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Assisted Living: A Devastating Truth (Part 1 of 2)

Elder abuse is alive and well in San Diego. Here’s the surprise for most people: The perpetrators are not always the usual suspects; often they are the providers of elder care.

There was a recent article in the September 8th edition of the Union Tribune titled “Deadly Neglect”, which is about the pandemic neglect in San Diego’s assisted livings. It is an important article and it should open a lot of eyes. For instance, this article cites that 27 San Diego County seniors have died since 2008 from injuries and neglect suffered in local assisted living facilities. Even harder to believe is that of the 27 seniors who died, only 18 of these cases were investigated by the state agency responsible for overseeing them! Of those 18 deaths, in which the state did find the facilities negligent, the fine for such a tragic outcome was only $150 which is the maximum allowed by law.
Unfortunately, for those of us who know elder care from the inside out, this sad tale is all too believable. The real story is that the problem is far worse and more systemic than anyone, even the writers of this article are aware. What is described is only the proverbial tip of the iceberg.

There are several high profile facilities owned by large elder care corporations mentioned in the article, but after being a professional advocate for the elderly in San Diego since the 90’s, I have to tell you the problem is not isolated to a few poorly run facilities. It is everywhere. Every single assisted living in San Diego is a potential set up for neglect and mismanagement of the elders they care for.

What is wrong with this system of elder care?

For starters, let’s look at the regulatory entity responsible for oversight of these assisted livings. You’d think that the agency that oversees our elders in assisted livings would be a health and human services agency right? You’d be wrong.

Reality check number one: The assisted living facilities referred to in this article are overseen by the Department of Social Services (DSS) which doesn’t necessarily know the first thing about managing the multiple chronic illnesses of the geriatric population. What they lack in expertise and ability to recognize problems, they do not make up in any dedication to monitor quality or safety by putting “boots on the ground” in the ongoing war against elder neglect and abuse.

There simply are no “boots on the ground.” Shrinking budgets of all state agencies means that there are not enough investigators, or ombudsmen or advocates of any governmental stripe, to monitor those elders or families who’ve made complaints about their care in facilities. There’s thousands more elders who cannot voice their complaints to ombudsmen even if they wanted to, since they suffer from dementia (a full 50% over 80 years of age have this diagnosis) or fear retribution from direct care staff. So, they remain mute.

Simply stated, the state is not going to save your loved one from the tragedies painfully brought to light in this Union Tribune article. That expectation, in the face of shrinking health care dollars and governmental budgets, is a denial of reality that may be as dangerous as the reality itself. What is needed here is for people to know the truth about the fact that there is little to no governmental oversight in these assisted livings and residential care facilities.

Reality check number two: The assisted living model is a set up for failure because it is not structurally or functionally sound. It is a non-medical model serving a medical fragile population. At the heart of it this is an oxymoron. There is no such thing as “non-medical” in properly serving the needs of the geriatric population with multiple chronic illnesses!

Now wait a minute. This is confusing. People are drawn to the non-institutional, “non-medical” setting of the assisted livings, that feel more “normal” and more like home, precisely because they are not based on a medical model. Assisted livings and residential care facilities for the elderly (RCFE’s) are more like home, or a lovely bed and breakfast, than a cold and scary nursing home. They are also less expensive by half.

So here is the problem in a nutshell: The reason for the success of the assisted livings and RCFE’s is also the very reason they are apt to fail so many of our elders. This is true because the large majority of assisted living and RCFE residents have multiple chronic illnesses and no one to adequately oversee the management of their medical needs.

To put it more bluntly, these residents of the in-between world of assisted livings are frail elders who need skilled medical management. These elders are many times on the edge of the event that will catapult them into the hospital, or the nursing home they are so afraid of, or… an early death as the Union Tribune article points out, because they don’t have the benefit of continuously focused medical management as an overlay to the non-medical support environment.

I don’t mean just one licensed nurse on the dayshift with too many residents to monitor, I mean an actual certified geriatric care manager on staff or even as a consultant. The critical pulse points for these elders need to be monitored carefully, or these medically complex residents will be on the fast track to tragedy. After 20 years of providing professional care management in San Diego, I’ve come to realize the life changing effect our expertise can have on an elder.
What to do when the very reason for success is also the reason for failure?

These non-medical models of care delivery need to adapt to this critical deficit by providing options for skilled oversight and advocacy, as needed and desired by their clients and families. This is a very large elephant in the room and no one in the industry quite knows what to do with it.

Solutions will take a paradigm shift of pachyderm proportions for sure, but regardless of the difficulty and resistance inherent in all transformational change, we are compelled to point to what successful navigation between a rock and hard place looks like in our world.

A change in structure must be designed so that a change in function can be achieved. There is a path forward and our elders and their families desperately need to be given answers. They need road maps and guides so they can steer to safer and more satisfying experiences during the most important and difficult times of their lives.
Birth is difficult and growing up is no cakewalk, but it only gets harder towards the end.

Aging and death need to be infused with compassion and meaning, not tragically marred with horrific and wholly avoidable experiences.

Our next blog will be part two of this exploration into assisted living care delivery. We will look at it from a systems analysis point of view and offer solutions.

To read the referenced article “Deadly Neglect” from the Union Tribune, follow this link:

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