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The assisted living model is “under threat” following increased federal scrutiny and negative attention from lay media outlets, but providers can take steps to educate lawmakers and the public about the positive aspects of the setting, speakers in two settings said Wednesday.

During an Argentum Advocates call on Wednesday, association executives encouraged senior living providers and their community-level staff members to share positive stories about the setting to counter the recent negative attention from policymakers and the press. Also Wednesday, Willis Towers Watson hosted a webinar to share risk management solutions providers can use to mitigate elopement risks in senior living.

The US Senate Special Committee on Aging launched a review of the assisted living industry following articles in the Washington Post, which reported on the deaths of residents who wandered from communities, as well as the New York Times and KFF Health News, which scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of most providers.

Committee Chairman Sen. Bob Casey (D-PA), who oversaw a January hearing, also sent letters to the leaders of Brookdale Senior Living, Atria Senior Living and Sunrise Senior Living, asking them to address his “significant concerns” about costs, staffing levels and resident safety.

“Last month’s hearing in the Senate, and the ongoing media coverage, has made it abundantly clear that assisted living is on the minds of policymakers who have the power to change the way we care for our seniors,” Argentum Government Relations Director Dan Samson said Wednesday during the Argentum Advocates monthly briefing. “We need everyone’s help to counter the narrative being pushed by the media and policymakers that is clearly one-sided and truly doesn’t understand the nature of what we do for the nearly 2 million seniors across senior living, and what we do for them on a daily basis.”

Argentum participated in a “productive” meeting last week with Senate Aging Committee senior staff members, who indicated that an upcoming hearing will focus on long-term care workforce challenges, according to Samson. And although those staff members said that no additional assisted living hearings or federal legislation are planned, Samson said that doesn’t mean the committee’s focus is off of assisted living.

At and in the wake of the hearing, the committee called for a government study on industry pricing and transparency, announced a website and email address where consumers can share their bills and experiences iterating with providers, and pondered increased federal involvement.

Samson encouraged providers and community-level staff members and caregivers to share their positive stories through the Aging Committee’s portal, which the committee has encouraged residents and resident families to use to share their experiences related to costs and quality.

“We know the threat of increasing federal involvement and what it would mean to undermine the existing state regulatory framework and community-based care model we already have that has been the foundation of assisted living,” Samson said. “We’ve never been under such great scrutiny and under a greater threat than right now.”

At the conclusion of the hearing, Casey announced that he and several Democratic colleagues had sent a letter to the Government Accountability Office asking it to study how much federal money is spent on assisted living communities, the cost of assisted living services, and the transparency and availability of that information to consumers. Samson said that a final report from the GAO is likely 12 to 18 months away and that Argentum anticipates increased scrutiny and attention on assisted living until then. 

Changing the narrative through risk mitigation

Of course, one way that senior living operators can help change the narrative is to try to prevent resident elopements from occurring in the first place.

Providers need to find solutions to decrease resident risk and the domino effect of costs to the overall healthcare system, including claim frequency and payouts, according to Rhonda DeMeno, RN, director of clinical risk services in the Willis Towers Watson Senior Living Center of Excellence. During a Wednesday webinar, she discussed the effects of elopements in senior living and potential solutions to mitigate risk.

First and foremost, DeMeno said, senior living communities must have policies that clearly define procedures for identifying, assessing, monitoring and managing residents at risk of eloping. 

“Everyone in a community wears the risk manager’s hat, and everyone should be responsible for understanding what’s in those policies and procedures,” DeMeno said. “We cannot stress enough the importance of having sound policies and procedures to mitigate events like this.”

Service plans and care plans also must include personalized interventions for at-risk residents, she said, advising communities to have conversations with family members early in the admissions process to gather information on any prior history of elopement or behaviors that could lead to wandering. Just as important, DeMeno said, is addressing any change in a resident’s condition.

“We’re seeing an increase in media activity and an increase in lawsuits in regard to elopement,” she said. “It’s incumbent upon all who work in the senior living space to try to find good, sound solutions to mitigate these terrible incidents from occurring.”

Plaintiffs’ attorneys will look at “duty of care” to drive claims against senior living providers, alleging that communities and organizations violated that duty of care by not supervising residents properly, DeMeno said. 

According to Willis Towers Watson, elopements fall just behind choking in highest claims losses, costing an average of $262,500 per claim. 

The causes of senior living resident elopement, the company said, come down to a lack of attention to residents living with dementia or residents who are at high risk for wandering, not updating staff members about frequent wanderers, low staffing levels, malfunctioning or inadequate security and alarm systems, not educating staff members and resident families about elopement policies and procedures, and not conducting monthly elopement drills.

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