Help with Elders-assisted living, elder care, elder law, aging parents, senior care, elder abuse, San Francisco bay area, California

LET YOUR PARENTS HAVE
A SAY
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.

Assisted living
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 bathing.

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, and nonprofits.

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:


•	Most facilities are operated by small private companies that don't provide information-- including data on their financial strength--needed to make a decision.
•	Neither size, décor, nor amenities necessarily determines the quality of care or assistance available at a facility.
•	There is no standard for care that should be provided and no clear guideline to indicate who belongs in assisted living and who doesn't.
•	The nearly 1 million people who now live in assisted-living residences have become frailer, raising concerns about their safety and care.
•	States regulate assisted living but provide little oversight or protection for residents.

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 National Academy 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 10 providers.)