Should video monitoring be required in small assisted living homes? In recent Senate testimony, ALFA president Rick Grimes sounded a bit defensive about the regulatory oversight of assisted living facilities (ALFs) in Florida (aka 'group homes' in other states). Let's back up: Even when multiple residents died of abuse and neglect and inspections revealed multiple violations, the Agency for Health Care Administration didn’t close these troubled small homes down. Says Mr. Grimes: regulation in all fifty states (aka 50 different sets of regulations) is plenty adequate, and by the way, each state’s seniors are ‘different’ -- the Florida deaths were due to ‘management’ issues.
So where can YOU go these days where there are no cameras? In smaller assisted living/group homes (6 – 20 residents in a modified private home), no one besides the manager/administrator is or can be watching the goings-on. Yet YOUR day-to-day life is heavily watched: your bank’s ATMs, entrances to apartment buildings, grocery and department stores, shopping malls, maybe even security cameras in Mr. Grimes’ own house. All are watching visitors and customers in the event that they present any kind of risk to the owner/manager’s premises. In large and luxurious assisted living communities, cameras are typical – the front desk and security staff can see hallways from multiple views in all directions. These organizations do this voluntarily, of course, to reduce risk and boost safety of residents and staff.
No nationwide regulation exists that mandates a security camera. Yet every state has a Florida situation where frail and/or demented seniors within small care settings are neglected -- and that neglect makes the news. My take is that Mr. Grimes is wrong – management is clearly not enough, either in the care of the disabled or the care of the elderly. At the very least, for assisted living homes that have been cited with violations and still not closed down, state and federal agencies should require cameras with audio to be installed in common areas – precisely to put fear of being monitored onto the premises. Cost of the technology should be born by the administrator or owner cited in the violations as part of enabling them to stay in business. Then inspectors should require a backup plan for moving residents, like a hurricane evacuation plan, if ‘violations’ such as abuse and neglect persist.
Assisted living today has an older and frailer clientele. The economy has kept seniors at home longer: today’s Assisted Living resident has an average age of 86, stays for an average of 28 months, is likely to have dementia as a member of the 85+ population, not to mention other disabilities, mobility limitations, behavior issues, and wound care requirements that may develop over time. The cliché persists that Assisted Living residents want to stay put as long as they can, that seniors fear a nursing home ‘worse than death.’ But when a woman dies in assisted living because too-tight restraints killed her, when lack of oversight does result in death or immobilization from drugs, than this is the ‘worse’ that could make heavily regulated nursing homes -- some with newer and creative designs, more staff training and certification requirements -- look pretty good.
In the meantime, in the state which is in the process of dismantling volunteer ombudsman programs, where the Miami Herald continues its multi-part investigations into abuse and neglect, where regulations of assisted living change rarely, let's put more of a lens on day-to-day life of frail elderly who cannot speak up for themselves.