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A Close Look at the Assisted Living Industry – And What You Should Do About It Christy Rakoczy

August 26th, 2013

Frontline-LifeDeath2Recently, PBS’s Frontline produced an in depth three part series on what life is like inside of assisted living facilities. PBS focused on assisted living facilities run by Emeritus, the parent company of the largest chain of assisted-living facilities in the nation.  Emeritus was chosen as the focus because, as a large national chain, it has the resources and infrastructure to provide adequate care to patients. Unfortunately, it alleged that Emeritus was falling short and letting patients down in many ways.

The disturbing three-part Frontline series highlighted tragic stories of patients in assisted living facilities who died in care facilities that did not have the tools or policies in place to care for them.  Unfortunately, variations of these stories may happen without the headlines at many assisted living facilities throughout the United States, as the business model of assisted living may be set up to encourage a focus on profits rather than people.

Problems in assisted living facilities typically occur for three primary reasons: there is insufficient data on facilities for families placing loved ones; many families and individuals fail to understand the differences between assisted living and nursing home care; and families often face time pressure when trying to place relatives who need care immediately.

An Absence of Information on Assisted Living Facilities Puts Patients at Risk

The problems at the Emeritus assisted living facilities stemmed from trying to keep beds full and prevent residents from moving out into nursing homes, patients died as a result of a lack of supervision and improper care. One patient, for example, was poisoned by industrial strength cleaners that were not locked away. Another suffered untreated bedsores.

These cases were well-publicized by the PBS documentary, but too many cases of neglect go unreported in the United States. In fact, the National Center on Elder Abuse estimates that for every one case of abuse, neglect or exploitation that is reported to authorities, five cases of elder abuse go unreported.

Even when deficiencies come to the attention of authorities, there is no central database that family members can easily go to in order to see that an assisted living facility has been cited for abuse or had complaints made against it. Where report cards and databases do exist, such as the Medicare nursing home compare tools, these databases are usually focused on nursing homes.   Assisted living facilities are generally subject to less regulation and less oversight, typically, because most of these facilities are not intended to provide nursing care to patients.

This leaves family members who are struggling to place loved ones left with limited sources of information about assisted living facilities.

A Fundamental Misunderstanding

The PBS documentary portrayed several situations where patients remained at an assisted living facility for too long, as the patients developed medical issues that should have resulted in them moving into a nursing home.

Unfortunately, many patients and families misunderstand the difference between nursing homes and assisted living environments.  As the documentary clearly illustrated, assisted living facilities are not equipped to provide advanced nursing care to patients and should provide a living solution for those who are not yet ready for nursing homes. Assisted living facilities are less restrictive and less institutional but do not have resources or trained personnel who are capable of responding to life-threatening conditions.

Unfortunately, some assisted living facilities focus on occupancy and want to keep beds filled.  As a result, employees discuss a focus on keeping patients from going “out the back door,” or leaving the residencies.

In one case, efforts to keep a patient in an assisted living facility resulted in employees covering up cases of severe bedsores, attempting to treat this problem in-house without the tools or ability to do so, so the patient would not move to a nursing home when they should. The result of this was fatal.  Individuals and family members of patients need to understand the fundamental differences between assisted living facilities and nursing homes so that they can ensure that patients are in the right place to get the help they need.

Time Pressure Exacerbates Problems 

The problems associated with a lack of information and a lack of understanding of the role of assisted living facilities are often exacerbated by the fact that families may wait to do research on assisted living facilities and nursing homes until they are in a situation where action needs to be taken right away. Once it becomes unsafe for a senior to live by himself or herself, a move needs to be made quickly.  This can result in family members scrambling to find a facility without doing the proper research to determine if the facility is the right one.

Difficulty finding facilities with open beds can make the situation worse, as family members may end up simply choosing the first home they can find without a waiting list, even if that home is not equipped to provide the necessary care to the senior.

Do you have any experience(s) with you or a loved one looking for a potential Assisted Living provider? Have you gone through any of these struggles and have first-hand information or feedback that you could share? Please do let us know and share it with our #OpenCommunity network and leave a comment and/or feedback below in the comments section.


  1. Laura Wayman, The Dementia Whisperer August 26, 2013

    Thank you for this very well researched and informative article. I feel as a dementia care expert and care provider that we all need to become more of a team to ensure all the many options of elder care are stepping up to do better in this industry. And every effort must be made to allow easy access to education for the family care provider to ensure that they are well educated consumers with realistic expectations of where to go-what they need-and how they can have the most peace of mind that their loved one is being cared for appropriately. I wrote my book, A Loving Approach to Dementia Care, published by Johns Hopkins University Press, for the family care giver as well as the professional care provider, and am continuing my educational outreach to help those who are caring for someone with any form of dementia. I often refer my clients to in home care, assisted living, memory care or day care services, but they are empowered with the knowledge that they can make informed care decisions. And the sooner they can start making informed decisions, just as your article explains, the more options they will be able to access. Thank you, Laura Wayman,, The Dementia Whisperer

  2. Tryn Rose August 28, 2013

    Thank you for this article. I agree with everything that Laura said above. It’s so important for care communities to have a realistic picture of what they can do for people, and serve them well by gracefully encouraging the transition to the next supportive place. This website helps with the thinking and deciding that caregivers and professionals need to do to make these moves easier for all involved. Keep up the good work. Tryn Rose Seley, Author, “15 Minutes of Fame: Empowering Caregivers of those with Alzheimer’s”

  3. Karen Patterson August 29, 2013

    As a client services manager in an Assisted living the assessment of patient condition was essential to accurate placement. If the management is more interested in filling vacancies than appropriate care levels there is total conflict resulting in dangerous health issues. Consequently the facility suffers due to the high turnover and reputation damage. Fine Lines need Fine people to walk them!

  4. Rick Lauber: Caregiver's Guide for Canadians August 29, 2013

    Having watched this mentioned PBS documentary, I am very familiar with the Emeritus situation and am dismayed. While long-term care is a business (and a growing business, considering our country’s aging population), such facilities should never forget that they are dealing with human beings whose care, well-being and quality of life in their final years should be of primary concern … the money will come.

  5. Emeritus August 29, 2013

    It’s unfortunate that you chose to take this TV program as fact, and manipulated its findings to promote your services.

    At Emeritus, we are deeply disappointed that Frontline chose to sensationalize our residents’ personal tragedies. In reality, we do care for 50,000 residents 24/7 every year, and it’s clear that Frontline chose the most unfortunate incidents from many years ago to feature in order to boost their ratings. Their doing so does a terrible disservice to people hoping to learn more about their senior care options and a missed opportunity to educate families about their rights and responsibilities in accessing care for their loved one.

    It was clear from the beginning of our one-year relationship with the Frontline reporters that they had no intention of presenting a fair report. Emeritus provided extensive amount of data, answers, information, and six hours of interviews with our top executives — very little of which were included in their report. Their own independent research turned up numerous stories where families reported the positive difference Emeritus made in their lives and employees who loved working for Emeritus. They chose to ignore them all, and didn’t offer on-camera interviews to anyone who had a positive experience to talk about.

    Instead of balancing a report with these real stories, Frontline seized on isolated incidents to fulfill their own agenda. The real story of Emeritus’ success is told from the thousands and thousands of letters, e-mails, cards, comments and notes Emeritus receives, thanking and praising our staff for enhancing the life of a loved one. Just some of these real-life stories can be read at

    The real story is not sensational television. It is simply the story of hundreds of thousands of residents and families whose lives are improved and enhanced by the care and compassion we provide to them every day.

    To learn more about the real story of Emeritus, please visit

    1. Christy Rakoczy August 30, 2013

      Thank you for this excellent comment and feedback! It is terrific to see how committed and dedicated Emeritus is to making this right. Unfortunately, you have quickly rushed to judgement and wrongly have accused me for taking this TV program for fact. If you careful read this post as well as the most recent post on the blog:

      The Fundamental Differences between Assisted Living Facilities and Nursing Care Facilities

      You will see that there are many things that all family members, potential residents and caregivers can do when evaluating Assisted Living providers and it is not all on the operator.

      There was no manipulation of any finding. Thank you though for taking the time to provide feedback to our readers. Though, it is best to understand and read the entire story first before rushing to judgment.

  6. Maitraee Samadder March 11, 2014

    Thank you so much for sharing this valuable knowledge with us. Looking forward for more posts from you.


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