By Steve Moran

On May 1, 2025, the Guardian published an article titled “In the US, not even $11,000 a month can buy you dignity at the end of your life.” It starts with this …

“The last time I visited my father, I walked into his $11,000-a-month room in a posh assisted living residence and found him curled up on the floor. My sister Amy and I knelt down, touched him, and asked if he was okay. ‘I don’t know,’ mumbled Dad, 96, a retired physician and lifelong outdoorsman. ‘I fell about 20 minutes ago and no one has come.'”

Content Warning: This one is long

The Industry Response

If you were to talk to leaders in the industry, the responses would be more or less like this …

“There must be more to the story …”

“It’s terrible but I am sure it was an isolated incident.”

“We are doing the best we can, but staffing is so hard …”

And from the not-for-profit world … “See, this is why not-for-profits are so much better.”

Mostly, though, the response is silence.

The Other Industry Response

But then, get in a quiet room where no one else is listening and talk to team members working on the front line. People closer to operations will, in hushed voices, tell you that it happens way more often than the industry cares to admit.

That it routinely takes too long for call devices to be answered; that when people fall, they can lie on the floor for many minutes before they are found.

That caregivers have too much to do on their shift, and so while they are doing the best they can, it’s not that good and not their fault.

That when a resident refuses help with a shower, that’s a good thing, because it reduces the workload.

That the problem is real and pervasive.

It is not just frivolous lawsuits

I stumbled across a couple of Reddit threads inspired by this article … look at these posts. These are not people who are suing, they are just expressing frustration.

“My mother was in two different nursing homes. The first was skilled nursing which was a higher level of care than she needed, and they damned near killed her from neglect.”

“My aunt is in a lovely memory care facility, with an elegant dining room and a ‘Main Street’ shops area inside; it’s $12,000/mo. But her bedroom reeks of urine because staff who are paid minimum wage either don’t care or don’t have time to mop it daily.”

“This article speaks the truth! Exactly what we’ve been going through with our 90 year old mom for the last 8 months. What a shock it was for us to find out that ‘assisted living’ is anything but.”

“This was almost the same as my experience with my Mom. It’s a crapshoot as to whether a place will provide good care. And you don’t really know until you get them in there, and then have to separate the issues the elderly is having with issues the facility is causing or having itself.

Mom laid on the floor for 7 hours after she broke her hip because no one came to help her in the toilet, even though she was fully mobile. I should have sued the place. It caused her so many issues that she most likely would not have had to deal with had she gotten the care she paid for but never received.

I would NEVER move into an assisted living facility, nor would I recommend ANYONE do the same for their loved ones. They simply are NOT regulated.

The one she was last in served them all you can drink beer and wine at ‘happy hour’. They never asked what kind of medication she was on. These places are horrible and run by horrible people if you ask me. Bunch of used car salesmen.”

Missing Pieces

This was a story with a lesson, and as such,h I don’t fault the author for not providing much in the way of balance, allowing senior living to tell their story. That being said, she did talk to and quote a number of “experts” who are known to be enemies of senior living, individuals who believe more regulation is the answer to better care.

The biggest miss was that she continued to perpetuate the myth that for-profit senior living is bad and not-for-profit is good.

It glossed over the really important point that Mom and Dad lived in a CCRC, but when the need for assisted living happened, there was no capacity. That is seriously wrong.

That myth also ignores that there are some really good for-profit senior living organizations.

A Massive Reputation Problem?

We tell ourselves that most people who move into senior living love it and wish they had done so sooner. We tell ourselves that these problems are isolated incidents, or that the stories are unfair, or that these things only happen in other people’s communities.

And I am not sure we actually even like and trust our own industry. I have seen dozens of people retire from the senior living industry, and I am only aware of one executive who lives in a senior living community as a lifestyle choice.

Yet at the end of the day, we have a massive reputation problem that we are not coming close to addressing. And it kind of makes sense. Those communities that are providing great services and great living experiences are all full or nearly so and making good margins, so it is not their problem.

Those communities that are struggling often have real operational problems that should be addressed, but it is hard to get very excited about tackling the problem when you are part of the problem.

The Care Level Problem

Perhaps the real problem is that too many communities accept residents they cannot adequately serve. Just because it is legally allowed does not mean they should, or more importantly, that it is right. In nearly every story about inadequate care that makes senior living look bad, the residents are significantly impaired physically and cognitively.

They are uniquely attractive for assisted living providers because levels of care can push the monthly rates way way up, and often when those rates jump way up, the amount of care usually does not increase at a corresponding rate.

My Own Story

In many respects, my stepfather, Gary, did not have high care needs, but he had some. In his particular case, he didn’t like showering, and he was reluctant to go to activities or meet new people. In my dream world, the community would have done what it took to persuade him to take a shower a couple of times a week (what we paid for) and figured out how to get him out of his room and to activities.

The problem was that when he refused, the path of least resistance was to leave him be and move on to other residents. They created cover by documenting that he was offered the services and refused.

In truth, they had an obligation to either not accept him as a resident or put a good-faith effort into making sure those things happened.

If the time comes that Gary needs to go back to assisted living, I won’t consider a large community. They simply don’t have the capacity or willingness to serve his needs. He will go into a small 6-bed, where people will be checking on him a few times every hour. The costs will be lower and the care much better.

I understand the incentives to take residents with a need for lots of care, as to stop taking those residents would mean a massive loss of revenue and occupancy. But it would solve lots of problems, and it might be that it would improve our reputation enough to keep communities full.

The other alternative would be for enterprise operators to figure out how to provide the same level of service that these smaller homes do very well.

The Path Forward

The path forward starts with acknowledging we have a problem. The next step is to figure out what great care, great resident experiences, great family experiences, and great team member experiences really look like.

What would I want for me? What would make me brag that I lived in senior living? What would make me brag that I worked in senior living? What would make me brag that my mom or dad lived in senior living?

That should set the minimum standard.

This would be a good start.