Differentiating assisted living from nursing homes

Here’s a word association game: I say, “long-term care” and you will probably respond, “nursing home.” But the truth is that there are nearly twice as many assisted living (ALF) and other residential care facilities (more than 30,000 in 2014) in the U.S. than nursing homes (about 15,000). And there are more than 800,000 people living in residential care facilities, almost equal to the roughly 1 million living in nursing homes, according to Forbes.

Many of these ALF residents have high care needs. About 40 percent have dementia—many living in separate “memory care” units of larger facilities. Half are age 85 or older and more than half need help dressing or bathing. It is more than a cliché to say that assisted living is the new nursing home.

Yet unlike skilled nursing facilities, which are heavily regulated by the federal government, assisted living and other residential care facilities are regulated only by the states, and the variation among jurisdictions is enormous. Even though about 330,000 ALF residents received about $10 billion in Medicaid benefits  in 2014 (and the numbers are surely far higher today), neither many states nor the federal government know much about the quality of care those Medicaid residents are receiving, according to a new study by the Government Accountability Office.

The study found huge gaps in oversight and reporting. According to GAO, Medicaid officials in 30 states do not routinely review the licensing and certification of facilities, and 18 don’t look at the results of  site visits.

GAO reviewed a list of critical incidents, ranging from abuse, evictions and discharges, and unexplained deaths. Last year, it asked the 48 states that provided Medicaid benefits for ALF residents for data on these events that occurred in 2014. Twenty-six did not have the information to respond to GAO. And 14 had no process to make this information available to consumers.

Read the full story at Forbes.


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