Long-Term Care

Several federal agencies have jurisdiction over consumer protection and quality of care in assisted living facilities. However, states have the primary responsibility for developing standards and monitoring care. State approaches to oversight vary: some states regulate these facilities under standards developed for the board and care industry, others have developed standards and licensing requirements specifically for assisted living facilities, and some are in the process of developing them. But little is known about the effectiveness of these state approaches or about the extent of problems that assisted living residents may be experiencing. Moreover, concerns have been raised that the rapid growth in the assisted living industry may be outpacing many states' ability to monitor and regulate care. According to some experts, consumers can find themselves in a facility unable to meet their needs. To determine whether an assisted living facility is appropriate for them, prospective residents rely on information supplied by the facility, including contracts that set forth residents' rights and provider responsibilities. However, one recent study found that contracts varied in detail and, in some cases, were vague and confusing. Overall, little is known about the accuracy and adequacy of information furnished to individuals and their families who are considering assisted living. GAO believes that further research may be needed on these consumer protection and quality-of-care issues.

GAO noted that: (1) a number of federal agencies have some jurisdiction over consumer protection and quality of care in ALFs; (2) however, states have the primary responsibility for developing standards and monitoring care provided in ALFs; (3) a recent compilation of state assisted living activities shows that state approaches to oversight vary; (4) some states regulate these facilities under standards previously developed for the board and care industry, some have developed standards and licensing requirements specifically for ALFs, and others are in the process of developing them; (5) but little is known about the effectiveness of the various state approaches to regulation and oversight or about the extent of problems assisted living residents may be experiencing; (6) moreover, some stakeholders are concerned that the rapid rate of assisted living market development may be outpacing many states' ability to monitor and regulate care furnished by providers; (7) not only do state approaches to regulation of ALFs vary, the level and intensity of services provided in ALFs may also vary; (8) according to some experts, consumers can find themselves in a facility unable to meet their expected needs; (9) to determine whether the ALF setting is appropriate for them, prospective residents rely on facility-supplied information including contracts that set forth residents' rights and provider responsibilities; (10) but one recent limited study found that contracts varied in detail and, in some cases, were vague and confusing; (11) for example, a number of contracts stated only that services would be provided as the facility deemed appropriate, and few specified what occurs if a resident's health status declines; (12) overall, little in known about the accuracy and adequacy of information furnished to individuals and their families who are considering assisted living; (13) many of these concerns about consumer protection and quality of care in assisted living have been identified by state governments, providers, and consumer advocates; (14) although several research efforts are under way currently, further research may be needed to determine the: (a) nature and extent of problems related to consumer protection and quality of care that may be occurring; (b) effectiveness and adequacy of existing models of oversight and regulation; and (c) accuracy and adequacy of information provided to consumers and whether that information enables them to make informed choices about their care.