Abuse Protections in Nursing Homes Don't Extend to Assisted Living

A spokeswoman for the assisted living industry said that the GAO's findings do not reflect the entire profession.

"The majority of caregivers are dedicated to serving residents with the highest quality of care,” Rachel Reeves at the National Center for Assisted Living said in email. She cautioned that more federal oversight is not a panacea and that state agencies are best-equipped to monitor assisted living communities.

"You also tend to see better collaboration between various stakeholders — consumers, policymakers and provider groups — at the state level where everyone is working together to develop new innovations or solutions,” Reeves wrote.

Yet a flurry of recent news investigations has revealed new problems.

• In Georgia, a 91-year-old World War II veteran in a Marietta assisted living facility died after an employee beat him, one of 90 abuse cases in a four-year period that the Atlanta Journal-Constitution pinpointed in the state.

• In Ohio, a resident with cognitive issues attacked and raped a 95-year-old woman with dementia in her own bed in a Middletown assisted living home, the (Cleveland) Plain Dealer reported. The woman died a month later.

• In Minnesota, an assisted-living resident in Bemidji molested a woman. The incident didn't result in her death, but a state probe dragged on for three years, including more than a year after she died, the (Minneapolis) StarTribune reported in a series that helped spur the toughening of state rules.

The drumbeat of revelations has prompted more calls for federal involvement.

"We definitely support more federal oversight of assisted living,” said Executive Director Kristine Sundberg of Elder Voice Family Advocates, which worked for the Minnesota reforms.

Reeves of the National Center for Assisted Living industry group is encouraging the federal government to give more guidance to states on how to define, report and investigate potential abuse and neglect.

You must be a watchdog

Some advocates for seniors worry about conditions in the homes that accept Medicaid payments under the so-called Medicaid waiver program, which allows people who might qualify for care in a nursing home or other institution to get money for long-term care in another setting. Those are the homes that sparked the GAO reports since they are paid with federal money, and some senior advocates say the quality of some of those homes is questionable.

Medicaid pays lower rates, so some places may cut corners in caring for residents, said principal investigator Chrisy Selder of San Diego-based Consumer Advocates for RCFE Reform, which helped strengthen California assisted living laws. RCFE is an abbreviation for residential care facility for the elderly.

The leader of California's assisted living trade group said all assisted living employees receive elder abuse training, and homes accepting Medicaid have added requirements.

"While we cannot speak for other states, California has strong and overlapping abuse reporting requirements and staff training mandates,” Sally Michael, president of the California Assisted Living Association, said in a statement to AARP.

In Oregon, the state's long-term care ombudsman is concerned about the differences in protections for residents of nursing homes vs. assisted living communities. Fully 95 percent of assisted living homes in his state are doing an excellent job, said the ombudsman, Fred Steele.

But nonlicensed, noncertified employees typically care for residents, he said. And he is especially concerned about homes with large numbers of residents on Medicaid that may be providing substandard care.

Steele recounted his visit to such a home after receiving a photo of its empty refrigerator. The front door was missing, every hand sanitizer dispenser was empty, and the decrepit van for transporting residents had expired license plates, he said.

"Very simply, CMS needs to be looking at this,” Steele said. “They need to be exploring and thinking about this with congressional members about what regulations are needed."

Deborah Schoch is an independent journalist who helped found the California Health Care Foundation's California Center for Health Reporting at the University of Southern California. Earlier, she worked for 18 years at the Los Angeles Times.