Too Sick for Assisted Living? Medical Care Can Be Uneven

“It really isn’t always clear from the start how much care people in these homes will receive, and there was a big difference in the first residence and the second one we had my mother in,” Conger says. “The second one had nurses on staff, it monitored medications and had all kinds of services we didn’t get in the first.”

In his editorial, Levenson strikes a related theme. “As with nursing homes, many assisted living facilities perform admirably,” he writes. “However, overall performance across the country is uneven and often problematic.”

The industry itself is cognizant of this growing discrepancy between what assisted living facilities offer and what more and more residents actually need.

“People want to age in place—they don’t want to go to nursing homes. And that desire to stay where they are is contributing to this discrepancy,” says Steve Maag, director of assisted living and continuing care at the American Association of Homes and Services for the Aging in Washington, an industry group of nonprofit care facilities. “This trend has been common knowledge for years,” he says.

As for the variability in medical services—from real continuing care to very limited health care—Maag says assisted living facilities are regulated on a state-by-state basis; while some states have strong oversight rules on medical care, others do not.

But, he stressed, the industry is trying to address the issue by adding more trained staff and adapting its services. “And we want to give consumers more information about what is actually offered at each residence,” Maag says.

“The industry now is working with state agencies and consumer groups to develop a uniform disclosure statement for consumers,” he says. The University of North Carolina, with money from a federal grant, is creating a disclosure form, which Maag says will allow consumers to compare the types of services and levels of medical care each assisted living facility offers. He says the disclosure document could be in use as early as the end of 2009.

“The key message is to do your research when you are looking at assisted living options. Don’t just take the most attractive home,” says McNabney. “Ask how the facility manages complex medical needs and how will they handle these needs as the resident grows frailer and sicker. The capabilities of the facility need to be out there on the table to help consumers make the right decision.”

Barbara Basler is a senior editor at AARP Bulletin Today.