A U.S. Senate committee has launched an examination of the assisted living industry, bringing attention to the high cost and mixed quality of long-term care facilities. In a hearing held last week, leaders from both parties expressed concerns about the financial practices and quality levels within the industry. The federal government has minimal oversight of assisted living, as it is regulated by states rather than by the federal government, as is the case with skilled nursing homes.
Prompted by a New York Times-KFF Health News series, Senator Bob Casey, the Pennsylvania Democrat who chairs the panel, called for residents and their families to submit their bills in order to assess the industry’s business practices. The goal of the inquiry is to improve transparency and provide consumers with better information to choose facilities. However, lawmakers expressed hesitation in taking a more direct role in regulating the sector, such as setting federal standards for staffing levels and worker training.
Assisted living facilities cater to more than 800,000 older Americans who require assistance with activities such as walking, eating, and other daily tasks, particularly those with dementia. Due to the fact that Medicare does not cover long-term care, residents are often forced to pay out-of-pocket, and only a small percentage of facilities accept Medicaid. The lack of coverage often leads to substantial costs for residents, with some facilities charging $10,000 or more per month for those with extensive needs.
The affordability issue is further exacerbated by reports of excessive billing by facilities. The New York Times-KFF Health News series highlighted how residents were charged extra fees for routine services, such as injections and blood pressure checks. Additionally, the series revealed that residents were charged $93 per month to order medications from a pharmacy.
Quality problems within the assisted living industry have been widely reported by national and state news outlets. Testimonies shared during the hearing shed light on poor care and overwhelmed staff at certain facilities. Patricia Vessenmeyer, a Virginia woman, recounted an incident where she had to intervene to stop a resident from beating another resident while staff members remained unresponsive. Vessenmeyer stated that the facility charged her late husband approximately $13,000 per month.
Experts in the field also testified about the inconsistent and nontransparent monitoring and enforcement of quality standards at assisted living facilities. Jennifer Craft Morgan, director of the Gerontology Institute at Georgia State University, pointed out that fewer than 10 states make information about these procedures easily accessible to the public.
Although the inquiry highlights widespread concerns about the assisted living industry, there is little support among lawmakers to increase federal regulation. Calls for improved federal oversight have been met with caution, with senators stressing the need to promote transparency without adding financial burdens to the federal budget.
The cost and quality issues faced by the assisted living industry have prompted lawmakers to request a study from the Government Accountability Office on the amount of Medicaid and other federal agencies’ payments toward assisted living. In 2014 alone, state Medicaid agencies spent $10 billion on care for 330,000 individuals within assisted living facilities.
In response to the scrutiny, the National Center for Assisted Living, an industry trade group, acknowledged the affordability crisis but emphasized that oversight should primarily fall under state jurisdiction. Industry representatives called for collaboration between government and private entities to develop more affordable options and address the shortage of caregivers.
As the Senate continues its examination of the assisted living industry, the hope is that increased transparency and awareness will empower consumers to make informed decisions about long-term care for their loved ones. While some lawmakers advocate for greater federal involvement, others champion the role of states in regulating facilities. The ultimate goal is to ensure safe and dignified living conditions for older Americans and protect them from financial exploitation and fraud.
