Assisted living facilities fall short when caring for aging US population, witnesses tell senators

Correction: This article has been updated to accurately reflect the testimony from Julie Simpkins, co-president at assisted living provider Gardant Management Solutions. A previous version contained incorrect information. 

The American population is aging — by 2060, nearly 1 in 4 Americans will be 65 or older, according to the U.S. Census Bureau. Assisted living facilities are already inadequately prepared for the aging population, witnesses told a Senate panel during a Thursday hearing. 

Patricia Vessenmeyer, who testified at the hearing, assisted her husband, John Whitney, during his journey living with dementia after he was diagnosed in 2013. Doctors diagnosed Whitney with dementia with Lewy bodies, causing him to act violently during dreams. 

“Dementia with Lewy bodies is a type of progressive dementia that leads to a decline in thinking, reasoning and independent function,” according to the Alzheimer’s Association. Symptoms can include “spontaneous changes in attention and alertness, recurrent visual hallucinations, REM sleep behavior disorder and slow movement, tremors or rigidity.”

In Whitney’s case, he lost his sense of smell, suffered decreased attention and alertness, gastrointestinal issues and visual hallucinations, and later experienced memory loss.

Vessenmeyer cared for her husband herself until January 2018, when he attempted to strangle her in his sleep. 

Authorities determined Whitney would have to be placed in a long-term care facility in Virginia, where Vessenmeyer lived. She placed him in an assisted living facility that specializes in memory care, making sure to instruct them about the specifics of her husband’s dementia. 

Vessenmeyer observed fundamental failures in the assisted living facility that caused residents distress and serious injury. 

Staff presence was wanting; they were often not around to help with care for her husband. Employees would sit residents who had trouble sleeping in front of TV’s while they worked elsewhere.

Vessenmeyer further described staff as kind but poorly trained and overwhelmed with the disparity between their numbers and residents.

Vessenmeyer noticed PVC pipes, some she claimed were the length of baseball bats, which she said distressed residents could and had used as a weapon.

Tripping hazards exposed residents to the risk of falling. She found a resident “bloody and staggering” after suffering a fall against hard flooring, which no one had noticed. 

Vessenmeyer said she paid $13,000 per month for Whitney’s care at the facility, despite its failings. “If he hadn’t passed away rather quickly in the time he was in there, it would have used up all of my nest egg,” she said.

Senate Special Committee on Aging Chair Sen. Bob Casey (D-Pa.) cited a survey from the National Council on Aging that found 80 percent of adults are unable to afford four years in an assisted living facility.

Assisted living facilities are supposed to be residential options for healthy, older adults who need supervision, while nursing homes are medical environments. Yet assisted living facilities are taking on residents that “have the same needs and vulnerabilities” as nursing home residents, according to Richard Mollot, executive director of the Long Term Care Community Coalition.

This trend comes as the sector has experienced a marked decline in its workforce, which already struggled prior to COVID. According to Julie Simpkins, co-president at assisted living provider Gardant Management Solutions, the industry requires 5 million new direct care workers by 2030 to meet swelling demand. 

Simpkins said her company, the fifth-largest assisted living provider in the U.S., has been limited to operating in states where Medicaid programs make their model viable, such as Indiana, Iowa and Ohio.

Ranking member Sen. Mike Braun (R-Ind.) said his state “is using a combination of state and federal tools to provide more affordable assisted living. As a result, Indiana has seen affordability and quality improve.” 

“To increase safety and transparency, Indiana requires staffing ratios, dementia training and maintains a website that discloses reports and enforcement actions,” Braun said. 

Sen. Elizabeth Warren (D-Mass.) referenced a 2018 Government Accountability Office Report that found “more than half of the 48 states providing [assisted living] services couldn’t tell us the number or nature of critical incidents in assisted living facilities.”

“Critical incidents” can refer to instances of physical, emotional or sexual abuse, according to the report.

Simpkins defended the quality of care her company’s resident’s experience as “life-affirming” and “safe.” But she said the cost and quality of residence, and the competence of staff responsible for a loved one, is dependent on state policy regarding reimbursements.

For families searching for care, “there is no independent, validated information on assisted living,” Mollot said. Americans are forced to rely on the promises of facilities, marketing materials, consumer resource sites paid by facilities to list their operation, and state websites that “tend to be very flimsy,” he added.  

“There’s ‘nursing home care compare,’ ‘home health care compare,’ [and] ‘hospital care compare’ on the Medicaid website.” Mollot said. “There should be an ‘assisted living compare.’” 

Mollot argued the absence of a national standard of care and a comparative database like those provided by Medicare will continue to invite investments from “sophisticated private enterprises who can shuffle around resources and take profits with little regard for the promises made to seniors and their families.” 

“We know that when [private equity] comes into a sector, they often pillage it,” he said.