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One national senior living company’s staffing algorithm drew repeated complaints from building managers for failing to capture the nuances of caring for older adults, leading to residents going without showers, rooms left uncleaned and a lack of supervision for vulnerable residents, according to a Washington Post story published Monday.

In a follow up to the Post’s December Memory Inc. series on elopements in assisted living communities, the Post delved into a staffing algorithm used by Brookdale Senior Living — called Service Alignment — alleging that the system underestimated the number of staff memmbers needed to meet residents’ needs. 

A Brookdale spokesperson told McKnight’s Senior Living that the company disagreed with the characterizations about Service Alignment, which was created in the early 2000s “as a way to identify best practices to meet the needs of residents” and does not dictate staffing maximums or determine care costs.

“The handful of examples cited in this article fail to take into account the full set of facts and are otherwise not representative of Brookdale’s mission of enriching the lives of those we we serve with compassion, respect, excellence and integrity,” the spokesperson said, adding that the company’s top priority is to earn its customers’ trust and satisfaction by providing high-quality care and personalized service. “Service Alignment is a resource to help guide community leaders on staffing decisions, but local leaders have autonomy and discretion to adjust staffing levels as necessary to meet resident needs.”

‘Slanted and incomplete portrait’

Argentum President and CEO James Balda called the media outlet’s portrayal of assisted living a “slanted and incomplete portrait,” and said Post’s reliance on “isolated events and anecdotal reporting” “mischaracterizes the experiences of a vast majority of the 1.4 million Americans” who live in assisted living communities.

“The Post fails to acknowledge that older adults who live in senior housing communities live longer, receive more healthcare services and benefit from greater rehabilitative and preventive care than those who do not,” Balda told McKnight’s Senior Living. “In addition to fulfilling and often exceeding minimum state staffing requirements, Argentum and its members are committed to maintaining sufficient qualified staffing based on the needs of residents, which is central to the concept of person-centered care.”

Using court records, internal company documents and interviews with more than 35 current and former Brookdale employees, the newspaper reported that Alterra Healthcare had invented the system for determining staff levels based on stopwatch studies that timed caregivers performing various tasks.

The Post reported that Brookdale saw the program as a way to “rein in ballooning expenses and manage its growing empire from afar.” The company began rolling out the algorithm to all of its buildings in 2013 in what former CEO Andrew Smith said was an attempt to “make sure we don’t overstaff,” according to The Post.

Using Service Alignment, Brookdale assessed each resident to determine the tasks necessary to meet their needs. The algorithm determined the number of minutes needed to care for each resident per shift, then calculated the number of staff necessary to complete those tasks, according to The Post.  

But the new program reportedly drew complaints from building-level managers, who said the algorithm underestimated the number of staff members needed to meet residents’ needs, particularly residents with cognitive issues. Several managers who objected to the system either quit or were fired, according to the media outlet. 

The Brookdale spokesperson said that the allegations regarding staffing are largely derived from purported class action litigation that Brookdale and other senior living providers have been facing over the past several years, “driven by  plaintiffs’ attorneys seeking to earn fees.”

“Brookdale disputes the allegations and has been successful in defending against them to date,” the spokesperson said.

The article comes as the company faces two lawsuits related to staffing levels. Last year, a federal judge denied class action certification for some claims in the California staffing lawsuit because plaintiffs could not show that communities were similarly staffed, according to The Post. Meanwhile, plaintiffs in a Tennessee lawsuit have requested class action certification.

Brookdale is the largest senior living operator and third-largest owner in the United States, according to the 2023 ASHA 50 list published by the American Seniors Housing Association. The company also topped Argentum’s 2023 list of largest senior living providers.

Brookdale pointed to customer satisfaction recognitions from US News & World Report’s Best Senior Living ratings for 2023, as well as its top rating among assisted living and memory care communities in both the 2020 and the 2022 J.D. Power U.S. Senior Living Satisfaction Study.

“This article does not acknowledge the tens of thousands of residents and families who are highly satisfied with their care at Brookdale, and who have helped recognize our communities as some of the best in the nation,” the Brookdale spokesperson said of the Post reporting. 

Argentum pointed to national surveys reporting that 90% of senior living residents have high satisfaction with their care and communities, 99% indicated they feel safe in their communities and 85% of families reported high value in their loved one’s community. In addition, national surveys found that 96% of residents reported that their assisted living communities provided sufficient healthcare and access to care, and almost three in four said assisted living improved their quality of life.

The Post noted at the end of its story that the outlet will continue to report on the assisted living industry, and it invited readers to share their experiences with elder care, assisted living and dementia care providers. 

Other operators face staffing lawsuits

Other senior living operators have faced or are facing lawsuits related to the ways in which staffing levels are determined.

In one ongoing suit, Chancellor Senior Management, a Columbus, OH-based organization that manages four assisted living communities, is accused of applying a formula to determine the hours of care each resident needed based on their individual condition for billing purposes, but not for staffing levels. The lawsuit further alleges that staffing decisions are made at the corporate rather than community level.

In 2021, Aegis Living of Bellevue, WA, settled two class action lawsuits for a combined $16.25 million. The lawsuits had alleged that Aegis based staffing levels on predetermined staffing budgets rather than on resident care needs and in doing so violated elder abuse and consumer protection laws.

The former Emeritus Corp., which merged with Brookdale in 2014, settled a class action lawsuit in 2016 for $13.5 million. That suit alleged that Emeritus had misled assisted living residents about the use of a computerized system to evaluate residents and determine sufficient staffing and care levels.

Atria Senior Living settled a similar lawsuit for $6.4 million that same year, and Oakmont Senior Living settled a class action lawsuit for $9 million earlier this year. A similar lawsuit against Sunrise Senior Living is pending.

Increased scrutiny

Assisted living providers have come under scrutiny recently after articles in The Post in December, as well as in The New York Times and KFF Health News in November, reporting on the deaths of residents with dementia who eloped from communities, the industry pricing structure, rate increases or the for-profit status of most providers.

Those stories prompted the chair of the Senate Special Committee on Aging, Sen. Bob Casey (D-PA), to send letters to the leaders of Brookdale, Atria and Sunrise asking them to address his “significant concerns” about costs, staffing levels and resident safety.

At a subsequent Aging Committee hearing in January, some senators pondered increased federal involvement and called for the US Government Accountability Office 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. The committee also asked consumers to share their bills and experiences interacting with providers. Casey said the actions represent “the most significant congressional review of assisted living facilities in 20 years.”

During Brookdale’s most recent earnings call in February, President and CEO Lucinda “Cindy” Baier said that the company has cooperated with Casey’s request for information. The senator had asked the providers for details about how they communicate the cost of services to residents and their families, the rates they charge in each state, their schedules of services and costs, the average revenue per occupied unit they receive, statistics on elopement and injuries, how accessible information is about community complaints and citations, staffing levels, and employee job titles and pay rates. 

“We take great pride in serving our hundreds of thousands of residents at communities across the county over the last decade,” Baier said during the call. “At this point, it’s too soon to tell what the outcome of the inquiry could be, but I’m very comfortable our focus is and has always been providing quality care.”

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