Whenever there are headlines about anything in senior care, we can always count on Senate hearings, with a lot of unfounded accusations and unrealistic recommendations. This usually leads to a new commission being formed, the results of which are delivered a year later in 300 pages that no one reads, except perhaps Richard Mollot of the Long Term Care Community Coalition. But that is his job. It is doubtful Liz Warren will read it.
Let me start with Richard Mollot, who apparently claimed at the January 25th Senate hearing that there is a crisis in assisted living, and compared assisted living today with nursing homes in the 1970s and 1980s. Really? Did he ever go into a nursing home back then? I did, and trust me, there is no comparison. And any “crisis” was not of their doing (the pandemic) and is now how to ramp up staffing and increase margins to afford the staffing, which comes at a higher cost.
Assisted living mostly started as a hospitality model, but evolved into a healthcare model for two primary reasons. First, there was a demand as the elderly and their families preferred AL over SNFs. Hellooooo. Second, people aged, became frailer and needed more care, and if they could afford it, they chose assisted living. Why wouldn’t you?
There were also complaints in the hearing about the high cost of assisted living, yet there were recommendations for national standards, federal rules or oversight, more staffing mandates and training, and on and on. All of these cost money, and they would all drive the cost up. This will make assisted living affordable for a smaller and smaller share of the elderly population. That benefits no one.
All one has to do is look at the disaster that regulations and miserly Medicaid reimbursement have done to the nursing home industry. Is that really what the expert presenters at the Senate hearing want? Of course not, but we all know that is exactly what would happen.
There were also calls for a national database for all manner of facts and statistics about assisted living. If this is for the consumer’s benefit, think again, as they will not do this kind of research, and will most likely not understand much of it. For nursing homes, the only thing they really look at (if that) is the five-star rating, and we all know how unreliable that can be. I think a national database would be beneficial to researchers, lawyers, academics….and people like me, but not the consumer.
Now, it is not all roses for the assisted living sector. There have been too many providers over the years who, with soft census, open a memory care wing without having a clue about what that entails. Training has not been as good as it should be, and memory care was often seen as a way to increase rates, which it does. But you have to deliver, and we as an industry too often are not walking the memory care walk as well as we have promised.
There has also been criticism of taking in people at acuity levels that the staff is not prepared for, or keeping the back door closed for as long as possible. In some cases, these are valid criticisms. But in the last four years, many assisted living providers have been gasping for air (residents), so some of this can be forgiven.
And then there is the cost creep, which is not explained as well as it could be. Having mom move in at a fixed rate, and then two months later an evaluation indicates she needs more care, at more cost, can be very frustrating for a family, which may be tight on the funds in the first place. The increased care may be valid, but you can just see the eyes roll when the family talks about it.
There definitely needs to be more transparency, and it will come as we continue to emerge from the pandemic problems. But the costs will not be going down, and my fear is that assisted living will be available to an ever-decreasing percentage of the elderly. At least, assisted living as we know it.
Remember, it is all about choice, and explaining why assisted living makes sense.
