large facilities! But most people can't afford the cost of $3500 a week, or $14,000 a month, or almost $170,000 a year! that a full time coverage of home health aides would mean (on top of all other ordinary costs like rent, utilities, food, etc.). Every person who applies to live in an AL facility is evaluated; therefore, if the patient NEEDS skilled nursing or dementia care, but the AL facility accepts them anyways….whose fault is that? You are blaming the family, who probably don't know the difference?

  85. @Concerned Citizen You should write a book about your experiences in ALFs.

  86. Those of us who are older need to think this through and make some plans of our own. Each of us needs to decide the point at which we need to take action to end our lives. It doesn't need to be dramatic (eg. shooting ourselves), it can be as simple as refusing food and water for several days. And if you have grown children you need to assert your right to make this decision. And keep in mind that dementia can progress faster than you may think and deprive you of your ability to decide for yourself. You need to think about when you need to act sooner rather than later. And, no, this isn't grim or "giving up", it's acting like a responsible adult.

  87. @BA My father did, after 4 years in a decent nursing home, but suffering from dementia, stop eating. This was a stated intention. He knew what he was doing and asked for my support . " Do not let them make me eat." He was very brave. It took considerably longer than several days however. I have recently gone on a botanical tour of my own garden. You'd be amazed at how many things you pass by all of the time are quite poisonous when ingested. I think that this sort of thing is good to know. Because I do not want that existence and am sorry he was subjected to it. I have told my children.

  88. @BA I absolutely agree. We need to decide about when. And Especially, we must specify no treatments of medical problems that arise after we reach that point.

  89. @BA : well….good luck. And you'd better do it BEFORE going into Assisted Living, because once there -- there's no escape or going back. You won't have a garden from which to pluck poisonous plants! you won't have a gun! you won't be allowed near pills that would kill you. And if it not easy refusing food as you state. It's awful. I've seen what happens to people who are denied water for a week -- it's pure unadulterated torture. Even your eyeballs dry out. It is not a peaceful death. Even worse; if you develop dementia or a stroke, you won't have the ability or agency to do ANY of the things you state.

  90. I am a nursing instructor and take students to nursing home facilities for their clinical rotations. Unfortunately, care in most facilities is sub par. Staff is overworked and underpaid. Often there might be 1 RN for the whole facility. The care, when it is done, is provided by CNA's who try to do their best. Many of these residents would be better served to stay in their homes and have staff provide care there. The only ones making money in this field are the owners whose bottom line is always profit. If you need to have a loved one in one of these facilities look for a not for profit and visit often and at different times to assess the care. Our senior citizens deserve better than this.

  91. @Sandra C : RN? are you kidding? Every Assisted LIving facility I've been in (at least 20, if not 30) -- not nursing homes, but AL -- has only a part-time LPN at best. My aunt's facility had ONE LPN for the whole place, which was 5 cottage-like buildings on one campus. The poor LPN had to run from place to place! each building got about 2 hours a day out of her time, barely enough to pass out medications! Mistakes were made all the time. I routinely had to report things like pills found spilled all over the carpeting -- wrong pills given -- or pills needed that were skipped! The nursing MANAGER was an RN, but did not work direct with patients nor have regular hours -- they were more of an administrator. Many residents WOULD be better off in their own homes -- but believe it or not, as costly as it is -- Assisted LIving is much cheaper than a round-the-clock home health aide. At $25 an hour (to an agency), a home health aide would run $180,000 a year.

  92. Paula, if you are interested in doing an article about families who have had positive experiences with Assisted Living facilities please don't hesitate to contact me. (Please note: I do no own nor have any financial interests in any AL.)

  93. I worked for several decades as a state inspector of assisted living and personal care homes. One interaction I had always comes to mind: During a routine visit, I met with the administrator of a large facility (one of the chains mentioned in the article), who was clearly stressed. In our review and conversation, I learned that the issue was straightforward: Pennsylvania required one hour of direct care per resident per day. His facility records showed that they were providing 1.06 hours of care per person per day. The bean counters at "corporate" were riding this poor fellow to get the number down closer to 1.00. As someone who dealt with this industry for decades, take my advice. Go with a locally owned and operated facility, preferably part of a faith-based organization. Avoid the chains like the plague.

  94. @Terry Boots Wonderful advice. I so agree with you.

  95. @Jerry Bruns of course, the local ones are liable to be purchased by a chain.....happened to us.

  96. @Terry Boots : in principal, I agree with you. But the chains are huge. Some own over a thousand facilities! and employ tens of thousands of workers. And they buy up nursing homes and Assisted LIving facilities. I choose one for my elderly relative in 2013 -- nothing in the literature, signs, the tour said this was anything but a "one off" Assisted Living center. It had a unique name. Only AFTER my relative was settled, did I find it had been bought out by the largest chain of nursing homes and AL facilities in the US. After about 2 years, they changed the name to reflect this. It's not as easy as you think getting into a faith based facility -- if you are NOT of that faith. And you might not be comfortable (say) as the only Jew in a Catholic facility with mass every Sunday! and a Christmas tree! Some faith based facilities are extremely expensive and can be 35-50% more than a non-denominational facility. Most people can't just "pick and choose". Most entry into Assisted Living comes after a couple of miserable stays in hospitals and rehab facilities until the patient can't go home again. Then they have to find a facility with a few weeks or even days notice -- meaning…you go where they have a room open. This is NOT as easy as it sounds! many facilities have waiting lists that last for months or even YEARS.

  97. Planning is key.11 years ego,at 72 we sold our large home and moved in to an active adult community.Granted, it's not the perfect solution but the apartment is ideally suited for aging in place.With family nearby,we will get the help we need and stay in our home as long as possible.For those considering a non profit,I strongly recommend looking at IRS form 990 and pay particular attention at executive compensation.

  98. @Marcus : an "active adult community" or senior 55+ apartment complex IS NOT ASSISTED LIVING (nor is it a nursing home or dementia unit). It requires that the resident be in their right mind, and ambulatory, and able to do most of the "chores of daily living" like bathing & eating & dressing. So long as your health holds out....what you have sounds wonderful. It is also much, much cheaper -- roughly 1/3rd of the cheapest Assisted Living facility.

  99. Living in a senior friendly townhouse or apartment independently among others is a nice place. And if one needs assistance, someone can come regularly at a cost much less than Assisted Living Facility. Neighbors and family members need to stay in close contact.

  100. Those "veteran researchers" sound like defense lawyers for the deceptive nursing homes. The lawsuits have found a way to shed light on the deception, although it would help if the report tells us where the millions of settlement would go and ask a couple of researchers with knowledge about the economics of nursing centers: ceo pay vs. staff pay, for instance.

  101. @JY Keep in mind that these cases involve assisted living facilities, not nursing homes. In the Emeritus settlement of $13 million, after litigation expenses and attorneys' fees, $8.5 million was earmarked for cash payments to the members of the class or their heirs. In the Atria settlement of $6.4 million, it was about $4 million. The checks were small because the number of current and former assisted living residents in each class was so large. The Atria class, for instance, comprised nearly 14,000 people. In the Sunrise case and two others that are pending, we don't know whether there will be a settlement, or even if judges will certify the classes and allow the cases to go forward

  102. My step mom is at Edgehill in Stamford, Connecticut, owned by Benchmark. The place looks great, but the rehab and some other interactions can be horrific. For example, I witnessed at terrible experience a few days ago where a resident requested help but finally when a woman came, she was rude--ok, people have bad days--but she refused his request for a wheelchair, which he clearly needed. Instead, she dragged him backwards on his walker when he could not even lift his feet. This for $5,500 per month? Also, the rehab facility, while renovated, is poor.

  103. @Steven W. Giovinco : in my experience, this goes on all the time. I've seen devastating examples of neglect and abuse, and yes, in facilities where the costs would easily pay for a luxury Caribbean cruise -- every single day of the month! -- but instead, residents get shabby treatment, gloppy steam table food, lack of activities and socialization, infantilization by staffers and worse. Many facilities are dirty. Worse: in my state (Ohio)...I have eye witness examples of corruption between state agencies that are supposed to oversee nursing and assisted living facilities, but instead are in cahoots with them! so the facilities are "tipped off" to when inspections occur, so they can clean up (briefly) and get "5 star ratings" which are apparently handed out like candy to grossly inadequate facilities.

  104. Dear god, I hope they go after BROOKDALE LIVING, which is the largest nursing home/assisted living provider in the country, with over 1000 facilities -- totally correct, guilty of everything stated here and much worse! I will be contacting this law firm, as I have eye witness accounts of abuse and neglect at Brookdale facilities.

  105. I am sorry to read all the negative comments and feel very sorry for people whose family members are in places that are less than satisfactory. However it is not the case for everyone. My mom is in a very nice place, is well cared for, and I have no complaints.

  106. @Daphne philipson I'm glad. My brother was in a very well run and staffed facility on East Coast, I spent more than a week with him and couldn't see any faults. Except perhaps that the staff put in country music when with him overnight, when I got it in the morning I would change it to a rock channel--relief was visible!

  107. In the early 2000s my mother in law was in a nearby AL facility, to the tune of almost $6000 a month at that time. This got her a low-level “ apartment” with commercial carpet, unfinished cabinets and bare-bones bathroom with a twin bed, but had an opulent lobby and “activity rooms”. If she needed medications, that was extra, and involved constant oversight, as there were frequent errors with ordering. Bathing every day was not accommodated unless she paid extra. Assistance of any kind was extra. My husband washed her clothes and brought fresh clothes in daily because they did not bother to see if she had clean clothes on (she would put on her previously worn dirty clothes otherwise.). Although the aides were kind, there were only one or two on the floor at a time, to assist dozens of residents, and unfortunately were hard for her to understand with her impaired hearing, as they had thick accents. Good luck trying to find the nurse on duty for the whole facility. We filled in the gaps for what she needed as much as we could, while still working full time. Was the cost justified? No, not even close.

  108. @Nancy : I can affirm all of that 100% even though I live 2500 miles away in Ohio!!! Exactly the same, though the costs here are (logically) slightly less. My family members in AL have gotten a small room, like a studio apartment. It had very cheap commercial carpet which was not changed out with new tenants despite stains and "accidents". She had to bring HER OWN furniture. There was a tiny kitchenette, but designed to be almost impossible for a senior to use -- a dorm fridge ON THE FLOOR (!) that was impossible to bend over to use and a microwave mounted on the wall, far too high to reach without a stepladder! We paid several hundred a month so my relative could have two showers (with shampoos) every week, but observing her it was very clear this happened randomly if at all and was often missed. My relative was also left in dirty clothing! (though this facility did provide decent laundry service). In a building with 24 residents on two floors, there were two (20) aides at any given time -- to assist all those residents, most over 87 and in wheelchairs or walkers! -- give showers to all twice a week! -- help with dressing -- oh and serve all meals, including setting tables and bussing afterwards. They were paid $9 an hour, while the residents were billed $4200 a month….

  109. My aunt lived in a Sunrise facility in NYS for 7 years. They nickled and dimed her for everything and never fixed anything that didn't work inside the room. When we questioned if there was enough staff to care for the 50 people who lived there, we were told that NYS only required 2 staff to be in the building at any one time, because it was assisted living, not a nursing home. But of the 50 people living there, 45 were 1 step out of a nursing home and required assistance dressing and bathing. We thought it would be a good place for her, because it was a new building and near relatives. She hated it.

  110. My parents moved into a senior living/assisted living facility about 15 years ago. This year, my father was moved into assisted living after suffering from dementia for years. My mother could no longer care for him in their apartment.....the over $6000 a month they paid did not include additional nursing aid for my father. This facility is huge and very upscale. The facilities are like a country club.....except for assisted living. When I visit my father there, it’s depressing. He is in small a basic shared room, with uncomfortable furniture. He is “assisted” largely by nurses aids....I’ve never seen the nurse. When I have shown up to visit, I’ve found him in bed in the middle of the day, undressed and unshaven. Several cups of water are around the room..usually still full. No one checks to make sure he is getting fluids. What’s the worst is that my father is well aware of what’s happening, pleads “get me out of here” and cries when I leave. It’s horrible. The rest of my family, while acknowledging lapses in care, say this is the best place for him. My mother is always telling me how this place has a “five star” rating. I feel my parents are being duped, I’m fairly certain my father knows it, and has decided to die. I’m disgusted by the huge fees charged and the (clearly) enormous profits this facility is making. It’s nothing but a big business.

  111. My mother was in assisted living for 6 years. The cost on Long Island is over $7000 a month, and goes up to $9000 for Alzheimer’s care. The facilities are frequently understaffed, the menu of food choices pitched to you nonexistent, and the caretakers were not properly trained, nor emotionally or mentally up for the task. Local physicians stop by weekly, and often refer the patients to incompetent specialists, that over medicate to make the residents more pliant. In my mother’s case, an older Psychiatrist, who had no prior experience with her, put her on a psychotropic medication that resulted in a hospital admission, a sharp mental and physical decline, and admission to a nursing home for her remaining days. This happened despite the fact that it was notated on her computer record to inform the family of any medication changes or additions. IF anyone is considering assisted living for a family member, speak with families who have experience with them. The “sales people” will paint a different picture to lure you in. The reality is another story. And it’s usually not a happy one.

  112. We have a family member at an ALF in San Francisco with about 50 or so residents. When one of the resident's daughters complained that there was only one staff member on duty on the overnight shift, she got a swift and prickly response from the facility head, who cited California's Title 22 policy saying that for 16-100 residents, there needs to be only one staff member on duty. Clearly it doesn't matter what the needs are of the residents --some of them are not ambulatory, some have medical needs requiring care around the clock. Nevermind that the whole place is toast if there is an emergency. The facility can coast thanks to nebulously worded Title 22. The staff at this facility don't make much money and San Francisco (need I say it) is exorbitantly expensive. So the staff work multiple jobs. They are tired. They can be unkind. But who's responsible? Sometimes they are asked to work double shifts and tasked to do more because one of their co-workers is out. The only person who has "regular" work hours seems to be the facility head who is probably making a lot of money. In the meantime, the facility is old and falling apart, and the staff do not even have their own coffee machine. But the management and the board look the other way and dump money into their marketing efforts. As long as the legislation is loose, it will be hard to foster change. Hopefully families and advocates persist in their fight to protect the elderly as it seems it is all we can do.

  113. If the conditions are as such, why do you condone your loved one living there ?

  114. I fear this will be taken the wrong way but here goes. A great many staffers in these large buildings are immigrants. As such, there are two hindrances. One- they’ve come from a perspective of poverty and sometimes filth so their take on the conditions and logistics is not harsh in comparison. Two- they are afraid to make waves about what is right and wrong to management in terms of adequate coverage, supplies, protocols and rules. They are hard working and kind. However they are not accustomed or willing to take a risk of criticism and revolt to force changes for their elderly charges.

  115. Just Call Saul.