Would you rather live in a nursing home?  Or an assisted living facility?

    Most Americans would not hesitate to choose assisted living.  A “nursing home” sounds sterile and terrifying.  An “assisted living facility,” on the other hand, actually sounds like a relatively pleasant place in which to spend your retirement years.  Do what you want to do, and have staff people available to help you out as necessary.  As you get older, frailer, and sicker, the facility’s care will increase in intensity to match your increased needs.  You will “age in place” with confidence that the facility can provide you with what you need until the end of your days.  

    The underlying problem lies with the flexible nature of the term “assisted living facility” in most states’ laws.  (Assisted living is regulated state by state – there is essentially no federal law on assisted living.)  Commonly “assisted living facility” is defined in state law as a type of facility that provides room, board, and some sort of health-related services.  Which is true, but not specific enough.  Under such definitions, an assisted living facility may have around-the-clock nurse staffing with the capacity to handle a resident with significant health care needs.  Or it may be a glorified board and care home, with few services beyond meals and housekeeping.

    Here are some real life situations.  Some states’ regulations set virtually no standards for the training provided to direct-care workers, and in still other states the regulations set trivial standards such as ten hours of initial training.  Thus, while the regulatory looseness allows better assisted living facilities to provide high-quality training that meets residents’ particular needs, the looseness also allows less conscientious facilities to employ direct-care workers with little or no training, regardless of residents’ needs.  (Information on each state’s direct-care training requirements can be found in NSCLC’s Critical Issues in Assisted Living: Who’s In, Who’s Out, and Who’s Providing the Care, available at www.nsclc.org.)

    Here’s another real life situation.  State regulations often are vague as to what type of care needs an assisted living facility is required to accommodate.  Regulations commonly say that a resident can be evicted when a facility can no longer meet her needs, but with little specificity of a what (if anything) the facility is required to do to try to meet those needs.  (Again, details can be found in NSCLC’s Critical Issues in Assisted Living.)  Assume that a resident’s worsening dementia causes her to wander through the facility, or that another resident loses strength to the point where he needs assistance from two persons in order to get in and out of a bed or wheelchair.  The residents and their families might expect that the facility, following an “aging in place” paradigm, would provide services necessary for the residents to remain in the facility.  In many states, however, a facility would have the legal right to instead evict the residents.

    The status quo is unacceptable, in large part because assisted living has not received enough attention from consumers, legislators, and state officials.  To shed more light on these issues, the National Senior Citizens Law Center and other consumer groups have founded the Assisted Living Consumer Alliance (ALCA).  ALCA provides information to consumers and policymakers, and is developing recommendations to guide the development of assisted living law on both the state and federal levels.  The ALCA website – www.assistedlivingconsumers.org – includes explanations of each state’s assisted living law, along with articles, consumer information, and advocacy tips.

     Now is the time for consumers and their representatives to speak up, both in negotiations with individual facilities and in discussions with legislators and other policymakers.  Assisted living facilities are supposed to be focused on consumer needs, but that will only happen if consumers make their voices heard.