The New York Times had an incredible (and scary) article on assisted living facilities. Billions of dollars in government spending is flowing to assisted living industry even as it operates under vague standards and limited supervision. “Federal investigators say they have found huge gaps in the regulation of assisted living facilities, a shortfall that they say has potentially jeopardized the care of hundreds of thousands of people served by the booming industry.”

The federal government lacks even basic information about the quality of assisted living services provided to low-income people on Medicaid according to the Government Accountability Office, a nonpartisan investigative arm of Congress.  The report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Titled “Improved Federal Oversight of Beneficiary Health and Welfare Is Needed,” it grew out of a two-year study requested by a bipartisan group of four senators.  See GAO Report on ALFs here.

States reported spending more than $10 billion a year in federal and state funds for assisted living services for more than 330,000 Medicaid beneficiaries, an average of more than $30,000 a person, the Government Accountability Office found in a survey of states.

States are supposed to keep track of cases involving the abuse, neglect, exploitation or unexplained death of Medicaid beneficiaries in assisted living facilities. But more than half of the states were unable to provide information on the number or nature of such cases.

Just 22 states were able to provide data on “critical incidents — cases of potential or actual harm.” In one year, those states reported a total of more than 22,900 incidents, including the physical, emotional or sexual abuse of residents.

Congress has not established standards for assisted living facilities comparable to those for nursing homes. In 1987, Congress adopted a law that strengthened the protection of nursing home residents’ rights, imposed dozens of new requirements on homes and specified the services they must provide.

One Thought on “Regulatory Gaps in ALFs

  1. In this video, I explain some of the changes that Medicare and Medicaid are planning on making regarding who qualifies to receive the Spinraza treatments. Eleven states, including the state that I live in, Texas, are having possible stipulations and requirements imposed by the Medicaid and Medicare system detailing who qualifies to receive the Spinraza injections. When Biogen and Ionis created Spinraza, there were no stipulations as to who could and could not receive this potentially life-changing treatment. Since there were no stipulations and requirements when they developed Spinraza, there should be no conditions or requirements imposed by the Medicare and Medicaid system. As a collective voice, we have every right to demand that there be no stipulations or restrictions put on anybody who has SMA, and their rights to receive this treatment, including individuals that have Medicaid and Medicare as their insurance carrier. Please take time out of your day and help those of us that are on Medicaid and Medicare.

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