Quality-of-Care and Consumer Protection Issues in Four States
HEHS-99-27: Published: Apr 26, 1999. Publicly Released: Apr 26, 1999.
Pursuant to a congressional request, GAO provided information on whether consumers are able to make informed choices about their care and about the nature and extent of problems that may be occurring in assisted living, focusing on: (1) residents' needs and the services provided in assisted living facilities; (2) the extent to which facilities provide consumers with information sufficient to help them choose a facility that is appropriate for their needs; (3) state approaches to the oversight of assisted living; and (4) the type and frequency of quality-of-care and consumer protection problems identified by Congress.
GAO noted that: (1) assisted living facilities in California, Florida, Ohio, and Oregon serve a wide range of resident needs in a variety of residential settings; (2) the 622 facilities that responded to GAO's survey include small homes providing meals, housekeeping, and limited assistance for few residents, as well as large, multilevel communities that provide or arrange a variety of care for as many as 600 residents; (3) a majority of the facilities reported that more than half their residents need staff assistance with bathing and medications, and 94 percent reported serving some residents who are cognitively impaired; (4) providers do not always give consumers information sufficient to determine whether a particular facility can meet their needs; (5) marketing material, contracts, and other written material provided by facilities are often incomplete and are sometimes vague or misleading; (6) only about half of the facilities reported that they provide prospective residents with such key written information as the amount of assistance residents can expect to receive with medications, the circumstances under which the cost of services might change, or when residents might be required to leave if their health changes; (7) all four states have licensing requirements that must be met by facilities that provide assisted living services; (8) each of these states inspects or surveys assisted living facilities to ensure that they comply with regulations, yet they vary in the frequency and content of inspections and the range of enforcement mechanisms available to ensure compliance; (9) in all four states, the state long-term care ombudsman agency may investigate and resolve complaints involving residents of long-term care facilities, including those providing assisted living; (10) GAO determined that more than one-fourth of the facilities reviewed were cited by state licensing, ombudsman, or other agencies for five or more quality-of-care or consumer-protection related deficiencies or violations during 1996 and 1997; (11) most of the problems identified were related to quality of care rather than consumer protection; (12) while data were not available to assess the seriousness of each identified problem, many problems seemed serious enough to warrant concern; and (13) frequently identified problems included facilities: (a) providing inadequate or insufficient care to residents; (b) having insufficient, unqualified, and untrained staff; (c) not providing residents the appropriate medications or storing medication improperly; and (d) not following admission and discharge policies required by state regulation.