Assisted living

Aug 7, 2013

Good evening.  I’m Susan Kohler, CEO of Missoula Aging Services; the Area Agency on Aging for Missoula and Ravalli Counties. This evening I would like to share some of my perspectives about the issues raised in the recent Frontline episode on public television.  It was called “Life and Death in Assisted Living.” 

First, let me explain what an assisted living facility is.  They were created to serve as a middle point in the continuum of care for older adults who could no longer handle many of their Activities of Daily Living, but were not necessarily eligible to meet the level of care for a nursing home.  Elderly residents would live largely independent lives and receive primarily non-medical assistance for things they could no longer do on their own. 

According to the Frontline story, this has all changed.  The episode was co-produced with ProPublica and used reporters to investigate allegations of understaffed and under-qualified assisted living facilities operated by Seattle-based Emeritus Senior Living, the largest for-profit assisted living chain in the country. With facilities in nearly every state and about 40,000 residents, Emeritus makes more than $1 billion in yearly revenue.

I don’t want to get into the details of the episode tonight, but I encourage all listeners to go online to and click “Frontline” on the menu at the right. “Life and Death in Assisted Living” is well worth watching.  My reactions were anger, shock and disappointment at the reality of how some, not all, assisted living facilities are evolving as an industry—one in which many families entrust the care of a loved one.  I felt the pain of family members who naively believed they had placed their loved one in a facility where good care was given, because that’s what they were told they would receive for the money they were paying. 

After viewing this program, I encourage anyone who has a loved one in an assisted living facility, or is considering placing a loved one in assisted living, to know their rights. Do not assume proper care is being delivered at all times and absolutely know who you or a resident can turn to as an advocate, should concerns arise.

Part of the problem is that assisted living facilities are not well regulated.  For example, in Montana the regulation for staff-to-resident ratio is loosely defined as providing “adequate staff” to meet the needs of the residents.  What constitutes “adequate staff” is left to the interpretation of the administrator, who answers to a corporation whose motive is largely profit based.

On the other hand, rights of residents are clearly defined.  They are intended to be much the same as when you live in your own home or apartment.  You have the right to privacy in your room; in communications like mail, phone and visits; and while receiving personal care and medical treatment.  You may have your own belongings, pursue your own interests and participate in activities inside and outside the facility.  You also have the right to leave, and the right to stay.  You have the right to access health care providers of your choice, rehabilitation services as you need them and special diets per your request.  Lastly, you have the right to be free from abuse, neglect, discrimination, exploitation, retaliation and restraints. 

Earlier I mentioned that all residents and family members have access to an advocate who does not work for the facility.  These advocates are called  Long Term Care Ombudsmen, and they are employed by Area Agencies on Aging. Their responsibility is to ensure resident’s rights are being met.  An ombudsman can serve as a liaison between a resident and/or family member and the facility.  Their goals are to make sure concerns are resolved and the resident is receiving the care he or she needs.  Ombudsmen visit facilities regularly and a poster in each facility lets you know how to contact them.  You may also call 1-800-551-3191 to reach the Area Agency on Aging that covers that facility.

As we age and our care needs increase, it becomes essential to have someone who will help advocate for our proper care.  It starts with a family member or friend who asks questions, observes care, participates in the care team meetings and will call an ombudsman if issues are not getting resolved. I don’t want to paint a broad brush that all assisted living facilities are bad--there are many good ones out there.  I simply don’t want any of you to end up like some of the families on Frontline’s episode “Life and Death in Assisted Living.”

This is Susan Kohler, CEO of Missoula Aging Services.  As always, thanks for listening.