The Assisted Living Report Card That Doesn’t Exist
Why can’t families easily compare the quality, staffing and safety of the place where they may spend $6,000, $8,000 or $10,000 a month?
In a recent Sixty and Me article about ownership of senior living communities, one reader was shocked that few if any regulations exist in assisted living.
“Wow, I did not know most of this information. Are there independent reviews done in a standard format for Assisted Living? Where are they published? If not, is there a spreadsheet available with all the critical factors listed, that we can use to perform the review ourselves?”
My answer – no. Not really. And that may be one of the biggest failures in the entire assisted-living system.
Standardized Rating Exists in Most Businesses
We have standardized ratings for hotels, restaurants, cars, colleges, hospitals and nursing homes to name a few.
Yet when a family is about to make a $70,000–$120,000-a-year decision involving an older person’s safety and quality of life, there is no universally accepted consumer report card.
Why can I compare hotels by cleanliness, service and customer reviews, but I can’t easily compare assisted-living communities by staffing, turnover, training, medication errors or regulatory violations?
Why It Is Fragmented
The basic problem: Assisted living is largely regulated by the states. So there isn’t one national standard for staffing, staff-to-resident ratios, training, inspections, reporting requirements, medication management, dementia care, complaints, disclosure of deficiencies.
When information exists, it may be buried in state databases, inspection reports or licensing records. Information isn’t the same thing as transparency. So don’t expect the community you’re evaluating to readily supply this information.
If you have to search three government websites and decipher a 40-page inspection report to figure out whether Mom’s prospective home has chronic staffing problems, that’s not meaningful transparency.
In a nutshell:
- The industry argues that assisted living is fundamentally different from nursing homes.
- Communities have different resident populations and care models.
- More regulation costs money.
- Higher staffing requirements can increase the cost to families.
- Operators don’t want a one-size-fits-all model.
- There is a long history of treating assisted living as housing plus services rather than healthcare.
What Could a Real Assisted Living Report Card Measure?
Here is a start in creating your own checklist.
A. Staffing: Ask about
- Residents per caregiver
- Staffing by shift
- Overnight staffing
- RN/LPN availability
- Use of agency/temporary staff
- Staff turnover
- Average tenure
- Call-outs/open positions
Don’t just ask how many employees they have. Ask who is actually working at 2 a.m.
B. Training: Ask about
- Orientation hours
- Annual training hours
- Dementia training
- Medication training
- Fall prevention
- Emergency preparedness
- CPR/first aid
- De-escalation
- Abuse/neglect recognition
C. Safety & Quality: Ask about
- Falls
- Medication errors
- Hospital transfers
- Serious injuries
- Complaints
- Regulatory violations
- Corrective actions
D. Resident Experience: Ask about
- Resident satisfaction
- Family satisfaction
- Activities
- Dining
- Transportation
- Social engagement
- Ability to personalize care
- Resident/family councils
E. Leadership – Ask about
- Executive director tenure
- Director of nursing tenure
- Turnover in leadership
- Ownership
- For-profit/nonprofit
- Recent ownership change
F. Financial Transparency: Ask about
- Base monthly price
- Average actual monthly cost
- Care-level increases
- Medication fees
- Ancillary charges
- Move-in fees
- Annual increases
- What happens when care needs increase?
The advertised price isn’t necessarily the price.
We Need a “Minimum Floor”
Every resident should be entitled to certain minimum standards.
Whatever state you live in, shouldn’t there be a minimum level of training for someone responsible for administering medications?
Shouldn’t there be some minimum expectation for how many qualified people are available to care for residents overnight?
Shouldn’t families know how often employees are leaving?
Shouldn’t consumers be able to see a community’s history of serious complaints and violations in a standardized format?
Until Somebody Creates that Report Card, Families Can Create Their Own
After asking the important questions above, document your ratings by starting here. On a scale of 1-5, rate:
| Category | Score |
| Staffing | /5 |
| Staff turnover | /5 |
| Training | /5 |
| Safety | /5 |
| Dementia care | /5 |
| Resident experience | /5 |
| Leadership stability | /5 |
| Transparency | /5 |
| Cost transparency | /5 |
| Regulatory history | /5 |
Ask Specific Questions
- “How many caregivers will actually be working on Mom’s floor at 7 p.m. tonight?”
- “What percentage of your direct-care employees left in the last 12 months?”
- “How many hours of dementia-specific training does a new caregiver receive before working independently?”
- “What did the average resident actually pay last month, including care and ancillary fees?”
You get the idea.
We have decided that families deserve standardized information when buying a refrigerator, a car or a hotel room. Yet when they’re choosing where their mother, father or spouse will live – and where they may spend the final years of their life – we essentially tell them to take a tour and trust their gut.
That’s not a system of transparency. It’s a system of hope.
Maybe it’s time for an assisted-living report card.
Let’s Start a Discussion:
If a standardized Assisted Living Consumer Scorecard existed, would you use it? What would you add?
