Who Jackie Pinkowitz
and her father, Melvin Spungin, 88, Colts Neck, N.J.
Situation When Parkinson’s
disease kept Spungin from living alone, he and his daughter chose the
Monmouth Crossing assisted-living facility in Freehold, N.J. “Parents and
kids have different ideas about what makes the best place,” she says. She
was impressed that the facility was connected to a state health-care
system. He liked the food and the non-hotel atmosphere.
How much assistance can you really count on?
Since they started to dot the U.S. landscape in the
early 1980s, assisted-living facilities have become the best hope of America‘s seniors for
avoiding confinement in a nursing home. Instead of a hospital environment,
assisted living promised private apartments and communal dining in
hotel-like settings, and some help with daily needs such as dressing and
In the Consumer Reports three-month investigation, we found that
assisted living now presents quite a different picture. Settings vary
dramatically. Among the dozen facilities we visited, there are high-rise
apartment buildings, down-at-the-heels mansions, and single-family houses.
They are run by large public companies, states, families, small businesses,
Each one has a different notion of how much or what kind of assistance
assisted living should provide. Some facilities offer an apartment, meals,
and some activities. Others provide several levels of help, each at a
higher price. Some facilities require residents to be ambulatory; others
have units for people with Alzheimer’s disease.
Seniors and their families, anxious to avoid nursing homes, have come to
look upon assisted living as the preferred placed to go when health starts
failing. Assisted-living operators, out of compassion or a need to fill
beds, accept and keep residents even if their condition has worsened.
CR Quick Take
In our three-month
investigation of assisted living, we visited a dozen sites and talked to
experts as well as residents and their families. We found that picking an
appropriate assisted-living facility can be extremely difficult because:
facilities are operated by small private companies that don’t provide
including data on their financial
strength–needed to make a decision.
size, décor, nor amenities necessarily determines the quality of care
or assistance available at a facility.
is no standard for care that should be provided and no clear guideline
to indicate who belongs in assisted living and who doesn’t.
nearly 1 million people who now live in assisted-living residences have
become frailer, raising concerns about their safety and care.
regulate assisted living but provide little oversight or protection for
As a result, many of the nearly 1 million people now in
assisted-living facilities are more likely to be frail and sick than
independent. And that has created a troubling mismatch between the care a
resident needs and the care a facility and its staff can give.
The result can be neglect or poor care for residents. Example: A draft
report of a 2004 national survey conducted by the NationalAcademy for State Health
Policy found that 28 states reported that problems with medication occurred
frequently or very often.
More critically, no one seems to be watching very closely. While the
federal government protects nursing-home residents–albeit not always
effectively–with rigid regulations and state-run inspections about once a
year, states monitor assisted living with a hodgepodge of licensing,
inspection, and staff-training standards of varying strictness.
Finding a good, safe, and affordable facility has thus become problematic
for seniors and their families. There’s a lot to consider: the setting, the
cost, the array of services, the condition of the other residents, the
solvency of the company, not to mention the rights of residents to stay, or
the necessity for them to go, if their condition deteriorates.
Getting information to make your choice can be difficult. Posing as adult
children from out of state whose parent was considering assisted living, we
contacted at least three locations for each of the 10 largest
assisted-living chains in the country. We asked each to send us all the
information we’d need to decide on the facility, including the services it
provides, pricing structures for different levels of care, and its
contract. None gave us everything we requested. Mostly we received glossy
brochures showing happy, peppy seniors. (See Big