Is an Assisted Living Home Better than a Long-term Care Facility?



Is an Assisted Living home better than a long-term care facility?


Advocates for the aging and disabled are tossing out a “red flag” warning to families and the public as the state of Illinois moves closer to having more patients on Medicare and Medicaid cared for within Assisted Living and “sheltered” environments rather than increase home care funding that would allow individuals to remain in their own home longer, or care within traditional long-term facilities.
The move to smaller assisted living environments is one critics insist is based upon money and political interests, not quality care, and one in which many will fall into the cracks of an already badly broken system, increasing the likelihood of expanded abuse and neglect.
Assisted living care typically requires a resident to be able to manage their basic needs, such as dressing themselves, simple hygiene, and joining in for group meals. The danger is that once placed into a smaller, mostly semi-dependent environment, caregivers will be reluctant to recommend transfer to intermediate or long-term care placement if and when, the health and independence of the resident declines, as profitability depends on occupancy and maintaining a “full house”. How far a resident will sink into physical and/or mental despair before a transfer to a more suitable care environment happens is anyone’s guess, for oversight of Assisted Living care facilities is even worse than that of long-term care establishments.
From the outside, the smaller more intimate environment has its appeal. Fewer residents imply that more time and care to an individual’s needs can be given, while the home-like environment also congers up images of a family setting where dining and daily activities are shared with others.
But the more glorified and marketable idea behind such a loving and giving environment quickly falls away when oversight by the state is nearly non-existent to protect residents of Assisted Living. Illinois currently has three categories of Assisted Living environments and it is not clear how increased oversight will be managed as patients are shuffled, or by whom. There have also been cases in which such facilities have advertised as Assisted Living environments without the necessary license to do so, yet according to advocates for the aging, the Department of Public Health has yet to issue any fines against such places.
Some facilities, primarily within the category of Sheltered Living classification, fail to maintain safe medication administration records, adequate emergency contact and medical history information, and many rely upon cheap labor consisting of inexperienced staff, often non-English speaking help that are ill equipped and poorly trained; unable to understand a resident’s needs or communicate properly to emergency personnel when a crisis arises. Worse yet, there are few laws that require more, and even fewer state representatives to perform routine evaluations.
The laws currently on the books (although ignored day in and day out by state appointed agencies, such as the Dept. of Aging and governor’s office itself) protecting long-term care residents, do not apply to Assisted Living. Laws governing and protecting Assisted Living residents and their quality of care (or not) are either non-existent or much more lenient under the State.
Federal laws governing long-term care, for example, requires that every resident be provided a care plan that includes monitoring and updating, outlining limitations and special needs and how those limitations and needs will be met. Within Assisted Living the process is defined as “plan for care” and is far less regulated; no mandatory checks and balances and no one oversight that could prove the wiser.  Furthermore, the state is currently failing miserably in their attempt to simply provide adequate inspections at long-term care facilities, let alone add the growing number of less-regulated Assisted Living establishments to their under-funded, over-taxed staff levels.
And probably most important, there are no standard fines for citations that place residents “at risk” within the Assisted Care program; little oversight, no accountability and shamefully few protections for the resident who lacks family members close by to be their advocates.
Fines assessed for the increasing number of new and reoccurring long-term care citations (crimes against human beings) are already whittled down to pennies on the dollar or never collected at all; a contributing factor to the state’s inability to afford a more expanded Ombudsman program giving families and patients adequate help and representation when problems of abuse or neglect occur.
The state has left families, as well as disabled and aging individuals with little choice but to succumb to care that often offer little more than public storage of human beings. It is a care system that violates even the most basic of federal guidelines and yet, continues to decline with shameful indifference by those who have the ability to change it at the state level.
Those who could otherwise manage care within their own home environment through true cost-savings actions by the state, such as more funding for at-home assistance, are sacrificed so that the financial health and welfare of commercial and corporate interests prevail, allowing for an expanded age-driven marketplace that preys on human life while the state remains blindly silent.
In far too many cases, the term “Assisted Living”, much like that of Long-Term Care applies to helping those charged with providing care and paid well to do so, live better lives themselves at the expense of the needy, the poor, the disabled and the elderly.