The U.S. Senate Committee on Aging is gathering information to assess conditions and costs at assisted living centers. (Photo by Getty Images)
WASHINGTON — Bipartisan U.S. senators are sounding the alarm on cost, workforce shortages and dangerous incidents at assisted living facilities across the country as the needs of aging Americans are forecast to sharply increase.
Sen. Bob Casey, chair of the Senate Committee on Aging, led a hearing Thursday to highlight the panel’s fact finding mission. Unlike nursing homes, assisted living care is largely unregulated at the federal level.
“It is long past time for Congress to re-examine this model and ensure that it’s meeting our nation’s needs,” the Pennsylvania Democrat said in his opening remarks.
Citing a recent survey that found 80% of adults would not be able to afford four years in an assisted living facility, Casey appealed directly to the public to share their experiences.
“I want to hear from you about the true cost of assisted living,” Casey said, holding a sign that urged people to submit stories to aging.senate.gov/assistedlivingbills.
“I think it’s very important that we hear from people — hear from people about their own experience as family members, as people who are paying the bill and also expecting the promises that are made when someone becomes a resident of an assisted living facility,” Casey said.
“It is only by hearing those stories, only by hearing about those experiences, can we bring the needed change that I know we all agree has to come.”
Residents and family members recall poor care
Among those who testified was a Virginia woman who said she witnessed alarming situations due to short staffing and poor training in a facility where her husband lived with Lewy Body Dementia.
Patty Vessenmeyer, of Gainesville, Virginia, described an “extremely loud” central group room at the facility and finding a resident “bloody and staggering down a hallway” after she tripped on a raised area of the floor covered by a rug.
“A company knowledgeable about dementia care would not design a facility this way,” she said.
She also told lawmakers about having to break up a physical altercation when one resident was beating another with his cane, and of finding her husband had soiled himself when staff was not around to help him reach the bathroom.
Without identifying the Warrenton, Virginia, facility, Vessenmeyer told the committee’s ranking member, Sen. Mike Braun, that the base cost for her husband’s room was $7,900 a month, but that her monthly bill eventually totaled $13,000.
“That sounds unaffordable,” Braun, an Indiana Republican, said.
“If he hadn’t passed away rather quickly … it would have used up all of my nest egg,” Vessenmeyer said.
“That’s the kind of stuff I’ve been appalled by,” Braun responded.
Jennifer Craft Morgan, director of the Gerontology Institute at the University of Georgia, told the panel that assisted living costs across the nation average $4,500 a month, making it “inaccessible to most Americans.”
In addition to breaking down cost barriers, Morgan recommended the industry consistently educate and train workers, reward companies that deliver high-quality care, and standardize monitoring and resources to increase state-based oversight and transparency.
Cost and care vary by state
But care is not as costly in all states, and operators can choose to go beyond state requirements, Julie Simpkins, co-president of Gardant Management Solutions, told the lawmakers.
The Illinois-based company is the fifth largest assisted living care provider in the U.S. Gardant operates services aimed at low-income seniors in Indiana, Illinois, Maryland, Ohio and West Virginia.
Simpkins told Braun that in states like Illinois and Indiana, low-income families see limited out-of-pocket expenses because of the states’ arrangements with federal Medicaid waiver programs.
When asked if that situation stretches across the country for low- and middle-income families, Simpkins told Braun: “Nationally, there needs to be programs in each state to provide access to affordable assisted living. They’re not all there yet.”
Simpkins also testified that Gardant’s facilities exceed state requirements “when we believe it is in the best interest of our residents.”
Those instances include immediately reporting to the state when residents wander out of the facilities, a situation the industry calls “elopement.”
“Even something as technical as a resident walking out the door and instantly returning with a staff member — we know they didn’t leave our community and our staff immediately addressed the situation, but we still report it,” Simpkins said.
Another example, Simpkins said, is that every employee at Gardant’s memory care facilities trains beyond the required levels to become certified dementia practitioners.
Debate over national standards
Still, “it’s important to note that every state, every community, and every resident is different,” Simpkins said in her testimony.
“Efforts to standardize all assisted living communities would be both unworkable and irresponsible for resident care,” she said.
Richard Mollot, executive director of the Long Term Care Community Coalition in New York City, disagreed.
As needs of aging adults have evolved since assisted living dawned in the 1980s, Mollot advocates for national standards and a national database of assisted living caregivers and companies.
“The absence of any federal quality or safety standards, coupled with a virtual absence of reliable public information on the quality, safety and cost of assisted living, have made assisted living a sector ripe for investment by sophisticated private enterprises who can shuffle around resources and take profits with little regard to the promises made to seniors and their family,” Mollot said in his opening statement.
Later, during questioning, Mollot told Casey: “Essentially, there’s no independent validated information on assisted living for the consumers, for policymakers, or for the general public. So families, as you noted, have to rely on facilities and facility marketing materials.”
Casey responded to Mollot, saying he thinks it’s “pretty fundamental that people should have the opportunity to place reliance upon a source that is objective and, to use your word, independent.”
Braun also criticized Simpkins’ argument against standardization, particularly when it comes to transparency.
“I don’t know how you could say that wouldn’t be good,” he said to Simpkins.
“I’ve been the most vocal senator that our health care system is broken,” Braun later continued. “We do not have transparency. We do not have competition.
“It’s kind of almost like an unregulated utility and you get your bill after you had a significant health care scrape or a bad accident. You gotta hold your breath to see how much it’s gonna cost or if you can afford it,” he said.
The hearing did not focus on pushing a particular piece of legislation forward. Rather, the senators said they will be gathering information to assess the industry.
Casey touted the letters he penned in mid-January to the three largest corporate assisted living care operators, including Atria Senior Living based in Louisville, Kentucky; Brookdale Senior Living in Brentwood, Tennessee; and Sunrise Senior Living in McLean, Virginia.
The Pennsylvania lawmaker also announced he was joining colleagues in requesting that the Government Accountability Office study how much federal money is spent on assisted living facilities, what those facilities are charging families and whether or not they make their charges easily known.
Democratic Sens. John Fetterman of Pennsylvania, Kirsten Gillibrand of New York, Elizabeth Warren of Massachusetts, Richard Blumenthal of Connecticut, Mark Kelly of Arizona and Raphael Warnock of Georgia co-signed the letter to GAO.
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