Seniors and their families may assume that federal safeguards against elder abuse apply equally to residents in nursing homes and assisted living facilities.
In reality, such federal protection is scant in the burgeoning world of assisted living residences. That's because the U.S. government largely leaves assisted living oversight to the states, resulting in a hodgepodge of rules coast to coast.
That continues even as assisted living residents, who largely pay for their care, grow older and medically needier. Most have cognitive disorders, resembling the residents of nursing homes in years past.
Today, nearly 29,000 assisted living homes are operating nationally, outnumbering nursing homes nearly 2 to 1.
More federal money is paying for assisted living: Medicaid pays for nearly 17 percent of assisted living residents. Even so, when it comes to elder abuse, the federal Centers for Medicare & Medicaid Services (CMS) continue to rely on states to police and prevent it.
State reporting provisions more lax
Now a government study published this year concludes that states’ rules for reporting and probing elder abuse in assisted living are typically far weaker than the parallel federal rules for nursing homes.
Signs of potential abuse
If you're visiting relatives or friends in assisted living residences, look for these warning signs of possible maltreatment or neglect.
• Fear. Intimidated by staff
• Injuries. Bruising, bedsores or broken bones
• Lack of cleanliness. Unkempt appearance and body odors, such as the smell of urine
• Mood changes. Crying, despondent or embarrassed
• Weight loss. Subpar food or a poor appetite.
If you suspect abuse, consult with facility managers and your state's long-term care ombudsman.
Sources: National Consumer Voice for Quality Long-Term Care, Justice in Aging
For instance, if a senior is abused in a nursing home, federal law requires the home to notify law enforcement in a specific time frame. No such federal rule governs abuse in assisted living homes, according to the August 2019 report from the Government Accountability Office (GAO), the federal government's lead audit agency.
Another GAO report last year found that 26 of 48 state Medicaid agencies could not cite the number of serious incidents in assisted living — including physical, emotional and sexual abuse — in part because agencies lacked systems to collect that data.
It found that three states don't monitor unexpected or unexplained deaths, five states don't monitor unauthorized use of restraints and three states don't record police or doctor referrals to adult protective services, the agencies that aid abused and neglected older adults.