Assisted Living: A Devastating Truth (Part 1 of 2)

Elder abuse is alive and well in San Diego. Here’s the surprise for most people: The perpetrators are not always the usual suspects; often they are the providers of elder care.

The Union Tribune wrote a series of investigative articles titled “Deadly Neglect”, about the pandemic-related conditions in San Diego’s assisted living facilities. These were important articles and should have opened a lot of eyes. For instance, they found evidence that many San Diego County seniors have died from injuries and neglect suffered in local assisted living facilities, and very few cases were ever investigated by the state agency responsible for overseeing them!

Unfortunately, for those of us who know elder care from the inside out, this sad tale is all too believable. The real story is that the problem is far worse and more systemic than anyone, even the writers of these articles were aware. What is described is only the proverbial tip of the iceberg.

There are several high-profile facilities owned by large elder care corporations mentioned in these articles, but after being a professional advocate for the elderly in San Diego since the 90’s, I have to tell you that the problem is not isolated to a few poorly run facilities. It is everywhere. Every single assisted living in San Diego is a potential set up for neglect and mismanagement of the elders they care for.

What is wrong with this system of elder care?

For starters, let’s look at the regulatory entity responsible for oversight of these assisted livings. You’d think that the agency that oversees our elders in assisted livings would be a health and human services agency, right? You’d be wrong.

Reality check number one: The assisted living facilities referred to in these articles are overseen by the Department of Social Services (DSS) which doesn’t necessarily know the first thing about managing the multiple chronic illnesses of the geriatric population. What they lack in expertise and ability to recognize problems; they do not make up in any dedication to monitor quality or safety by putting “boots on the ground” in the ongoing war against elder neglect and abuse.

There simply are no “boots on the ground.” Shrinking budgets of all state agencies means that there are not enough investigators, or ombudsmen or advocates of any governmental stripe, to monitor those elders or families who’ve made complaints about their care in facilities. There are thousands more elders who cannot voice their complaints to ombudsmen even if they wanted to, since many suffer from dementia or fear retribution from direct care staff. So, they remain mute.

Simply stated, the state is not going to save your loved one from the tragedies painfully brought to light in this Union Tribune investigative series. That expectation, in the face of shrinking health care dollars and governmental budgets, is a denial of reality that may be as dangerous as the reality itself. What is needed here is for people to know the truth; there is little to no governmental oversight in these assisted livings and residential care facilities.

Reality check number two: The assisted living model is a set up for failure because it is not structurally or functionally sound. It is a non-medical model serving a medically fragile population. At the heart of it, this is an oxymoron. There is no such thing as “non-medical” in properly serving the needs of the geriatric population with multiple chronic illnesses!

You may say, “Now wait a minute, this is confusing.” People are drawn to the non-institutional, “non-medical” setting of the assisted livings, that feel more “normal” and more like home, precisely because they are not based on a medical model. Assisted livings and residential care facilities for the elderly (RCFE’s) are more like home, or a lovely bed and breakfast, than a cold and scary nursing home. They are also less expensive by about half.

So, here is the problem in a nutshell: The reason for the success of the assisted livings and RCFE’s is also the very reason they are apt to fail so many of our elders. This is true because the large majority of assisted living and RCFE residents have multiple chronic illnesses and no one to adequately oversee the management of their medical needs.

To put it more bluntly, these residents of the in-between world of assisted livings are frail elders who need skilled medical management. These elders are many times on the edge of the event that will catapult them into the hospital, or the nursing home they are so afraid of, or… an early death, as one of the Union Tribune article points out.  They simply don’t have the benefit of continuously focused medical management as an overlay to the non-medical support environment.

I don’t mean just one licensed nurse on the dayshift with too many residents to monitor; I mean an actual certified geriatric care manager on staff or even as a consultant. The critical pulse points for these elders need to be monitored carefully, or these medically complex residents will be on the fast track to tragedy. After 30 years of providing professional care management in San Diego, I’ve come to realize the life changing effect our expertise can have on an elder.

What to do when the very reason for success is also the reason for failure?

These non-medical models of care delivery need to adapt to this critical deficit by providing options for skilled oversight and advocacy, as needed and desired by their clients and families. This is a very large elephant in the room and no one in the industry quite knows what to do with it.

Solutions will take a paradigm shift of pachyderm proportions for sure, but regardless of the difficulty and resistance inherent in all transformational change, we are compelled to point to what successful navigation between a rock and hard place looks like in our world.

A change in structure must be designed so that a change in function can be achieved. There is a path forward, and our elders and their families desperately need to be given answers. They need road maps and guides so they can steer to safer and more satisfying experiences during the most important and difficult times of their lives.

Birth is difficult and growing up is no cakewalk, but it only gets harder towards the end.

Aging and death need to be infused with compassion and meaning, not tragically marred with horrific and wholly avoidable experiences.

Be sure to read Part Two of this exploration into assisted living care delivery. We will look at it from a systems analysis point of view and offer solutions.

If you feel unseen, scared, or confused about your or your loved one’s living situation, or you just need help managing the care of your loved one, Grace Care Management is here to support you. Give us a call at (760) 789-9177 for a free consultation.