By now, you’ve probably heard about or seen it. PBS’ Frontline and ProPublica spent a year researching care, life and wrongful deaths in the largest of assisted living companies, Emeritus Senior Living. After the broadcast, some honest self-examination, but also those expected positioning statements and self-righteous comments emerged from Emeritus, industry observers, plus defensive responses from the industry lobbying leaders – ALFA and Leading Age. Larry Minnix (Leading Age) tells ALF executives to ask themselves, “What are your staffing levels?” Indeed. And we should ask as well. What should they be in an AL memory unit? He doesn’t say. Read the Frontline attached interview with a regulatory agency CEO -- and how variations across state boundaries can be justified. Really. So shouldn't facilities be shut down after horrible incidents like these? Remember the Miami Herald series Neglected to Death? Not just one company (as in the Frontline story) but many organizations, large and small, throughout Florida, not just one incident but multiple. As with many incidents, company growth may slow a bit, organizations may consolidate under new ownership or new names, but rarely are they shut down.
What’s in a name? The term Assisted Living sets an expectation. The moniker 'Assisted Living' implies but does not really specify a level of care. Designs and décor amplify this comforting impressionism – and industry articles champion quality. The PBS documentary would have you believe that Emeritus is more profit- and real estate-focused, more aggressive at marketing and more likely to fire whistle blower employees. But really, are they so unique in accepting residents who supposedly are too frail to meet the industry’s vague differentiation from nursing homes? Really, is Emeritus the only company that has inadequate dementia care staff training; are they the only ones who have too few staffers for the number and acuity of residents? After all, the most profitable service in assisted living today is memory care – averaging $57K per year, a 42% price hike over average assisted living prices. Perhaps you’ve visited memory care units. Do you look around and see that 42% price/services differential beyond the locked door?
Other industries see expectation management as critical. Maintaining profit in a labor-intensive service industry – for example, hospitality – must meet expectations by having enough staff, pay, and supervision to serve guests. If you found dirty linens when checking into a hotel or encountered rude staff, you’d squawk; next time you’d warn others and pen a review on TripAdvisor. But if we see our mother or father’s dirty bathroom or we observe residents who are unkempt, at first we try not to notice -- it undermines our faith that we made the right choice. But each time we visit and see a problem, our optimism dwindles as our reluctance deepens to avoid moving a family member yet again. And the Internet is not helpful. There are no well-populated review sites for assisted living. For example, OurParents.com and Caring.com have a few reviews of this Florida Emeritus facility -- but no link to the widely publicized news story about the resident who took off his Project Lifesaver bracelet, wandered away and was never found.
What would you want for yourself? We repeat our desire to age at home, but some of us are going to need some type of assisted living. Maybe dementia or some other condition will make it seem like a reasonable choice. Maybe we will feel safer than in our danger-laden houses located in deserted areas or with a solitary home care worker. Perhaps we will be able to afford the no-holds-barred price because we were lucky and sold an expensive property, or perhaps we managed our finances well. We put it off, but now we’ve moved in. What is different from the news makers of 2013? Will it be remote monitoring technology? Redesigned layouts maintaining sight lines for staff? Silent alert door warning systems? Or will it be well-marketed high staffing ratios, low staff turnover, experienced executives, engaged nursing oversight, staff-and-family training programs, vocal family councils and well-established volunteer programs that maximize observation opportunity -- plus service and activity personalization that will match our family’s high expectations and optimism about care? Although the profit margin may suffer, the definition of quality will be well understood; online reviews will be widely available with many comments – feedback will be encouraged and responses from management will be expected. And whether it is Kansas or Kentucky, even consumers will know what to expect.