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Washington Post Investigation on Elopements Puts Memory Care in the Spotlight, Industry Responds

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A series of investigations from the Washington Post on resident elopement and staffing has shone a new light on memory care operators and the challenges they face keeping residents safe.

One of the Post stories, published over the weekend, centered on residents who wandered away from memory care communities since 2018, almost 100 of which died.

Most of the incidents involved residents of memory care communities, and among the struggles highlighted were staffing shortages and improper training. The story represents a new source of scrutiny for an industry that has intermittently struggled with bad press since the start of the Covid-19 pandemic.

Prominent members of the senior living industry, including leaders of some of the major industry associations, pushed back against the story after it was published, noting that they believe it did not properly convey the popularity and safety of assisted living and memory care communities. They also highlighted efforts underway they say are moving the needle in favor of better dementia care across the U.S.

Post investigation into AL, memory care elopements

Much of the Post’s investigation focused on residents of assisted living and memory care communities.

Post reporters studied survey data, primarily from the 29 states in the U.S. that make such reports available online. Other sources of information included police documents, lawsuits, obituaries and local media reports.

According to the Post’s analysis, more than 2,000 residents have wandered away from the communities where they lived since 2018. Of those residents, 98 died, largely of exposure in hot or cold weather or by injuries sustained while wandering. Common causes of the resident “elopements” included improperly unlocked doors and alarms that did not properly alert staff.

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According to the Post, that might be an undercount of the total number of residents who have wandered from their senior living communities, given that 19 states do not provide reports the public can download. Many states also do not have regulations requiring licensing for assisted living.

Those cases help weave “a pattern of neglect by an industry that charges families an average of $6,000 a month for the explicit promise of safeguarding their loved ones,” the story’s authors wrote.

Another Post story examined staffing shortfalls and linked them with adverse effects on resident care. The story, which examined a case where a resident died after allegedly being locked out of the assisted living community where she lived on a freezing-cold night.

According to the Post, part of the issue at hand is limited state oversight, with 13 states in the country requiring a minimum number of staff per resident and only nine requiring at least six hours of training to work with residents living with a form of dementia. Additionally, 21 states either don’t provide or only provide limited information on violations.

The Post also took aim at the capital behind senior living communities, including investors such as private equity companies and ownership groups including REITs.

These and other companies have built a $34 billion market for assisted living and memory care, but they have also has also potentially contributed to cost-cutting that has left communities understaffed, according to the story’s authors, who reviewed 160,000 state inspection reports and interviewed more than 50 assisted living employees and residents’ families.

“Hundreds of properties change corporate owners every year, and staffing and pay are often the first expenses trimmed by investors focused on profits, according to interviews with industry experts and current and former employees at multiple companies,” the Post authors wrote.

Industry responds

Some of the senior living industry’s industry associations pushed back on the stories not long after they were published Sunday.

Earlier this week, Argentum CEO James Balda said that “any fatality is one too many.” But he added that he does not believe the story is indicative of the modern senior living experience, citing survey data like J.D. Power results showing that assisted living and memory care communities are “overwhelmingly popular with residents and their families.”

Additionally, Balda added that the total number of fatalities in the report were only a very small portion of the 6.2 million residents living in assisted living in the past five years. He also noted that many residents living with cognitive impairment successfully live in “less restrictive” settings, such as assisted living communities.

A spokesperson for the National Center for Assisted Living (NCAL) similarly noted that the “rare incidents” described in the Post story “are not indicative of the life-affirming experience that 99.9% of assisted living residents typically receive.”

Balda noted how operators are exploring and implementing new care and technology “that promote safety, balanced with the highest quality of life for residents with memory impairment.”

“Argentum strongly believes that future trends will continue to dictate caring for residents across multiple senior living care settings, such as assisted living with and without memory care units,” Balda said. “The key will be to continue to place resident safety at the forefront while providing specialized care, activities and quality of life for these residents.”

Argentum “strongly advocates” for specialized training for all senior living workers directly caring for those living with cognitive impairment. NCAL also encourages specialized dementia worker training, “but each community should determine how much training is necessary based on their specific resident population,” a spokesperson for the organization said.

“Effective resident cognitive assessment involves the resident, resident’s family, resident’s physician and care staff to determine appropriate level of care and setting,” Balda said. “Continuous evaluation of a resident’s condition, including memory impairment, is critical to ensure changing conditions are addressed with appropriate care. This will be the industry’s focus now and going forward.”

Katie Smith Sloan, president and CEO of the nonprofit LeadingAge, told SHN that setting an “arbitrary minimum” at the state or federal level, as some have suggested, wouldn’t be a guaranteed solution, as assisted living has no uniform definition and a “one size fits all” approach wouldn’t result in the desired transparency or guaranteed safety.

“It’s also worth noting that staffing mandates are a proposed solution for care in a setting that is federally financed and regulated,” Sloan said. “Because assisted living services are not, for the most part, publicly financed, no federal structure exists to allow for quality of care comparisons across providers and states.”

Sloan added that imposing staffing mandates for one care service, such as assisted living or memory care, would likely impact other sectors of senior living care.

Argentum also supports the “enhancement” of the National Alzheimer’s Project Act, more funding for federal and state dementia initiatives, and “enhanced” reimbursement for direct care workers through home and community-based services programs.

“Argentum will continue to push for funding on the workforce development front to augment The Argentum Health Care Apprenticeship Expansion Program (HAEP) and other initiatives that address the senior living workforce needs, including those who provide care to residents with Alzheimer’s Disease and related dementia,” Balda said.

NCAL similarly supports “accountability and evidenced-based initiatives that help enhance memory care.” But the organization is “cautious” of additional regulations that “would limit residents’ independence and autonomy, as well as the ability to customize care for the individual.”

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