Senior living might want to reconsider its superiority complex

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John O'Connor
John O'Connor

It wasn't long ago when many assisted living operators disparaged their skilled care brethren as being somehow second-class.

It wasn't hard to see why. Back then, assisted living communities generally could claim to offer greater choice, autonomy and aesthetics. As for nursing homes, they were comparatively bleak at best. Plus it seemed they were always getting themselves into trouble.

But much has changed in the past two decades. For one, many skilled care settings have stepped up their games, big time. The old institutional look largely is a thing of the past. In fact, many skilled care operators are offering amenities and choices that more than hold their own.

At the same time, the assisted living sector has lost one of its best old marketing messages: that it is an alternative to nursing homes. That claim can hardly be made with a straight face these days, except maybe in conversations with hospital discharge planners.

To be fair, a lot has changed in every business over the past two decades. Why should seniors housing and care be any different? But something even more troubling has altered the landscape when it comes to the respective players.

And that something, quite frankly, is that we are seeing a lot more rogues on the senior living side of the fence these days. Think I'm offering an overly harsh assessment? Here are some developments from just this week:

  • In California, the state's labor commissioner has accused an assisted living chain of dramatically underpaying its workers. Some employees were allegedly making as little as $2.40 an hour. The commissioner has ordered the chain to pay $7 million in back pay and penalties.
  • In Ohio, the former administrator of a since-closed community faces more than four years in prison after pleading guilty to reckless homicide and patient abuse in the death of an 85-year-old resident.
  • In Tennessee, a Jefferson County woman was charged with endangering elderly residents at group home after police said they discovered nine residents were living without heat for several days.
  • In Wisconsin, the body of a dead resident was found outside an assisted living center because employees were apparently not trained to keep doors locked.

And remember, that's the tip of the iceberg from less than one week.

So what should we make of these increasingly troubling stories? One obvious answer is that such developments are the inevitable residue of a growing market. Fifty years ago, assisted living basically didn't exist. Now its communities are at least twice as common as skilled care settings. And any time you increase the size of something, so too do you increase the odds that bad things will occur. Or so the thinking goes.

But more may be going on here.

When assisted living began to gain traction a few decades ago, its practitioners for the most part were an unusually proud group. Many saw it as their mission to provide an alternative to nursing homes that ensured autonomy, choice and, above all, a better living experience. To be sure, that sentiment still can be found today.

But senior living now must compete with new challenges. One is the need for many operators to accept Medicaid payments. That is not in and of itself a bad thing. But you don't have to be an accountant to know that fewer Medicaid dollars coming in (at least when compared with private-pay dollars) reduces your amenity and staffing options.

Plus there's the upstream movement. Most residents now have profiles that are similar to those of nursing home residents circa 1990. Yes, hospitality remains an important part of this business. But it would be quite a stretch to insist this remains a hospitality-centric or hospitality-driven business.

Oh, and by the way, competition is fiercer than ever.

What we have here is a field that finds itself dealing with uncomfortable change and less predictability. Those are not typically forces that drive improvements of the warm and fuzzy variety.

Is it really surprising that we're seeing more operators doing things that would have been heavily frowned upon in the past?

I'm not going to go so far as to suggest the sector has lost its way. But clearly, things have changed.

And some of the most notable changes are nothing to feel superior about.

John O'Connor is editorial director of McKnight's Senior Living. Email him at john.oconnor@mcknights.com.

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