By Jack Cumming

On January 25, as expected, the Senate Special Committee on Aging held its hearing titled “Assisted Living Facilities: Understanding Long-Term Care Options for Older Adults.” This article gives my impressions from the hearing. As such it reflects an aging resident’s perspective and my personal bias favoring empowerment politics.

Overall Impression

The attendance, for at least part of the time, of most of the committee members reflects popular interest in the safety of assisted living. This contrasted, for instance, with the committee’s hearing on CCRCs in July 2010 when only three of 21 committee members showed interest. As is often true with legislative “hearings,” the senators’ “questions” often took more time than the answers. Most senators seemed to have predecided, though they showed the “witnesses” courtesy.

The hearing began with senators reading prepared opening statements, followed by the four witnesses reading their statements. Patricia Vessenmeyer spoke of her husband’s struggle with dementia in a memory care facility. Jennifer Craft Morgan, PhD, shared a social scientific overview. Julie Simpkins spoke of the challenges in serving people with low income. Richard Mollot closed out the witnesses with a thoughtful presentation.

Mr. Mollot described the trend toward higher acuity assisted living; he spoke of increasing “ownership by real estate investment trusts, private equity, and other sophisticated private investment structures,” and he noted increasing government funding. He called for greater transparency, for better consumer guidance, and for an increasing role for the federal government.

Not surprisingly, the push for federal oversight gained traction when Sen. Elizabeth Warren (D-MA) arrived. She was attending two hearings at once, so she arrived late to the Aging Committee. She cited the lack of uniformity in state oversight. She declared that private equity “comes in and slashes jobs.” Her suggestion was that federal regulation of skilled nursing be extended to assisted living as well.

Let’s Not Play God

As the title suggests, I disagree that mountaintop federal regulation is the answer.  We have recently seen providers moving away from skilled nursing because of the constraints of federal government micromanagement and below-cost federal reimbursements. Federal legislation has led us to house many skilled nursing residents in rooms and bathrooms shared with strangers. No one should have to live like that.

The uniformity that Senator Warren mentioned can be achieved with less risk and greater deliberation at the state level. The senior living trade associations could promote a proactive course of uniform model legislation, as we have now, say, for electrical codes, for insurance regulation, and for the Uniform Commercial Code. This is not a novel approach.

One wonders why it is thought that a partisan divide — the Aging Committee is divided between majority and minority members — is the best format for resolving complex questions. We can all agree that safety, best practices, and sensitive humanity are desirable when dealing with a frail, gullible, or mentally impaired group of people.

During the hearing, much was made of the dramatics of residents pummeling fellow residents with canes or other objects. It’s easy to denounce providers, but they step up to handle tragic circumstances while others only criticize. It’s easier to criticize than to incentivize constructive solutions.

Let’s Reason Together 

Wouldn’t it be better for the federal government to direct industry, consumers, and regulators to work together to devise better approaches? The usual response is to legislate minimum staff, as if creating jobs were the solution to all ills. Sometimes, it requires the commonsense thinking of gifted caregivers like Teepa Snow to come up with something that works. That can’t be legislated.

We’ve mentioned examples of effective efforts to create uniform state codes after extended discussion, deliberation, and cooperative analysis among regulators from several states. A Google search for “uniform public health codes” is in sharp contrast with one for “uniform commercial codes.” The latter shows how citizens and legislators can work together beyond seeking party advantage to provide an effective regulatory framework. The other — public health — directs the searcher to the fact that the U.S. Public Health Service is one of the nation’s eight uniformed services (Army, Navy, Air Force, Marine Corps, Coast Guard, NOAA Corps, Public Health Service, and Space Force). Get it? “Uniform.”

From this, it’s evident that a little thought and constructive dialogue, in which legislators listen to each other instead of reading statements, can give us better solutions to these pressing challenges of health care, including assisted living, which was in the January 25 spotlight. The Senate could set in place a principled framework toward proactive state and local legislation in place of the reactive superficiality which today is too often the legislative outcome.

Accountability Vs. Directives

Beyond that, though, providers do take on a mission, and they should have accountability for how they carry that out. That means that eldercare contracts of adhesion should not allow providers to unilaterally take away citizen rights. Citizens should be allowed to require fiduciary accountability for providers, to join in class actions, and to appeal ill-considered decisions within the judicial system.

Current and future residents and their families deserve the right to receive qualified, intelligent care. Eldercare is a national challenge, and, if we come together proactively as citizens — residents, families, operators, financiers, all of us — we can do better.

One wonders why the New York Times and Washington Post weren’t present to defend the objectivity and applicability of their reporting. Click here for the full record of the hearing.