As assisted living facilities increase dementia care, resident safety risks rise

dumbrella-300x256They look like nursing homes, but they’re not. And for the health and safety of our elderly loved ones, we must know the difference.

These so-called assisted living facilities, operating with much less regulation and oversight than nursing homes, are raising concerns about the safety and quality of their dealings with a growing number of elderly Americans. That’s because they’re full not only of older residents but also difficult — and costly to care for — seniors with dementia.

Jordan Rau, of the independent, nonpartisan Kaiser Health News Service, deserves credit for diving deep into rising complaints and documented harms to residents of facilities “originally designed for people who were largely independent but required help bathing, eating or other daily tasks.” These places, “unlike nursing homes … generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.”

But assisted living facility operators have heeded a siren’s song of the big money that can be made as residences for seniors with dementia, a daunting cognitive decline that requires 24/7 intensive care and assistance. That’s because those with the condition, now irreversible and with little or no medical remedy, may wander, babble, and require extensive help with basic functions, including hygiene and bathroom functions. They also tend to be older in their fuller decline, acting out, becoming aggressive, and sometimes sexually demonstrative in inappropriate ways.

They become so hard to deal with at home, often in the care of spouses and loved ones who themselves are elderly, disabled, and ill, that traditional nursing homes have become a leading alternative. That also comes at a cost, as specialized nursing home care for dementia patients can be stark and expensive. it forces patients’ families into a gantlet of tough Medicare and Medicaid qualification requirements for long-term and custodial care that they may not be able to meet.

Assisted living facilities, meantime, have marketed themselves as an alternative, notably offering patients safety and greater freedom, including their being less locked down and more able to move around. Some facilities emphasized this option and claimed that it was integral and beneficial.

But Rau found that dementia patients, instead, frightened and even attacked others in assisted living. They also have hurt themselves or suffered poor care because assisted living facilities have failed to provide adequate staffing.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the havoc that can be wreaked on vulnerable seniors by nursing home abuse and neglect. It’s unacceptable that problems documented by the reams in nursing homes also can occur in assisted living facilities without regulators stepping in — and lawmakers giving them oversight power to do so, including with comparable inspections, fines and sanctions, and information sharing about their quality and safety.

The abuses in assisted living facilities can be even more galling, given their profit-seeking push, as Rau reported of the facilities’ handling of those with dementia. They typically reside in “memory care units …  wings [with] locked doors and other safeguards to prevent residents from leaving. The facilities often train staff members in techniques to manage behavior related to these diseases and provide activities to keep the residents engaged and stimulated.”

But he goes on:

These units usually are more expensive, with monthly costs averaging $6,472, compared with $4,835 for regular assisted living, according to a survey by the National Investment Center for Seniors Housing & Care, a group that analyzes elder care market trends. Senior housing investors earned nearly 15 percent annual returns over the last five years, higher than for apartment, hotel, office and retail properties, according to the center. Beth Burnham Mace, chief economist at the center, said memory care unit construction was outpacing all other types of senior housing.

With the nation graying and long-term care options costly, and too few and far between, especially for seniors with dementia, we have much work to do. Some of this will occur through research and medical science, although this is proving to be far more difficult than many experts anticipated.

It also includes dealing with a tragic, challenging, and controversial aspect of U.S. policy: immigration. Our care-giving needs, medical and otherwise, grow by the day, and we rely on hard-working, earnest, and ambitious people from around the globe to fill these needs. We must have safe and secure borders. But we cannot demonize nor turn away invaluable talents that nourish this country and sustain increasing numbers of its people in needs. Shaming and blaming strangers isn’t who we are, nor is inhospitable treatment or even cruel custody of kids. That’s worth keeping that in mind as tens of millions of Americans celebrate a religious miracle involving a family forced to wander and flee.

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