Governor Ferguson signed a bill to increase standards and certification requirements for assisted living facilities that have memory care residents. Despite the obvious – people experiencing cognitive challenges are extremely vulnerable – there has been a shockingly low level of oversight, licensing and staffing requirements governing care in assisted living homes.
When the need to move into a long term care facility arises, leaving familiar faces and surroundings and the loss of independence is hard enough on our loved ones. Add the pressure of finding a home that’s a good fit and the financial strain of covering the costs, it’s incredibly stressful for families. Based on my experience working in long term care facilities, here are some important things to keep in mind when choosing a long-term care home.
First, don’t judge a book by its cover.
When challenges due to age or disability put our health and safety at risk, we need quality care and support, not a change of scenery. Buyer beware, tours don’t give you the whole picture. Look beyond the sales pitch and surroundings. Like a luxury apartment building manager, the sales staff may woo you with fancy lobbies, movie theaters, activities and services, clubs and events. As enticing as the setting may seem, what’s most important for long term care residents is their quality of life, which hinges to a great extent on the quality of the care they receive. Long term care residents, first and foremost, need to feel supported and safe. It isn’t the wallpaper, carpeting or big screen TVs that matters most.
Second, do your homework.
Take time to talk to residents and their family members. How long do residents wait for help after pressing the call button? Is the food consistently nutritious and tasty? Has your loved one ever fallen, had bed sores, or been found in soiled linens? Have costs gone up unexpectedly? Are there any hidden fees? Do residents feel they are being treated with respect and dignity? When facilities try to maximize profits by understaffing or cutting corners on health and safety, both caregivers and residents suffer. It’s not rude to ask the caregiving staff or facility managers questions. What’s the employee turnover, are staff sticking around or frequently leaving? What’s the staff ratio (number of staff per resident)? How many staff are available overnight and on weekends? Is a registered nurse on site 24/7?
Says Lori Smetanka, executive director for the National Consumer Voice for Quality Long Term Care, “Inadequate staffing has plagued the industry for decades. We call healthcare workers heroes, but caregivers are paid low wages, rarely provided benefits, and often do not receive adequate training. As a result, long term care facilities have difficulty attracting and retaining high-quality staff, and turnover rates are staggeringly high.”
A multitude of studies have shown clear correlation between staffing levels and quality of care. And inversely, research shows facilities with high turnover and inadequate staffing have poor outcomes for residents, including overuse of anti-psychotic drugs, more frequent infections and hospitalizations. When facilities try to maximize profits by understaffing, both caregivers and residents suffer. Low pay and burnout drives high staff turnover. Studies have shown that long term care homes where workers are represented by a union have lower staff turnover, are more likely to report data that helps prevent illness and injuries, and experienced lower mortality rates during the pandemic from Covid.
Third, remember, high cost doesn’t guarantee high quality.
Costs vary widely depending on the level of care needed but can easily climb to $15-$20,000 a month. Here in the Puget Sound region, for example, Aegis Living runs dozens of “luxury” assisted living facilities. I worked at Aegis for six years and saw the disconnect between the sales pitch and the reality of care. Aegis Living and other facilities may charge residents rent plus “care costs” and additional fees, but the award-winning lobbies, luxury-hotel like settings and higher monthly fees may not always reflect the highest levels of care.
Finally, once you’ve chosen an assisted living home for your loved one, stay vigilant.
Accountability for quality of care for residents and conditions for employees in assisted living can be challenging. Care staff, residents and their advocates are often reluctant to complain due to concerns about retaliation, including displacement or firing. Frequent visits are one of the best ways to assess your loved one’s health and happiness. If you note violations of your loved one’s rights, or deficiencies that may pose a safety or health threat and are not being addressed by facility management, contact your local Ombudsman for Long Term Care.
Joey Perlmutter of Seattle has worked in long term care for ten years.
Editor’s Note: The State of Washington offers resources for people considering moving into an assisted living facility. The following link provides a good overview of Senior Housing Options that Offer Care in Washington State. Another State of Washington resource to consider is the Assisted Living Facility Locator and REPORTS lists. This resource allows the user to look up assisted living facilities in the state by location, by name and if the facility accepts Medicaid or not. The lists that pop up on these searches will alert the user if the facility “has reports.” Reports outline inspection results, investigations to ensure that the facility is in compliance with applicable rules and regulations, and resident safety concerns. And don’t hesitate to contact the Ombudsman for Long Term Care to learn more about the facility you are considering, even before a move.
