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Senior living industry leaders stressed their belief in the importance of quality, safety and accountability Sunday in response to a package of articles in the Washington Post titled “Memory Inc.,” about assisted living and memory care community residents who had eloped and died. Many communities are “dangerously understaffed,” an article in the report alleged.

“Since 2018, more than 2,000 people have wandered away from assisted-living and memory-care facilities unnoticed or been left unattended for hours outside,” according to another article in the report, published Sunday, which counted 98 deaths among whom the authors described as “walkaways.” The writers said that their calculations were based on an “exhaustive search of inspection results, incident reports and media accounts nationwide” but that because they were unable to obtain records in all states, “the data … is certainly an undercount.”

“The bulk of the official records came from 29 states that make current reports public online. Two additional states said they had no incidents; 10 did not provide records nor do they make them available online; some provided only partial records,” they wrote. The article detailed several instances of residents wandering outside and subsequently dying after spending too much time in excessive cold or hot temperatures or under other circumstances.

“In case after case examined by The Post, inspectors cited evidence of too few people on duty to care for the number of residents, of staff ignoring alarms, of skipped bed checks and staff sleeping on the job, of general neglect and, in a few cases, falsified records,” the authors said.

‘Nothing more important than safety’

Argentum President and CEO James Balda told McKnight’s Senior Living: “Nothing is more important than our residents’ safety, and any fatality is one too many. Any community in which an incident occurs is subject to appropriate state regulatory penalties, up to, and including, loss of license.”

Argentum was one of the major national associations that advocates on behalf of providers and was quoted or mentioned in the report. The National Center for Assisted Living, the American Seniors Housing Association and LeadingAge also were included.

“To be clear, LeadingAge has no tolerance for bad care, and quality is a top priority for our nonprofit, mission-driven members,” LeadingAge President and CEO Katie Smith Sloan told McKnight’s Senior Living.

Older adults and their families, she added, “deserve a strong national aging services system that supports and sustains providers of high-quality assisted living, including adequate and well-trained staff,” and elected officials and other stakeholders should “prioritize policies to support older adults and the professionals working in aging services to ensure equitable access to high-quality care in assisted living as well as other care settings.”

The report shared factors known by those active in the field — that assisted living mainly is regulated at the state level, that care and services primarily are paid for via residents’ private funds, that retaining staff members remains a challenge and that pay for aides averages “less than most Starbucks baristas.”

It also maintained that, in elopement cases, “[f]acilities and senior managers largely have not faced serious consequences,” that “regulatory fines seldom exceed $10,000,” and that “[t]he biggest financial risk facilities face usually comes from lawsuits,” which are “typically covered by operators’ insurance.”

State oversight of the industry “is often weak in several areas,” the authors wrote. For instance, they said, their analysis found that only 13 states mandate a minimum number of on-duty caregivers per resident, that only nine states require caregivers to obtain at least six hours of training about caring for residents living with dementia, and that information about violations is incomplete or not available to the public online in 21 states. Overall training requirements, the authors added, vary from five to 90 hours across states where an amount is specified, although many states mandate training but do not specify an amount.

“Our association has participated in multiple efforts to build sector consensus on assisted living quality measures and other topics,” Sloan said. “Our engagement in those, as well as our advocacy, educational and research efforts to improve care throughout  aging services, are ongoing and, given the stresses of our country’s current approach to long-term care financing, increasingly urgent.”

In one effort this year, LeadingAge, Argentum, NCAL and ASHA in June announced that they had joined with the National Association for Regulatory Administration to develop guidance for the industry and resources for operators, regulators, policymakers and other stakeholders. Infection prevention and control was the initial focus of the effort, called the Quality in Assisted Living Collaborative. The work “will help the sector collaboratively address the most urgent issues,” Sloan predicted at the time, and Balda said that the initiative ultimately could lead to greater consistency across the states.

“Assisted living will continue to evolve with our country’s changing needs. Regulations, staffing needs and training requirements must evolve with them,” Sloan said Sunday.

In a statement to McKnight’s Senior Living on Monday, NCAL said: “The assisted living profession remains steadfast in constantly improving and adapting to meet the needs of their residents, including those living with dementia. We will continue to seek out opportunities to work with policymakers and stakeholders to advance high-quality, personalized assisted living care.” 

Balda pointed out Sunday that “[a]ssisted living and memory care communities are overwhelmingly popular with residents and their families. Our communities offer choice and dignity to 1.4 million seniors each day, and surveys find that 94% of residents report good or great satisfaction, and 91% say they feel safer than living on their own.”

In a recent J.D. Power satisfaction study, he added, assisted living and memory care communities were found to be “overwhelmingly popular with residents and their families,” scoring 837 on a 1,000-point scale.

“Professionally managed communities have security procedures such as exit/entry logs, wearable tracking devices, and cameras in place to keep residents safe, and unless an independent physician has deemed them a risk for their own safety, they are free to come and go from their home as they choose,” Balda said.

The association, he added, has “serious concerns about the validity of the Post’s data,” but “even taking it at face value, fatalities due to wandering are 0.0015% of the more than 6.2 million assisted living residents served in the last five years.”

In its statement, NCAL said that the stories in the Post report were “tragic,” and the association expressed condolences to those affected. “However, these rare incidents are not indicative of the life-affirming experience that 99.9% of assisted living residents typically receive,” NCAL said. “Caregivers make the safety and well-being of every resident their utmost priority, and their passion for serving seniors is evident through the high levels of satisfaction that residents and their family members report each year.”

ASHA President and CEO David Schless told McKnight’s Senior Living that the association had not yet issued a statement on the Post’s report.

On Monday, Argentum posted on its website additional information about its reaction to the series as well as links to all of the Washington Post articles.

REITs a focus as well

Senior living organizations were not the only focus of the report. Another article in the story package concentrated on real estate investment trusts, especially Toledo, OH-based Welltower, which, according to the 2023 ASHA 50 list, is the largest owner of senior living properties.

Many assisted living communities, the Washington Post authors wrote, “are now held by investors under pressure to produce profits for shareholders. In some places, a bare-bones approach to staffing and pay has produced a chaotic environment where medications are missed, falls and bed sores go unnoticed, residents are abused and confused seniors wander away undetected.”

One former Balfour Senior Living executive, who was not named in the report, told the media outlet that Welltower, which owned the operator’s buildings, would not let the company give raises “to hire and train more and better workers to improve safety” because it was concerned about the potential effect on profitability.

A Welltower company spokesperson told McKnight’s Senior Living that “[c]ontrary to the allegations … Welltower did not oppose wage increases for Balfour employees at the property in question.”

The Washington Post report, the spokesperson said, “contains numerous inaccuracies, hearsay from anonymous sources and demonstrates a general lack of understanding of the industry.”

The Welltower spokesperson said that the REIT “has continuously supported the investment by its operators in human capital and did so throughout the pandemic and the extreme staffing crisis that the world was navigating. In fact, since 2019, compensation expense per resident has increased over 23% across the Welltower portfolio with compensation at the Balfour properties increasing by a comparable amount.”

The REIT also “is innovating and investing in technology and tools to improve the resident and employee experience,” according to the spokesperson.

“We operate in the competitive private-pay seniors housing market,” the spokesperson said. “Ensuring that our operating partners are able to provide residents with high-quality care and a fulfilling experience are the key factors that result in residents choosing to move into our properties, in turn driving our long-term success.”

A source close to the Washington Post reporting told McKnight’s Senior Living that “well before publication,” the REIT was sent Welltower-related details that were planned for the article and that spokespeople for the REIT “repeatedly” declined to provide a comment. Additionally, the source noted that the article reported that Balfour and Kisco Senior Living representatives did not respond to “numerous” requests for comment and that a Lavender Farms manager declined to answer questions from a reporter from the media outlet who visited the site. Balfour is an affiliate of Kisco, and Lavender Farms is the assisted living section of Balfour’s senior living community in Louisville, CO.

A Washington Post spokesperson told McKnight’s Senior Living that the publication stands by its reporting.

Another report

The Washington Post articles come on the heels of a package of articles published in November by the New York Times and KFF Health News. That report, titled “Dying Broke,” scrutinized an industry pricing structure that adds fees on top of basic charges, to cover additional services such as help with activities of daily living, insulin injections and blood pressure checks.

The package also had cited the growth of rate increases, the for-profit status of most providers, and the operating margins they see. And it reported the results of a survey that in part found that 66% of Americans aged 50 or more years are “mostly” or “somewhat” anxious about being able to afford the cost of an assisted living community or nursing home if they need to move to one.

In response, association leaders submitted letters to the editor to the New York Times.

McKnight’s Senior Living Content Editor Kimberly Bonvissuto contributed reporting to this article.

The Washington Post’s “Memory Inc.” package of articles:

Dozens of assisted-living residents died after wandering away unnoticed

Senior homes left dangerously understaffed amid assisted-living boom

How your state regulates assisted-living facilities

Questions to ask before choosing an assisted living facility

Facilities where seniors died after walking away or being left unattended