It is hard to know exactly where to start, so here are my initial random thoughts, bullet point style:
- The very worst thing about this story is that it suggests assisted living residents across the nation should be very afraid. It suggests that frail seniors would be better off anyplace but assisted living.
- In effect they are suggesting these residents would be better off in skilled nursing or at home alone and isolated . . . they would be better cared for and happier.
- If only they had actually done a comparison for injuries, falls and deaths with 40,000 frail seniors living at home or in nursing homes. I am thinking Emeritus and assisted living across the board would have looked pretty good.
- I know a bunch of Emeritus people mostly in California and the ones I know are all striving to provide great care to their residents. This report does great damage to those people who pour their hearts and souls into caring for these frail seniors each day.
- Hearing statements suggesting all Emeritus cares about are heads in the beds and profits is ridiculous. If that were the case, one of two situations would be true; there would be hundreds of similar law suits or Emeritus would not have let this happen, because a $23 million dollar judgment would pay for a lot of additional staff with money left over.
- For all of that, at least with Joan Boice Emeritus screwed up. It is hard to know how to react to her falls, because falls do happen with frail residents unless they are restrained physically or with drugs, but the pressure wounds are incredibly damning. While I suppose from a legal point of view they had to take a public position that they were providing great care, in truth it is impossible to swallow.
- I wish I knew where it broke down. Was it the executive director? Did it go higher to the regional or state level? or . . . does it really source all the way back to the corporate office? It would do a lot for Emeritus and for the industry for them to talk about lessons learned and how they have changed their culture to make sure this will not happen again.
- It was hard to watch Frontline use Pat McGinnis a California anti-nursing home gadfly as an expert who suggests we need more regulations. First: the attorney for Joan Boice made the point that Emeritus broke regulations, which if true, demonstrates more regulations do not automatically make for better care.
- Secondly, nursing homes are incredibly regulated intuitions and still no one wants to go to one. Given the choice of a typical nursing home or a typical Emeritus assisted living community, assisted living would win 98 times out of 100.
- There is risk in all of life including living in an assisted living community. The question is what level of risk is acceptable for us as individuals and as a society? Even if we had one-on-one care there would still be falls, and medication errors and deaths. We already have a huge affordability problem; we need a serious debate about this trade off.
- The attorney for Joan Boice claims that she is typical of today’s assisted living residents. This is simply false.
- There was a claim that most assisted living communities are not “prepared”/equipped to deal with the frail seniors that comprise the current assisted living population. It is nuts to say this. Assisted Living residents and their families are overwhelming extremely happy with the care they are getting and it is not because they are being duped.
- The Medication aid suggested that she alone was dealing with thousands of medications for 80 residents, seriously ? This speaks to credibility.
- They found more than a dozen ex-employees to trash Emeritus for an enterprise of their size, it is rather a small number.
- I am fearful this will put a tremendous amount pressure on politicians to pile on new regulations that will ultimately make assisted living more expensive and will not make residents safer.
These are my initial reactions: what do you think? What questions do you wish you could ask PBS? Here is the video if you missed it.
Steve Moran
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Very well said Steve. I think it is absurd that the story implied that elders are better off going anywhere but assisted living. This is simply ridiculous.
Thanks for the very well done dissemination of the Frontline piece. One of the most interesting aspects of any media coverage regarding senior living is how they continually blur the lines between independent, assisted, memory care, and skilled care. The public in general is clueless about the differences, made worse by the media, weather it be print, broadcast, or on-line. The fact that anti-nursing home advocates were interviewed at all was senseless.
I must say, however, that there are issues that do exist in this industry. At a recent week-long assisted living administrator training class I attended, discussions I had with a few of the attendees regarding their experiences with the largest AL companies was alarming. They stated that “corporate” became very involved when they attempted to discharge residents who no longer met the AL criteria, forcing the community staff to keep the residents. I hope it doesn’t take more huge jury verdicts for these companies to realize their faults.
From LinkedIn Groups
OK, I gave in and watch most of the investigation. This was all predictable years ago. The assisted living industry basically grew because no one want to go to a nursing home. This level of care was called supervised living and delivered in long term care settings. As one person interviewed stated, the family and administrator the facility could not provide the level of care needed. We will no doubt see similar stories of home care in the coming years. As census levels drop in independent living, people are often admitted that belong in assisted living neighborhoods or at home with extensive home healthcare. It would be nice if the media and politicians would focus on solutions rather than the problems. The family in this piece is $22 million dollars richer but has anything changed at the corporate level where the focus is on the bottom-line? More government regulations are not likely to solve the problem, but will increase the cost and quality of care. Bill Thomas and the LTC pioneers have offered solutions but have battled regulators for going on two decades. It is time to change paradigms.
By G. Richard ‘Dick’ Ambrosius
From LinkedIn Groups
http://m.delcotimes.com/delcotimes/pm_108972/contentdetail.htm?contentguid=bQodUodE
By Gloria Hoffner
From LinkedIn Groups
So what is the assistive living community doing to make sure that they have in place a set of practices that will ensure that seniors are safe? Couldn’t this be done like Joint Commission did for hospitals? Self management of stand practices can go a long way to increase the safety and safe feelings for our senior communities It is up to the industry to set up standards so that citizens can make selections that will assure that best practice is being maintained in their facility.
By CHARLENE JEBENS
Steve- I also concur that this was a very broad attack on Assisted Living, and that I also believe that a majority of us are in this industry because we are compassionate and love working with seniors.In addition I feel that we do provide a much safer alternative to staying in ones own home. Each time I visit a community and see a Care Team Member sitting with a Resident and providing meaningful interaction, I am reminded of why we do what we do. However, I do feel that all of us, on an ongoing basis, should check on the messaging that we are providing to our communities, and be sure that we are not over promising and then failing in the delivery. I believe we must emphasize communication and training even more so. In addition each of us who is an operator should ask themselves a simple question- ‘Would I want my own Mother or Father in my Community, were I not the Manager’? If the answer is anything other than,’Yes’, there is work to be done!
David
I’m very surprised that they used Emeritus as a target for bad operation they pay their employees better than other firms in the field. In addition they provide health insurance to all of the their employees the mark of a quality company. Based upon all of the metrics I have followed Emeritus has some of the best practices in the industry and the management from the top down cares about their clients. I have walked many assisted living facilities over the years and I have never seen Emeritus trying to save a penny at the expense, health or safety of their clients.
From LinkedIn Groups
Mixed emotions from watching this Frontline expose. As someone who works in senior care and knows many of the weak links in that care as well as the difficult business decisions that must be made, my heart goes out to the residents and families and also the senior care workers and their communities affected by less than honorable care. On the other hand, most people I know work in senior care because of the tremendous compassion and empathy they have for this increasingly vulnerable population. Most people I know, and have worked with, think of their residents almost like extended family and work tirelessly to bring some measure of happiness to their residents. One of the great tragedies many of us witness that was not brought forth in this Frontline expose is the abandonment of a resident by some families who are unable or unwilling to provide the nurturing that all deserve and therefore the compensatory care given by many senior care workers which in many cases lead to burnout.
What struck me initially is the length to which the media will go to garner viewership. I expected an expose of the assisted living industry and initially thought the story would be well balanced. For many of us “in the know” a hopeful expectation was that some of the mystery and misinformation might be dispelled. In me, the title created an expectation of a concise, broad spectrum look into senior living choices and differences leading to end-of-life care and finally death. What Frontline’s expose devolved into was a broad brushstroke indictment of an entire industry based upon a few situations from ONE, albeit large, provider and seemingly from a few selected communities. Lest one mistake my comments, there is NO excuse for ANY of the wrongs committed but mistakes do happen whenever humans are involved and unethical and immoral behavior isn’t confined to the assisted living industry. Frontline however has used a time tested formula to prey upon the fears and guilt of people who are already worried about the difference between aging-in-place at home or in community. One can bet many people who were aware of this expose and are possibly faced with the decision of what to do with mom and/or dad will have tuned in and had their pre-conceived biases confirmed and strengthened to the detriment of their loved ones, the industry in general, and senior care workers in particular but to the benefit of Frontline. What I am left with is anger over wrongs committed and anger over a media titan’s narrow focus and therefore exploitation of its viewership and their possible pre-conceived ideas.
What I would have liked to have viewed was an expose exploring the decision making one goes through, the options available, the business of assisted living and levels of care one needs to be informed of, and especially the dedicated senior care workers, most of whom work tirelessly to care for other’s loved ones.
By Bryan Busse
From LinkedIn Groups
As a former Emeritus employee, this was hard to watch. I am saddened by the global sweeping perspective of Assisted living that this portrays. I enjoyed your analysis and I think your points are very succinct and a good summary of an unfortunate presentation.
By Leslie Quintanar
So let’s stand back a bit — and look at the defensive response from inside the industry:
1) ALFA:
http://www.alfa.org/News/3339/ALFA%27s-Official-Response-to-Frontline
2) LeadingAge:
http://www.leadingage.org/Making_My_Blood_Boil_Frontline_Expose_on_Assisted_Living.aspx
So in the face of this ‘We’re Okay, Frontline has it in for us’ — let’s admit it that this is a self-regulating industry. And are the leaders reminding themselves that they need to enforce a minimum level of staffing levels in memory units (especially during the second and third shifts), that the average age of residents has risen to 87, likely has dementia and other needs and that the fastest growing and most profitable are those very memory units where the residents cannot and do not advocate for themselves.
They cannot design their own programming, manage their own personal care or alert family on weekends or evenings when staff may call in sick.
There is no industry standard of use of cameras in common areas, no tactics for motivating and keeping good staff — who are the most burdened when other staffers quit and leave them on their own. Think about how family members are shopping for a service that they’ve never purchased before, and that is not subject to any standard description of services offered — where else in a consumer economy is that the case?
Reaction from the industry is not encouraging — other than standard PR statements — and Emeritus making the most amazing PR blooper:
http://www.propublica.org/article/for-assisted-living-industry-a-media-strategy-to-thwart-federal-ovesight#strategy-memo
What exactly is the next step for the industry?
Good Comments. I actually think that for as big a deal as it has been for us within the industry, I am not so sure the rest of the country cares. When you look at the viewership of PBS is . . . I think it is entirely possible that nothing will happen.
My question for you . . . actually two:
1. What do you think the industry people should have said?
2. What do you think Emeritus should have said?
Steve
This video is all over the Internet — no need to watch PBS. And in the NY Times. I wrote about it and linked around to many places ( including the Times).
http://www.ageinplacetech.com/blog/pbs-shines-bright-light-assisted-living-will-change-follow
This CEO of ACHA explaining why assisted living can be defined differently in every state is a particularly poor spokesperson for the industry, followed only by the Emeritus execs themselves.
There is nothing unique about senior care needs in dementia units in Florida versus California — competition and price are the only variables. Only the industry fighting cross-state standards (and let’s call it what it is, the dreaded regulation) enable the multiple definitions and state-by-state attempts at oversight. These attempts are weakening as we speak.
To answer your two questions:
1) What industry people should have said — Here are the steps we are taking in OUR organization (Sunrise, Brookdale, or smaller companies) to help avoid incidents such as these. These can (should) include: a) Clearly defined admissions criteria, clearly stated staffing levels (all shifts), b) clearly stated training levels of staff to accommodate dementia levels, c) clearly stated supervision of staff to make sure residents are safe, d) family engagement/council programs to keep families in the loop, e) resume and track record of facility executives posted on the website (as with other types of companies). We are creating a cross-industry consortium to standardize definitions, publish standards of care quality for residents with dementia.
2) What Emeritus should have said: Tthese incidents were management failures — because we believe in continuous improvement, because transparency about our practices and business model will help restore confidence in our company, we are launching a series of corrective steps to ensure that our company regains the reputation for outstanding service and care that make it the leading firm in our industry.
Thanks for asking.
Laurie
Over glorified “Tabloid-Trash TV” at its best Or Worse.
Its not secret that if it isn’t sensational its not going to get a lot of viewers, no given the viewership of PBS is so low I doubt if as many people outside of the industry watched or even stayed awake for the piece. IF it were a story on the long hard day of an employee in an assisted living who has had a resident swing at them, yelled at by a family member because her poor demented mother has someone else’s shoe on, and had a great time playing bingo with the residents and led a sing along during a snack time, you could likely count the viewers on one hand. ANy of us in the industry more than two hours knows that this could have been any company and this tragedy could have happened in any community. Having worked in an Emeritus Memory Care community both as Sales and Executive Director for over three years, I can vouch for the fact that they do indeed have a top notch memory care program, and I can not think of any time where resident care and well-being did not take top priority over money or head in bed. Yes, they are for profit and have stockholders to report to. They, or any company should not have to feel guilty for making a profit. People forget that the more money that an AL brings in generally means good things for those that live there. I think that the comparison to the nations bridges was a great viewpoint. Having lived in Minneapolis at the time of the horrible bridge collapse and worked in long term care for ten years I can agree whole heartily. Like was said someone who lost a loved one in an other than normal way, may look at it differently. I do think that if a company is going to say yes we take dementia than they need to have put some thought into it. And that’s way more than locking some doors, and windows in this case. There are way too many details that are not told by the directors of this program of course, but in any case, someone messed up, over looked something, didn’t do what they were supposed to, etc. Sadly, that can and does happen everywhere and if you are saying not where I work, then you are uneducated or lying. We’ve all thought “Whew I’m glad we caught this now” or “Thank goodness the family didn’t see that” or ” We need to fix this before someone gets hurt” at some point. What people forget is how much worse things would be at home without 24/7 oversight. As hard as we try we are human and we make mistakes. Some avoidable for sure, and some are not. The worst thing about this “story” is the fact that only one side really got told. The plus is, the low amount of people watching. Maybe its time the industry fights back a little. I think some more education for the families would help a ton. I always told my families that we are indeed not perfect. That they were the best caregiver their loved one would ever have, but that we would do our best and there are bound to be mistakes along the way, and to please keep the communication lines open so that we can learn from them. I think the industry should flex its muscles a bit too. I for one am tired of these attacks. Emeritus is a great company and happened to be the sacrificial lamb for this episode. As Brookdale, Sunrise, insert any AL company here has been in the past. Maybe its time a network with an actual viewer base dose an Expose on PBS and why our tax dollars are still funding this garbage? Maybe it would be better spent fixing those one in nine bridges.. something that benefits more than a handful of people? Just a thought!
I intently watched the Frontline expose’ on the Assisted Living Industry. I am not yet an industry insider but I am in graduate studies focused on gerontology and have had personal nursing home and ALF experiences with parental caregiving.
My observations: There are good points to be made on both sides. I was surprised that the program focused pretty much on one provider, Emeritus, and not a more indepth look at the industry as a whole and a mix of providers in this space. I do think that we can learn a lot from current and former employees so I wouldn’t be too quick to dismiss their negative commentary. It may also make some difference whether or not an ALF (in particular) is a for-profit, public company or a non-profit organization, in terms of its culture and standards. I will say that I was less than impressed with the executive level response to the events that had occurred. However, I’m not sure what part of their responses ended up on the editing room floor.
I think that the program had an opportunity to educate the public rather than debase an entire industry. References to websites and organizations are okay but one-on-one interviews of industry leaders and insiders is what resonates most it would seem within the context of a TV documentary. As with any healthcare choice, consumers (or their families) need to do their homework and shopping for caregiving options is not easy. I don’t recall much discussion about resources to help provide guidance to this end (e.g., professional fee-for-service Geriatric Care Management).
John Gonzales, I firmly applaud all you say in your response to Frontlines Life and Death in Assisted Living. I do so as a retired sales/marketing executive for a major insurance company, a former independent consultant to benefit plan administrators, a ten plus year resident of a Continuing Care Retirement Community (CCRC), a past Resident Director member of my Community’s Board and an active member of organizations that represent CCRC residents, present and potential.
Frontline’s program tilts to the left but is neither radical nor biased. The information it provides is complete and accurate. It delivered a much needed wake-up call to the assisted living business, the health care industry as a whole, and American consumers of their services. Thank NPR for its effort, It is difficult to imagine other media responding with equal or greater effectiveness.
That said, the Frontline program leaves huge unanswered questions. What standards did the Executive Committee for the Emeritus Board establish to measure CEO performance? How were they utilized when the Board evaluated the accomplishments of Grander Cobb and Daniel Baty, then approved their compensation packages?
Hi Joseph:
I have spent a ton of time on the story and honestly it is biased (I will have more to say about this in an article that will publish next week). It is possible that it is accurate (though I know Emeritus would dispute that and with some pretty compelling arguments), but it was far from complete.
There are so many important issues, not the least of which is that to give the standard of care that would be acceptable to the creators of this story might well double the cost of assisted living.
You are absolutely right about the unanswered questions, but they are questions that rightfully apply to all assisted living providers.
Steve
This “column” irritates the hell out of me. First, you review Frontline’s piece without even having watched it?
Second, you suggest that there should be accrediting organizations for senior living facilities, when in fact those organizations (such as CARF) already exist.
These are human beings we’re talking about. This is life and death. There is no excuse for medical error, and there is no excuse for errors and accidents and death in senior care.
Hi James:
Thanks for joining the conversation. A few things:
1. What leads you to believe I did not watch the special? This particular article was written immediately after watching it. The very first article I wrote, was before the video was released, but not this one.
2. I will confess with some embarrassment that I was not familiar with CARF, though I would note that I could only find a total of 72 Assisted living communities that have been certified by CARF in the United States and it looks like many of those are a part of CCRC’s. If you are a part of that organization I would love to hear more about it and figure out why the adoption rate is so low. I think it would be a good article or multiple articles.
3. You say “There is no excuse for medical error, and there is no excuse for errors and accidents and death in senior care.” And it sounds very good, but I wonder, do you think it is possible to make any healthcare or elder care community 100% error free? Do you think it is possible to eliminate every single accident or accidental death in every single senior community?
There is risk in life and as we get older the risks increase. We know that we could, as a for instance, dramatically reduce falls and the injuries that result from falls, by doing at least one of three things: 1. Using drugs to restrain seniors. 2. Using physical restraints. 3. Assigning 2 or three full-time care givers to each senior 24/7.
The problem is that not of these are acceptable both from a personal dignity perspective and a cost perspective.
Maybe I have it wrong and would be glad to have further dialog or even have you write an article outlining what I have gotten wrong.
Steve