Consumer Groups Disappointed With Assisted Living Report

A working group charged with making recommendations on how to regulate the rapidly expanding assisted living industry has issued its final report. A number of consumer members of the group expressed keen disappointment with the report, saying that the only consensus was that more work needs to be done.

Nearly 1 million U.S. residents live in the nation''s 36,399 assisted-living facilities, a nearly 50 percent increase since 1998. Although two-thirds of states have passed legislation or issued regulations to license or monitor assisted living, these facilities are not subject to the same regulations as nursing homes, and there have been concerns over the treatment of residents at some facilities.

The Assisted Living Workgroup was formed two years ago after a Senate Special Committee on Aging hearing into the assisted living industry. The group was comprised of almost 50 groups of health care professionals, providers, consumer advocates and representatives of the disability community. On April 29, the group presented its Final Report to the Senate committee.

Among other recommendations, the report calls for the establishment of a national center to analyze and suggest regulations to states and Congress, and urges that states require licensing for any facility that declares itself to be an assisted living residence. The report notes that regulations should ensure that "trained and awake staff are on duty" at all times and that medicines are kept and administered safely. The report also recommends that assisted living facilities offer written disclosure of their costs, services and policies, including a minimum notice for any changes or terminations.

But not all members of the Assisted Living Workgroup working group were pleased with the results. The National Senior Citizens Law Center (NSCLC) and eight other organizations refused to concur with the Final Report's recommendations, asserting that they were neither well-crafted, nor did they serve as good guidelines for future regulations at either the state or federal level. "The only clear consensus was that much more work remains to be done," the NSCLC said.

The NSCLC noted that the Workgroup was never even able to reach a consensus definition of 'assisted living.' Moreover, said the NSCLC:

  • The recommendations of the Final Report generally were made without recognition of existing quality of care problems in assisted living.
  • The Workgroup gave almost no consideration to states' existing assisted living laws, whether those laws have been successful or unsuccessful, and how those laws could be modified or improved.
  • The Final Report does not distinguish between different types of assisted living facilities, even if, for example, one type of assisted living facility provides relatively high-intensity health care services, and another type of assisted living facility provides no health care services whatsoever.

The NSCLC and the other dissenting organizations issued a minority report, Policy Principles for Assisted Living, which urges that states establish more than one level of license, depending on physical and mental conditions of residents at the facility and that assisted living facilities be subject to the same nondiscrimination rules that govern nursing homes to assure that low-income Medicaid beneficiaries are treated fairly.

Given the tepid nature of the working group''s recommendations, Congress may step in. "You can find more information on the Internet about a toaster oven than you can about an assisted-living facility," said Sen. John Breaux (D-La.), ranking minority member of the Senate Aging Committee. "The states know, and the user groups know, that if they don''t move on [regulations], Congress is going to do something. You can''t have 50 different sets of rules."

To download the report or purchase the print version ($24), go to the Assisted Living Workgroup Web site at

The Policy Principles for Assisted Living are available at:

To read an Associated Press news article on the report, click here. (Article may be only temporarily available.)