Ask hard questions of assisted-living facilities

Is an assisted-living community a wise choice?
The answer is a resounding "yes," depending on the health and needs of the individual and the careful selection of a well-run community.

However, recently, after watching a "Frontline" program entitled, "Life and Death in Assisted Living" on public television, I was left with the impression that I wouldn't consider it for my worst enemy; let alone a loved one.

The PBS program presented a very one-sided picture; but in fairness to them, it did dramatize a real and growing problem as our population ages and requires more complex care. (Currently, assisted-living communities are home to more than 750,000 Americans).

PBS reporters looked at regulatory records from Texas, California, Iowa, Mississippi, Georgia, Ohio and Florida. They found that one of the very largest companies, Emeritus, which has grown dramatically in recent years, had been cited for numerous violations. Inspectors in each state, have, since 2007, cited Emeritus for keeping seniors with aggressive dementia as well as wheelchair-bound residents who couldn't move. Residents with these types of problems are not appropriate for assisted-living situations.

Assisted living is designed to help those who need some help in order to continue to live independently; it cannot accommodate those who need nursing home care. Yet Emeritus was found to have a policy of "Keep the Back Door Shut," tracking any move-outs and penalizing any of their communities who "lost" residents.

Most shocking of all, was the case of a California resident, Joan Boice who due to advanced mental illness was unable to communicate to her family that she was in great pain from pressure ulcers in many parts of her body that were not being treated. After just a few months, Joan died, and the family sued and won a large settlement.

In Texas, Mabel Austin who suffered from Alzheimer's, wandered out from her room and froze to death. At another Emeritus Assisted Living in Iowa, it took 12 hours to call an ambulance after an 84-year-old fell; while in Pennsylvania, an 86-year-old woman died when she became locked in a bathroom for 36 hours before anyone noticed she was missing.

While these incidents may be the exception, that fact is of little solace to the families who lost loved ones through oversight and neglect. How can families be sure they have made a good choice for a loved one? First, it is important to know that while nursing homes are federally regulated, in assisted living, regulations vary widely from state to state; with not even an agreed-upon definition of assisted living.

I spoke with David Vail of Guilford, an outstanding consultant to the industry. Vail, along with the attorney, Martha Meng, was responsible for writing some very strict state laws, here in Connecticut. Dave told me that the very large, publicly traded companies such as Emeritus, are under pressure to hit financial goals and that often, size is not an indicator of quality.

While there is a website, Nursing Home Compare, where consumers can check on nursing homes, there is no truly independent source for assisted living. For 15 years, I have been helping seniors choose and then move into assisted-living and continuing-care communities, and I have often remained in touch with both the senior and their families over a long period of time.

In all those years, I have heard complaints about the food, the lack of storage space, or a missing laundry item, but I have not heard of one case of abuse or neglect. In fact, most residents praise the helpful staff, enjoy the many activities and new friends they have made and remark, "Why did I wait so long to move?"

If assisted living may be a future choice for you or a family member, this is what I suggest:

1. Find out what regulations are in place in that state.

2. Check state authorities to see if inspection reports are posted on line.

3. Do your homework. Ask the hard questions.

4. Visit the facility several times at different times of day.

5. Find out the longevity of the staff, their training and ratio of staff to resident.

6. Talk to residents.

7. Send for AARP's checklist for visiting assisted-living communities.

8. Check with an elder-law attorney before signing an admissions agreement.

For residents with dementia, know how the facility manages their care and safety. Understand what level of care is needed and how that may change with age. Assisted-living facilities often have limited medical staffs so for some seniors, a nursing home is the better option.

Contact Jean Cherni, certified senior adviser for Senior Living Solutions and Pearce Plus, a helpful, full-service program for seniors contemplating a move, at jeancherni@sbcglobal.net or 49 Rose St., Apt. 510, Branford, 06405.

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