For millions of older Americans, there’s nothing stronger than the desire to age in place, maintaining their independence and avoiding intensive institutional care for as long as possible. Increasingly, assisted living is filling the gap between home and a nursing facility. States spend a reported $10 billion in federal and state money per year on Medicaid beneficiaries in assisted living facilities, averaging $30,000 per patient, per year. But it’s not clear whether governments are getting their money’s worth in terms of quality of care and, critically, the safety and well-being of the facilities’ residents. Answers to some of those concerns came in a February report from the Government Accountability Office (GAO), which found significant shortcomings in oversight of assisted living facilities across the country. Forty-eight states receive some kind of Medicaid funding for assisted living facilities, but 26 of those states do not report “critical incidents” — including unexplained deaths, abuse, neglect or financial exploitation — to the federal government.
Yet for many who advocate for older Americans, the GAO report had shortcomings of its own. The advocacy group Justice in Aging put out a statement contending that the report “barely scratches the surface” of the lack of oversight and reporting requirements. And Eric Carlson, directing attorney for Justice in Aging, says that even for the 22 states that do collect data on serious infractions, the information isn’t easy enough for the public to obtain. “I’m not sure it would be all that useful,” he says. There is little in the way of federal standards around Medicaid-funded assisted living facilities, leaving states mostly in charge of regulating them. So without clear guidance from the federal Centers for Medicare and Medicaid Services (CMS), these facilities largely operate under a hodgepodge of rules set by states’ long-term care departments.