The United States Pays Billions of Dollars Annually for Senior Care Solutions, But Are We Getting Our Monies Worth?

WASHINGTON DC — Federal and State investigators say they have found huge gaps in the regulation of assisted living facilities, a shortfall of funds, that they say has potentially jeopardized the care of hundreds of thousands of seniors served by the booming senior care industry.

The federal government lacks even basic statistical information about the quality and quantity of assisted living services provided to poverty stricken and low-income people on Medicaid, the Government Accountability Office, a nonpartisan investigative arm of Congress, says in a recent report issued, We just don’t know the data gathering process yet and are trying to reign in documents to make decisions that are beneficial to the needy.

Billions of dollars in U.S. government spending is flowing to the industry even as it operates under a patchwork of vague standards and limited supervision by federal and state authorities. States reported spending more than $10 billion a year in federal and state funds for assisted living services for more than 300,000+ Medicaid beneficiaries, an average of more than $30,000 a person per year, the Government Accountability Office found in a survey of states that are of highly populated with low-income aged residents.

States are supposed to keep track of all the cases involving the abuse, neglect, exploitation or unexplained deaths of Medicaid beneficiaries in assisted living facilities. But, believe this, the report said, more than 50% of the states were not able to provide data records or any type of information on the number or nature of such cases regarding these people.

Just 22 out of 50 states were able to provide data only on “most critical of incidents of cases of potential or actual harm that was because the local police had the police report documents.” In one year, those states reported a total of almost 23,000 incidents, including the physical, emotional or sexual abuse to the residents.

Many of those people are “particularly vulnerable,” the report said, like older adults and people with physical or intellectual disabilities. More than a third of residents are believed to have Memory Problems, Alzheimer’s or other forms of daily dementia.

The recent report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Titled “Improved Federal Oversight of Beneficiary Health and Welfare Is Needed,” it grew out of a major two-year study requested by a bipartisan group of four senators.

Assisted living communities are intended to be a bridge between living at home and living in a nursing home. Residents can live in apartments or houses, with a high degree of self-independence, but can still receive help managing their medications and performing daily activities like bathing, dressing, eating and shopping.
Nothing in the report disputes the fact that some assisted living facilities provide high-quality, compassionate care that increases the quality of life.

The National Center for Assisted Living, a United States Trade group for service providers, said states already had “a robust oversight system” to ensure proper care for residents. In the last two years, it said, several states, including California, Oregon, Rhode Island and Virginia, have adopted laws to enhance licensing requirements and penalties for poor performance.
But the recent report casts a bad light on federal oversight, concluding that the Centers for Medicare and Medicaid Services has provided “unclear guidance” to states and done very little to monitor their use of the federal monies for assisted living providers.

As a result, it said, the federal health care agency “cannot ensure states are meeting their commitments to protect the health and welfare of Medicaid beneficiaries receiving assisted living services, potentially jeopardizing their care.”
Congress has not yet established strict standards for assisted living facilities comparable to those for nursing homes. In 1987, Congress adopted a law that strengthened the protection of nursing home residents’ rights, imposed dozens of new requirements and provisions on nursing homes and specified the services they must provide.

But even though assisted living facilities have largely escaped such scrutiny even though the Government Accountability Office says the demand for their services is likely to increase because of the aging of the baby boomer population and increased life expectancy.

The Trump-Pence administration agreed with the federal auditors’ recommendation that federal officials should clarify the requirement for the states to report on the abuse or neglect of people in assisted living facilities in all states. The administration said it was studying whether additional reporting requirements will be needed.
“Although the federal government has comprehensive information on nursing homes providing Medicaid services, not much is known about Medicaid beneficiaries in assisted living facilities,” the report said.

Assisted living was not part of the original Medicaid program, but many states now cover it under waivers intended to encourage “home and community-based services” as an alternative to nursing homes and other institutions.

The report said that the assisted living industry could potentially save millions of dollars for Medicaid just because it generally costs less than nursing home care. Under the most common type of waiver, Medicaid covers assisted living only for people who would be eligible for “an institutional level of care,” in a nursing home or hospital. So with more stringent reporting from the assisted living industry, this could lead to a win-win situation for government expenditures regarding assisted living facilities.

“Staff Writer – John Harrington US Elderly Health Report Blog”