Terrell · Hogan

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Leaders Forum 2016
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By Albert Lechner and Wayne Hogan

Today, according to the U.S. Department of Health and Human Services, more than 750,000 people reside in more than 31,000 assisted living facil­ities across the country. Assisted living facil­ities provide housing, meals and one or more personal services to residents. Like nursing homes, assisted living facil­ities are licensed by the State. Assisted living facil­ities became a growth industry in America; they attracted the affection of Wall Street. Assisted living facil­ities became a big business. As that big business grew, it also encoun­tered the ups and downs of the national economy and the business of assisted living facil­ities has confronted the question of how to maintain the life of the bottom line without contributing to the deaths of those they were trusted to assist.

Assisted living facil­ities that claim to provide care of persons with Alzheimer’s disease or other related disorders must meet certain, more stringent require­ments. These include having a specified number of providers on duty night and day depending on the number of residents and/or having mecha­nisms in place to monitor the safety of residents, and having activ­ities specif­i­cally designed for persons who are cogni­tively impaired. Assisted living facil­ities, also called “ALFs”, must hire and provide staff with specialized training and continuing specialized education on a yearly basis.

ALF’s are required to report changes in a resident’s cognition/brain function or signs of impairment or dementia to a licensed physician within a certain period of time. If such a condition is deter­mined to exist, the facility must provide the necessary care and services to treat the condition.

The assisted living facility is respon­sible for deter­mining the appro­pri­ateness of admission of a particular individual and the continued appro­pri­ateness of residence at the facility. However, a resident may not be moved from one facility to another without consul­tation with – and agreement from – the resident (or, if applicable, the resident’s repre­sen­tative or designee). A facility must give the resident at least 45 days notice of relocation or termi­nation of residency from the facility unless a physician can certify that for medical reasons the resident requires an emergency relocation. Reasons to terminate the residency must be set forth by the facility in writing.

Lately there have been increasing reports of ALFs across the country cited for hiring inappro­pri­ately trained staff, for inade­quate staffing levels, or for failing to provide appro­priate and necessary medical care. Many ALFs are owned by huge corporate entities; to deflect attention from proven viola­tions of federal and/or state regula­tions, they may point to “overall” resident satis­faction, but satis­fying some does not diminish the trauma of death and disease among other residents; one abused or neglected resident is one too many. Just as in nursing homes, when abuse or neglect in assisted living facil­ities cause personal injuries and wrongful deaths, the law provides ways to hold facil­ities accountable when they violate the trust of those who rely on them for assis­tance. In Florida, Florida Statute 429 covers how ALFs should operate.

Tonight, Frontline, on PBS, explores Life and Death in Assisted Living. There is much to learn about this growing aspect of aging in America. This documentary is one source of infor­mation about a subject that many, many families have faced, are facing now or will face over the coming years. It provides a history of the industry and how it has grown, reveals approaches to sales and promotion and how aspects of the industry conduct business, and discusses respon­si­bility and account­ability for the owners and operators of assisted living facil­ities.