By John Gonzales

Headline: Assisted Living Injuries From Resident-on-Resident Violence Skyrocket Nationwide in 2022!

Would that surprise you? Wouldn’t you want to know the source of this information? For better or worse, there really isn’t one.

A recent series in the Arizona Republic that focused on resident-on-resident violence in senior living sought to quantify the supposition that these types of incidents — resulting in injury — are on the rise. While I applaud this project and the transparency of the methodology employed, I am flummoxed at the mistake of blending data from skilled care facilities with that of assisted living communities. The two environments are separated by a myriad of differentiators, such as payer source, regulations, oversight, staffing levels, etc. Mixing data sets across all senior living environments produces a muddy result at best and a distorted view at worst.

Individual states collect this type of data, but “what” is collected varies greatly. 

While the CMS system provides national data for the skilled care industry, collecting this type of information is exponentially more difficult for assisted living because there is no singular national regulatory or reporting entity. Collecting and collating this data from individual states would require a herculean effort. It would also require the willingness of owners and operators to be transparent about these deleterious incidents in their communities and across their portfolio. While I cannot imagine this being likely to happen, is there an unselfish reason not to look at ourselves in the mirror, warts and all?

Our industry continues to struggle to balance the staffing shortage, rising wages, inflation, recession, and unaffordability with the unrelenting pressure to hit historical margins. Some operators may be tempted to loosen hiring criteria and hire the “warm body,” reduce staffing, or cut training hours and push new hires onto the floor too soon. What would be the result?

I pray that the occasional drip, drip, drip of negative news stories isn’t now being accompanied by the distant peal of thunder.

Do you intrinsically know that adverse incidents in our industry are on the rise? Logically, how could they not be? As evidence, I submit to you this from a recent article in McKnight’s:

Some insurers are wary of covering senior living and care providers, due to continued labor challenges … [and] the insurers are concerned about reduced staffing contributing to loss severity through lack of proper monitoring of residents and witnessing falls. [Emphasis added.]

And this:

Some insurers question the effect that mergers and acquisitions will have on the quality of resident and patient care, whether combining facilities could exacerbate workforce shortages and whether pre-acquisition due diligence provides enough accurate data to adequately underwrite the risks. [Emphasis added.]

As a veteran of the industry, I can validate the concern related to inadequate due diligence. I’ve experienced this in more than one organization during the rush to “close.” I’ve found myself advocating that we tap the brakes on deals — not a popular position to take.

“Why would we do that? We’re closing next week!”

“Oh, I don’t know, maybe we should evaluate their medication system before we sign. Or, maybe find out why all the employee signatures on this mandatory training participant form have the same handwriting? Hey, I have an idea! Why don’t we look at their risk management program, and crisis communication procedures?” Or my personal favorite, “Uh, we may want to make sure these residents are appropriate for assisted living, or that they even exist? I can see the nameplates on the apartment doors too, but ….”

Have you seen any of the recent news? Here are just a few snippets I googled yesterday. Took me five minutes.

“An employee at the facility is facing one count of felony elder abuse related to his death ….”

“Three elderly residents died from ingesting cleaning solution last summer ….”

“Woman sues … assisted living facility over mother’s death.”

“Senior living facilities are often understaffed, endangering workers and residents.”

“Assisted living facility failed to supervise residents, state regulators say.”

“Assisted living home closes after multiple complaints.”

“Increasing minimum wage would worsen assisted living workforce challenges, not fix them, coalition says.”

“Most seniors in America can’t afford nursing homes or assisted living, study finds. As many as 80% of aging adults in America lack the financial resources to pay for two years of nursing home care or four years of an assisted living community. That’s according to a new study ….”

“Caregivers picket for better wages: ‘We have to feed our families.’”

Again … five minutes and only two pages of search results.

I want to acknowledge that any singular one of these incidents could very well be an outlier and not inherent in a specific company’s practices — but aggregated, they do paint an increasingly concerning forecast for our industry.

The organic conditions that provided us with the freedom to innovate and accentuate the residential feel and approach to service and care have undeniably changed — and not for the better. If these conditions worsen and adverse incidents do increase, elected officials will act; the public outcry to “do something” will grow louder if we do not act first.

A recently published article in Senior Housing News reported that “creative desctruction” in our industry is necessary now. Although I much prefer the term “disruptive innovation,” whichever term we use, we’re all in this together. The same rain falls upon us all.

To be safe, pack an umbrella.