Assisted Living

Assisted-living facilities provide a growing number of elderly Americans with an alternative to nursing homes. To make informed choices about various facilities, however, consumers need clear and complete information on services, costs, and policies. A GAO review of assisted-living facilities in four states--California, Florida, Ohio, and Oregon--found that the facilities did not always give consumers enough information to determine whether a particular facility could meet their needs, for how long, and under what circumstances. Marketing materials, contracts, and other information provided by facilities are often incomplete and sometimes vague or misleading. Only about half of the facilities reported that they provide prospective residents with key information in writing, such as the amount of assistance residents can expect to receive with medications, the circumstances under which the cost of services might change, or when residents might be required to leave if their health deteriorates. Consumers also need assurance that the facilities provide high-quality care and protect consumers' interests. All four states license assisted-living facilities and conduct periodic inspections and complaint investigations. Yet GAO found that more than one-fourth of the facilities it reviewed had been cited by state licensing, ombudsman, or other agencies for five or more quality-of-care or consumer protection deficiencies or violations during 1996 and 1997. Eleven percent of the facilities had been cited for 10 or more deficiencies and violations during the same period. Frequently identified problems included facilities' (1) providing poor care to residents, such as inadequate medical attention following an accident; (2) having insufficient, unqualified, and untrained staff; (3) not providing residents with appropriate medications and not storing medications properly; and (4) not following admission and discharge policies required by state regulation. This report summarizes the April 1999 GAO report, GAO/HEHS-99-27.

GAO noted that: (1) assisted living facilities vary widely in the types of services they provide and the residents they serve; (2) they range from small, freestanding, independently-owned homes with a few residents to large, corporately owned communities that offer both assisted living and other levels of care to several hundred residents; (3) some assisted living facilities offer only meals, housekeeping, and limited personal assistance, while others provide or arrange for a range of specialized health and related services; (4) they also vary in the extent to which they admit residents with certain needs and whether they retain residents as their needs change; (5) given the variation in what is labelled assisted living, prospective residents must rely on information supplied to them by facilities to select one that best meets their needs and preferences; (6) in many cases, assisted living facilities did not routinely give consumers sufficient information to determine whether a particular facility could meet their needs, for how long, and under what circumstances; (7) moreover, GAO identified numerous examples of vague, misleading, or even contradictory information contained in written materials that facilities provide to consumers; (8) the states have the primary responsibility for the oversight of care furnished to assisted living facility residents; (9) all four states reviewed have licensing requirements that must be met by most facilities providing assisted living services, and state licensing agencies routinely inspect or survey facilities to ensure compliance with state regulations; (10) however, the licensing standards as well as the frequency and content of the periodic inspections vary across the states; (11) given the absence of any uniform standards for assisted facilities across the states and the variation in their oversight approaches, the results of state licensing and monitoring activities on quality-of-care and consumer protection issues also vary, including the frequency of identified problems; (12) however, using available inspection surveys and reports from the other oversight agencies in the four states, GAO determined that the states cited more than 25 percent of the 753 facilities in its sample for five or more quality-of-care or consumer-protection related deficiencies or violations during 1996 and 1997; and (13) state officials attributed most of the common problems identified in assisted living facilities to insufficient staffing and inadequate training, exacerbated by high staff turnover and low pay for caregiver staff.