Our Assisted Living System is Failing

As first appeared in The Hill

By Aron Solomon

The problem of seniors with cognitive issues wandering away from assisted living facilities or being left outside unattended has been thrust into the legal and societal spotlight as the year came to a close. Since 2018, at least 98 seniors have died under such circumstances, according tothe findings of a blockbuster investigation published in December by The Washington Post. 

The investigation analyzed over 100,000 state inspection reports and found that more than 61 percent of the deaths were due to exposure to extreme heat or cold. The causes of death varied, with some patients drowning or being hit by cars. The investigation also highlighted that the numbers the Post discovered are almost certainly a daily profound undercount, as 19 states don’t currently allow public access to their state reports.  

The cases uncovered by the investigation shed light on a concerning trend of neglect in the assisted living industry, where many elderly patients, particularly those with Alzheimer’s disease or other mental impairments, have suffered fatal consequences after wandering away from these facilities. 

Anyone reading the compelling interactive Post report is left with two pressing overarching questions: how do such horrific incidents occur, and what are potentially viable solutions to prevent them? 

Causes of the problem 

One of the primary reasons for these incidents is a lack of supervision in assisted living facilities. Understaffing these facilities places an undue and wholly unrealistic burden on their staff.  

As Lindsey E. Gale, a Florida nursing home abuse lawyer, observes, “Assisted living facilities create both a process and structural failure by understaffing. It’s a process failure because this conscious understaffing is often recognized and approved at every level of the facility’s senior leadership. It’s a structural failure because this understaffing becomes the practical foundation for what it causes, including the tragic deaths outlined in the Washington Post investigation.” 

Another contributing factor is the nature of cognitive decline in seniors. Three in five people with Alzheimer’s disease or another type of dementia will wander. This wandering can result from discomfort, anxiety or fear and can also occur when a senior tries to find someone or something.  

This quickly becomes a perfect storm with inadequate supervision. While we all would hope and expect that there would be failsafe procedures to ensure that every assisted living facility resident with cognitive decline would be prevented from wandering off and never be left unattended, the Post report reminds us that this simply isn’t the reality.  

Enhanced supervision and staffing 

Improving supervision is a crucial step in preventing such incidents. As Attorney Gale reminds us, “In every assisted living facility and nursing home across the nation, residents can be kept safe only with proper supervision. The cost of this adequate supervision is the cost of being in this business — it’s a must-have, not a nice-to-have.” 

The Washington Post investigation leads any reasonable reader to question the calculus some assisted living facilities clearly do. Suppose the cost of running the facility with unacceptable staffing and supervision and paying out legal fees and lawsuits is less than the cost of always running the facility properly. In that case, some less responsible and reputable facilities might choose the former.  

Regular reassessment of the needs of residents 

As dementia is a progressive and degenerative disease, the condition of affected residents can, and very likely will, change over time. This means that it is incumbent upon all assisted living facilities to thoroughly assess, document and monitor the ongoing condition of each impacted resident.  

Again, this seems like common sense to the general public and something that every assisted living facility and team would prioritize. The reality can be far different, as residents who were once reasonably alert and self-sufficient regarding walking and navigation can deteriorate. 

Improved facility design and safety measures 

Assisted living facilities can also implement safety measures to prevent falls and wandering. These measures can include keeping resident apartments and hallways free of clutter and fall hazards, using chair and bed alarms, and ensuring that hallways are wide and unobstructed for residents who use walkers and wheelchairs. All of these facilities should consider anything that is another layer of safety.  

Legislation for higher standards of care 

Legislation can play a crucial role in mandating higher standards of care in assisted living facilities. Current rules specify that an assisted living operator must provide each resident with considerate and respectful care, promoting the resident’s dignity, autonomy, independence, and privacy. In light of the Washington Post investigation, there is a powerful argument to be made that these rules should be expanded to include specific requirements for staffing levels, supervision standards and safety measures. 

Transition to higher care facilities

Ultimately, what this investigation reveals is that where an assisted living facility can’t prevent falls or wandering in a resident, they should consider discharging the resident to a higher care facility.  

The issue of seniors with cognitive issues wandering away from assisted living facilities or being left outside unattended is complex and multifaceted, and it isn’t going to go away. Only through enhanced supervision; regular reassessment of residents’ needs; improved facility design and safety measures; legislation for higher standards of care; and careful transition to higher care facilities can the occurrence of such tragic incidents be eventually reduced. 

About Aron Solomon

A Pulitzer Prize-nominated writer, Aron Solomon, JD, is the Chief Legal Analyst for Esquire Digital and the Editor-in-Chief for Today’s Esquire. He has taught entrepreneurship at McGill University and the University of Pennsylvania, and was elected to Fastcase 50, recognizing the top 50 legal innovators in the world. Aron has been featured in Forbes, CBS News, CNBC, USA Today, ESPN, TechCrunch, The Hill, BuzzFeed, Fortune, Venture Beat, The Independent, Fortune China, Yahoo!, ABA Journal, Law.com, The Boston Globe, YouTube, NewsBreak, and many other leading publications.