Monday, February 5, 2018

NYT: Questioning Regulation, Price and Value for "Assisted Living" In US

On Saturday, February 3, 2018, The New York Times published an article under the heading of "Politics," entitled "US Pays Billions for 'Assisted Living,' But What Does It Get?" The article points to a forthcoming GAO report, reportedly due to be released imminently.  Keep an eye on, under the tab for "reports."  According to the NYT, "the new report casts a harsh light on federal oversight, concluding that the Centers for Medicare and Medicaid Services has provided 'unclear guidance' to states and done little to monitor their use of federal money for assisted living."

The  Government Accountability Office report was requested by members of the Senate Special Committee on Aging in July  2015, with results expected in "early 2016," according to earlier news stories. Nineteen months is an exceptionally long leadtime for the actual report, in my experience.  

GAO studies of assisted living (AL) highlight a dilemma for the senior living industry.   On the one hand, operators would like to see better funding made available through Medicaid for AL, a view probably shared by families.  As explained by LeadingAge executive Stephen Maag, for McKnight's last year, he hoped the GAO study would highlight a "major weakness," as home- and community-based Medicaid "waiver" programs often cover certain AL services, but not room and board. Alas, federal standards typically are tied to nationwide funding, and AL operators reject there is any need for federal oversight of AL. 

The irony is that I'm typing this post while sitting with a family member and other residents in an AL center (in fact, that's why I haven't yet had time to add hyperlinks to the key articles and websites mentioned above). Regular readers of this blog will know this isn't my first time spending the night in AL or in other types of senior living.

Personally, I have great respect for well-run AL operations, and I appreciate that AL often has the flexibility to design smaller and more creative operations that can provide consumers with real choices.  But I reject the often repeated contention, that appears again in the above NYT's piece, that AL "communities are a bridge between living at home and living in a nursing homes." That makes AL sound like a compromise in care.  

Assisted living communities do not simply function as some sort of way-station to so-called "skilled"care.  Rather, AL sites are often the last home for older adults.  They serve individuals who need more help than families can provide in the individual's former home. AL are often purpose-built for seniors and can use their staff to provide vital supervision for those with dementia. The best AL offer appropriate daily activities. In fact, yesterday, I sat in on a first yoga lesson for a 90 year old woman.  

In my experience, a well-run assisted living center can reduce hospital admissions, and for individuals who have made advanced decisions to forgo end-of-life measures such as artificial resuscitation, tube-hydration or feeding, there may never be a need for other residential care.  In other words, AL staff also provide skilled care, just as important but different than the kind of skilled medical care associated with a hospital or nursing home, such as wound care, catheters, or I.V.s needed for medication.  

As such, states do need clear authority to inspect AL facilities for quality of care, and they need authority to close down poor operations.  

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