Nationally, rising costs and staffing shortages in assisted living facilities have raised alarm bells. Family members are worried about the sort of care that their loved ones receive at these homes. A recent survey from the Assisted Living Federation of America found that two-thirds of assisted living admins said they were currently facing moderate to high staffing shortages. At the same time, 90% of administrators reported having trouble hiring new staff, shedding light on a key challenge the industry is facing.
Charles Fraser’s experience underscores this troubling landscape. His time at a luxury assisted living community ran $11,000 a month. Every day, millions of families face a daunting cost when caring for the elderly in their families. This enormous financial investment does little to guarantee quality care and no dignity. Roxanne Crosby shared her frustrations: “Then they told me he needed $1,000 a day for private care on top of that.” These ancillary costs can be a barrier for families still dealing with the sticker shock of hefty registration fees.
The topography of the assisted living industry is not much clearer due to the confusing patchwork of regulations. The facilities are constrained by the narrow range of 350 licensing regulations that vary widely from state to state. Very few existing regulations are enforced or overseen. This complete lack of scrutiny raises many questions about what standards of care residents are receiving. Indeed, the average worker in assisted living makes about $15 per hour and works just under 36 hours per week. Such low wages frequently result in extreme turnover and subsequently leave many facilities understaffed.
Caregivers are a vital to the solution, but the training mandate is shockingly low. In reality, most only require a handful of hours of short-term training upon entering the workforce. Alarmingly, fewer than half of assisted living communities have a nurse on duty. This action further endangers the quality and continuity of medical care possible for the residents.
Paula Carder, director of the Institute on Aging at Portland State University, identified the problem on an epic scale. She highlighted that the greatest challenge in the profession today is hiring and retaining qualified staff. She made it clear that the key to providing good quality care to residents is by supporting caregivers, and that starts with fully funding it.
In fact, the demographic makeup of those actually living in assisted living has changed over the past decade. Sheryl Zimmerman noted, “The people who live in assisted living now are people who would have been in nursing homes 20 years ago.” In the years since, as assisted living communities have grown more corporatized and politically connected, those interests have made making money off of patients—er, residents a top priority.
The fiscal consequences of this change are deep. Almost 1 in 5 residents in assisted living facilities rely on Medicaid to pay for their care. Note, though, that this help does not extend to paying for room and board. Plus, nursing homes have an incentive to hide their profits, given the heightened federal scrutiny of profits made by nursing homes. Almost three quarters of these private facilities siphon billions in taxpayer dollars through “related party transactions.” This funding would be better spent addressing staffing needs to ensure that critical care and services are provided.
Johanna Meneses, a passionate direct care worker at Twilight Gardens in Norwalk, Ohio, demonstrates the value of going the extra mile with her residents. The heart of long-term care, she feels, is in cultivating meaningful relationships with residents and their families. Cristina Flores echoed this sentiment, stating, “Long-term care is about creating relationships with residents and families, and really understanding what the person needs, what they do and don’t want in their lives.” Caregivers are voicing their frustration at not receiving the support they need from the top.
Richard Mollot highlighted a growing sentiment among seniors: “A lot of people tell me they’d rather die than go into a nursing home.” That fear points to an underlying big issue with the industry. As one family told us, facilities have a long track record of not delivering on their commitments. Kathryn Stebner remarked on the ethical implications involved: “It’s financial elder abuse to take their money and not provide what they say they will.”
Tony Chicotel pointed out an alarming trend: “Whether the ownership is a closely held corporation, a publicly traded corporation, real estate investment trust, or private equity, they’re all run by people with business degrees and not by people who are actually professional caregivers.” That movement towards privatization increasingly favors profits over people by putting corporate owners and bottom lines ahead of high-quality health care.