About a quarter of assisted living residents need help  with three or more ADLs. State Efforts to Enhance Consumer Information on Facility Options

Given the wide diversity among assisted living facilities in the services  they offer and the populations they are prepared to serve, prospective  assisted living residents can have difficulty finding an appropriate—let  alone the most appropriate—facility to meet their individual needs. Initiatives such as the Florida “Find-a-Facility” Web site and the Texas  standardized disclosure statement help consumers make better choices by  providing them the information they need in an easier-to-absorb format. To make appropriate choices among  the wide range of facility options available in the market, consumers need  to learn about facility services, costs, and policies that impact residents. Moreover, they need this information to be not only complete and  accurate, but also presented in a timely way and in a form that they can  understand. Specifically,  the report found that facilities’ written materials often did not contain key  information, such as a description of services not covered or available at  the facility, the staff’s qualifications and training, circumstances under  which costs might change, assistance residents would receive with  medication administration, facility practices in assessing needs, or criteria  for discharging residents if their health changes. Our expert interviews and the studies we reviewed identified information  about staffing levels and qualifications, costs and potential cost increases,  and facility policies regarding discharge criteria as critical to informed  decision making. Under these circumstances, consumers often do not know  what questions to ask or how to assess and compare the responses that  they receive in order to identify the facility that can best meet their  individual needs. While a number of other states have developed similar forms—particularly  for specialized dementia units—Texas is notable for having been among  the first to develop a standardized disclosure statement for all assisted  living facilities, and to include detailed information on staffing levels. State Efforts to Facilitate Provider Compliance with Licensing Requirements

Assisted living providers may fall short of meeting state licensing  standards in part because they lack a full understanding of what the  standards require and how to meet them. The experience of Washington  State, which for 2 ½ years employed a staff of consultants to advise and  train assisted living providers, shows the potential benefits of licensing  assistance programs in improved provider compliance and resident  outcomes, as well as the challenge of sustaining them over time. These activities continued for 2 ½ years until, in the midst of a  state budget crisis, the state stopped funding the program. The second  evaluation occurred 2 years later. State Efforts to Strengthen Residents’ Complaint Procedures

Some assisted living residents have difficulty pursuing complaints with  their providers, particularly in cases involving an involuntary discharge. Georgia has established a spectrum of procedural remedies specifically for  assisted living residents that appear to strengthen their bargaining position  vis-a-vis providers. Among the avenues for residents to seek redress of their complaints is  through the long-term care ombudsmen program in each state. In fact, providers and residents may remain unaware of  their existence, until the advocates have reason to bring these remedies to  their attention in the course of resolving disputes. This working relationship has helped give the ombudsman more leverage  when dealing with providers. The state and provider representatives we spoke with agreed that having a  separate assisted living ombudsman program led its staff to become  increasingly knowledgeable about assisted living and the particular  problems that arise within it. We interviewed officials or individuals associated with the following  entities:  Florida Department of Elder Affairs  Florida Assisted Living Affiliation  Senior Resource Alliance (Florida)  Texas Department of Human Services  Texas Assisted Living Association  Texas Assisted Living Advisory Committee  Washington Department of Social and Health Services  Washington Health Care Association  Washington Long-term Care Ombudsman Program  Georgia Long-Term Care Ombudsman Program  Georgia Legal Aid Program  Senior Citizens Law Project (Georgia)  Assisted Living Association of Georgia  Massachusetts Executive Office of Elder Affairs  Massachusetts Assisted Living Facilities Association  Alice Mahar Dupler, Neva L Crogan, and Robert Short, “Pathways to  quality improvement for boarding homes: A Washington state model,”  Journal of Nursing Care Quality; Jul 2001; 15(4), 1-7.
Why GAO Did This Study

Assisted living facilities provide help with activities of daily living in a residential setting for individuals who cannot live independently but do not require 24-hour skilled nursing care. In 2002, over 36,000 assisted living facilities served approximately 900,000 residents. The states establish and enforce licensing standards for these institutions. Because states have taken widely differing approaches to regulating and supporting assisted living, they can potentially learn from each other's experiences as they consider changes to their own policies. GAO was asked to review challenges faced by consumers and providers of assisted living and seek out notable state initiatives addressing those challenges in three selected areas: (1) disclosure of full and accurate information to consumers, (2) state assistance to providers to meet licensing requirements, and (3) procedures for addressing residents' complaints. We identified specific examples of individual programs in Florida, Texas, Washington, Georgia, and Massachusetts that highlighted different approaches in these three areas, which other states might wish to consider emulating.

What GAO Found

Consumers faced with choosing an assisted living facility often do not have key information they need in order to identify the one most likely to meet their individual needs. Such information includes staffing levels and qualifications, costs and potential cost increases, and the circumstances that could lead to involuntary discharge from the facility. Initiatives in Florida and Texas have made critical data for consumer selection among facilities more readily available. Florida has created a Web site that enables consumers to learn about all of the facilities in their vicinity and identifies those providing the services the consumers are seeking at a specified price range. Texas has mandated a standardized disclosure statement for assisted living facilities, giving consumers concise and consistent data that facilitates comparisons across providers regarding services, charges, and policies. Assisted living facilities are more likely to meet and maintain licensing standards if they can obtain help in interpreting those standards and in determining what concrete changes they need to make to satisfy them. Washington State established a staff of quality consultants to provide such training and advice to assisted living providers on a voluntary basis. Evaluations of the program 6 months after its start and 2 years later documented improvements in provider compliance as well as resident health and safety. However, a statewide budget crisis led to a decision to stop funding the program, in order to maintain traditional licensing enforcement functions. Assisted living residents sometimes need help to pursue any complaints that they may have with their providers, especially when faced with an involuntary discharge. Long-term care ombudsmen are available in all states, but nursing home residents claim most of their attention. Georgia has legislated an extensive array of procedural remedies specifically for assisted living residents that provide them multiple means for seeking redress of their complaints. The existence of these remedies also strengthens the position of residents in the informal negotiations through which most such disputes are resolved in practice. Massachusetts has created a small staff of ombudsmen dedicated exclusively to serving assisted living residents. This allows them to specialize in addressing the particular problems that arise in assisted living facilities.