ProPublica: Life and Death in Assisted Living

  1. ProPublica: Life and Death in Assisted Living

    Last updated: Monday, July 29, 2013, 9:51 AM

    ...During a tour, a salesperson gave Myron and his two sons, Eric and Mark, a brochure. "Just because she's confused at times," the brochure reassured them, "doesn't mean she has to lose her independence."

    Here are a few things the brochure didn't mention: Just months earlier, Emeritus supervisors had audited the operations of the memory care unit where Joan would be living. It had been found wanting in almost every important regard. In truth, those "specially trained" staffers hadn't actually been trained to care for people with Alzheimer's and other forms of dementia, a violation of California law. The facility relied on a single nurse to track the health of its scores of residents, and the few licensed medical professionals who worked there tended not to last long. During the three years prior to Joan's arrival, Emerald Hills had cycled through three nurses and was now employing its fourth. At least one of those nurses was alarmed by what she saw, telling top Emeritus executives-in writing-that Emerald Hills suffered from "a huge shortage of staff" and was mired in "total dysfunction."

    During some stretches, the facility went months without a full-time nurse on the payroll. The paucity of workers led to neglect, according to a nurse who oversaw the facility before resigning in disgust. Calls for help went unanswered. Residents suffering from incontinence were left soaking in their own urine. One woman, addled by dementia, was allowed to urinate in the same spot in the hallway of the memory care wing over and over and over. The brochure also made no mention of the company's problems at its other facilities. State inspectors for years had cited Emeritus facilities across California, faulting them for failing to employ enough staff members or adequately train them, as well as for other basic shortcomings...


    Last edit by NRSKarenRN on Jul 30, '13
  2. Visit NRSKarenRN profile page

    About NRSKarenRN, BSN, RN Moderator

    Joined: Oct '00; Posts: 27,409; Likes: 13,622
    PI Compliance Specialist, prior Central Intake Mgr Home Care Agency; from PA , US
    Specialty: 35+ year(s) of experience in Home Care, VentsTelemetry, Home infusion


  3. by   GerberaDaisy
    I'd really like to read the next part, but I have a feeling how its going to go, and it's probably not going to go well...
  4. by   DoGoodThenGo
    Check your local PBS stations as Frontline is running a series based upon the ProPublica story.

    Long story short this isn't something many of us didn't already know but there is more out there, much, much more.

    Assisted living has become another "profit center" for persons to make money off the elderly and or their families. With nursing home beds declining as more older Americans turn to aging in place, this new market has grown to take advantage of a "niche" market. The best places do what they say and well, then there are others that are total nightmares and rival or equal the worst of nursing home abuses.

    Much of the problems stem from the often loose regulation in states of assisted living facilities. It is a growth industry with money to spread around (to grease the proper wheels), which seems in many instances to beat back proposals to tighten up laws and or oversight.
  5. by   anothergrumpyoldRN
    So so sad...and people pay big money for some of these places.
    For profit exercises in the care of our elderly and infirm.
  6. by   StNeotser
    Thanks, I will watch that when I have time. I have noticed through visiting AL facilities that many of the patients they have seem to need LTC but they are in AL.
  7. by   dirtyhippiegirl
    Is it bad that I'm more interested in what the original ALF apparently did right? (They re-taught her how to eat with silverware!) But that gets totally glossed over.
  8. by   SummerGarden
    Quote from StNeotser
    I have noticed through visiting AL facilities that many of the patients they have seem to need LTC but they are in AL.
    True!!! Part of the problem is that families and the patients are misinformed by ALFs (I suppose by the sales-side of the house) and will prefer Assisted Living Facilities (ALFs) even if it is obvious to any health care provider that the person will not do well in an assisted living environment. Assisted Living Facilities is a living environment for people who would normally be "OK" living at home, but are in need of some basic assistance (meal prep, medication admin reminders, ADLs, etc). Not people who are confused at baseline and who walk and fall every few steps.

    The resident and his/her family find out that the resident needs to live in a higher level of care after they paid a lot of money to the ALFs and had multiple ED visits for a variety of reasons that all relate to the fact that the resident cannot take care of themselves and are not taken care of properly at the ALF level. In fact, this is also after a Nurse Case Manager and/or Social Worker intervenes at the hospital. Ironically, that is also the first time the family is told by the ALF that the resident is not appropriate for an ALF and are better off somewhere else. At least, this has been my experience.
  9. by   StNeotser
    Thanks for your input. When I worked on a medicare rehab floor some years ago I remember that Assisted Livings would reject some of our possible discharges due to high ADL needs or too complex a level of medical care being required. Now that I am working hospice I seem to be visiting people who are incontinent of bowel and bladder as well as falling all the time. I did think that when they moved to the AL that perhaps they were at a higher level of functioning, but then I find out from the families that they were not.

    Of course this is just my humble opinion.
  10. by   DoGoodThenGo
  11. by   anothergrumpyoldRN
    Here in the interior of Alaska we have one SNF/LTC.
    All other facilities for the elderly are ALF.
    They are very loosely regulated.
    The care is NOT even close to being the same.
  12. by   VivaLasViejas
    Here's a perspective of ALFs from a nurse who's been there several times:

    As the only licensed nurse in a building of 80+ residents, I held a position of great responsibility but very little authority, even though I was the DON and staff trainer. I had no say-so in the discharge of residents who were no longer appropriate for ALF due to cognitive deficits, falls, exit-seeking behaviors etc. because "the family is paying $4,000 bucks a month and doesn't want their Mom in memory care" or "he could fall just as easily in a nursing home as here".

    People with psychiatric issues were mixed in with residents with dementia, and then the powers that be had the nerve to be surprised when fights broke out. There were only four resident assistants and two med aides for the entire facility---on day AND evening shifts, and only two at night. On any given day, about 85% of our population needed medication, toileting, and other ADL assistance, 50% needed escorting to meals or meal reminders, and about 25% needed a higher level of care due to falls, need for 2-3 person transfers, or behaviors associated with dementia. One particularly memorable resident had a history of Alzheimer's, bipolar 1 disorder with psychotic features, adjustment disorder, and ADD; she was finally moved out only after she'd beaten the hell out of several staff members, destroyed the carpet in her room with daily incontinence episodes, and tried to get herself run over in the street.

    And I, as the Registered Nurse, had the privilege of co-signing Corporate's B.S. in keeping my mouth shut about the need to move residents at risk for wandering or those with severe memory loss to a higher level of care. Well, I didn't stay quiet, but nobody listened to me when I did advocate for move-out, and in the meantime I had a minimum of 15 incident reports to comb through every week, staff who didn't know how to manage behaviors, and NO other nurse to consult with when I ran into a wall trying to figure out what might be going on with one resident, while still dealing with four score others.

    Looking back, it's a wonder that I didn't have my nervous breakdown a year or more before I did. I felt 100% responsible for these souls entrusted to my care, but the little I could do to improve their situation was a spit in the ocean.

    What's sad is, this was actually a GOOD facility. I've seen a couple of bad ones, and I wouldn't put my worst enemy's dog in there, let alone anyone I care about. The purpose of assisted living is SUPPOSED to be as a sort of halfway house for elders who are no longer safe to live at home, but who don't need 24/7 nursing care and can perform most of their own ADLs. Fifteen years ago, ALFs didn't even consider sliding-scale diabetics, two-person transfers, assisted feeders or anyone with a catheter; now they take all that and much more. Yet the staffing hasn't increased, and often, one nurse must oversee several of the company's buildings and delegate most nursing care to unlicensed assistants who haven't even taken CNA courses.

    Scary, huh?
  13. by   BrandonLPN
    As long as assisted living remains relatively unregulated, they will continue to admit residents who are completly inappropiate for their accuity level.

    I think assisted living has a place in the spectrum of health care, but right now it's admission policies consist largely of poaching skilled nursing-level patients, which benefits no one. (except their profit, of course).

    Assisted living should be an option for relatively independent and stable elderly who just need, well, assitance. But I see some of the children of residents at my faclity (a SNF) looking into tranfering mom or dad to an assisted living facility because it's "nicer". Said residents are total care, require mechanical lifts for transfer, and take literally dozens of medications including insulin, narcotics and nebulizer treatments. I'm sorry, but a minimum wage HHA popping in a couple times a day and a "med tech" to give all those meds is just not going to cut it.

    I grow weary of LTC being the "bogey man" of healthcare. It's not some horrible institution where we "warehouse" residents so they can wait to die. It's this preception that drives people to assisted living.

    But the lack of oversight and regulation for AL ensures they will continue to take any resident they want, without providing the proper nursing staff such residents need.

    I suspect the AL industry will fight tooth and nail any attempt to regulate it's practice. Because if they were regulated they would be forced to provide skilled nursing services for their skilled-level residents. And then, what would there be to differentriate themselves from traditional nursing homes?
  14. by   ChrisNZ
    Sounds much like some of the facilities I have worked at.

    I think my worst moment was:

    Walking into the unit I sight one of the residents on the ground crying for help. The [doesn't] "Care[r]" walked past and acknowledged her. Left the unit and went home 15 minutes early. As I approached the resident she was incontinent of urine and faeces.

    If children were treated like this there would be international outrage. Why such a different train of thought for our vulnerable elderly?