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Long-Term Care Facilities Lack Oversight, Advocates Say

Assisted living facilities have become more popular in recent years, but abundant closures and lax state regulations have led to more calls for new regulations.

HealthBeat Long Term Care Poll
Assisted living facilities have become popular alternatives to nursing homes in recent years, but many people say they're not held to the same standards.
Eric Risberg/AP
When the Valley Springs Manor assisted living facility in California closed with virtually no warning back in 2014, as many as 19 sick and bedridden residents were left alone inside. A cook and janitor herocially stayed behind to help them until they could be relocated. But the event prompted California lawmakers to pass the Residential Care for the Elderly Act in September 2014, which expands regulations that a long-term facility must meet.

Regulations like California's are rare, and if they do exist, advocates say they're simply not good enough. Fifteen states, for instance, don’t require an administrator to have a high school diploma, and eight states either don’t require any routine inspections or require them every few years. Furthermore, there is no federal oversight of assisted living facilities, despite the fact that some take Medicaid.

Prior to the Residential Care for the Elderly Act, California only required an inspection every five years. Even then, many facilities would go uninspected because the law didn’t have any teeth to it, said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

The new regulations change that. In addition to increasing inspections, they prevent past facility offenders from opening a new facility, increase training requirements and create a bill of rights for residents, among other things.

Assisted living facilities have become popular alternatives to nursing homes in recent years because they tend to offer more freedom. Nursing homes require round-the-clock nursing care, whereas assisted living facilities have aids on hand to help where needed.

The increased popularity has brought more calls for regulation, particularly to deal with facility closures. Last year, a facility in Salinas, Calif., was forced to close after 224 pages of complaints led inspectors to a bed-bug infested home with spoiled food.

There isn’t any data on just how many assisted living facilities close within a given year, but advocates say it happens regularly. “The incident in Salinas is a special case, but it’s not uncommon for an assisted living facility to close for other reasons -- like foreclosure on the property or because the administrator just wants to move on,” said Mike Connors, an advocate with the California Advocates for Nursing Home Reform.

Every state has a long-term care ombudsmen tasked with making sure that residents have enough notice when a closure happens -- typically 60 days -- and that they are transferred to another facility. The process can take months and can lead to other problems, such as transfer trauma. “It’s stressful for anyone when you’re forced to move. People in assisted living facilities are often struggling with many issues, so it’s even more disorientating. It sets people back and it’s a real problem,” said Eric Carlson, directing attorney for Justice in Aging.

Cynthia Rudder, project director for the National Consumer Voice for Quality Long-Term Care, is currently working on a report that looks at exactly how common nursing home closures are and how states can best handle them. It will be released in a few months, but preliminary findings call for extra measures such as requiring states to have a “closure plan,” intervening when a facility is at risk for closure and letting residents visit a facility before moving them. “We need to hold facilities accountable early on. If all we’re doing is fining them when something goes wrong, what incentive does that give them to change?” Rudder said.

While the federal government has never given any indication that it would step in and create regulations for assisted living facilities, advocates worry that the piecemeal regulations among state just isn’t sustainable. “I feel that the bubble will burst if there isn’t some sort of federal oversight eventually. Because at the state level, it’s a disaster waiting to happen,” Rudder said.

Mattie covers all things health for Governing.

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