In some cases, assisted living facilities may serve residents who meet the level-of-care criteria for admission to a nursing home. The states have the primary responsibility for overseeing the care that assisted living facilities provide residents, and few federal standards or guidelines govern assisted living. Assisted Living Facility Services and Resident Needs Vary Widely

provide housekeeping, laundry, meals, transportation to medical appointments, special diets, and assistance with medications. Consumers May Lack Adequate Information to Select a Facility That Best Meets Their Needs

Given the variation in what is labeled assisted living, prospective residents must rely primarily on information supplied to them by facilities to select one that best meets their needs and preferences. Such information should include the cost of the basic service package and what it includes; the availability of additional services, who will provide them, and their cost; the circumstances under which costs may change; how the facility monitors resident health care; the qualifications of staff who provide personal care, medications, and health services; discharge criteria, such as when a resident may be required to leave the facility, and the procedures for notifying and relocating the resident; and grievance procedures. Contracts and other written materials we reviewed were often unclear or inconsistent with each other or with requirements of state regulation regarding how long residents could remain as their needs change, resident notification requirements, and other procedural requirements for discharge. To ensure that assisted living facilities comply with the various licensing requirements, all four states conduct periodic inspections or surveys of facilities, and they may also conduct more frequent inspections in response to specific complaints. However, the four states vary in the frequency and content of assisted living facility inspections. In addition to the state licensing agency, other state agencies play a role in the oversight of assisted living facilities. The States Identify Quality-of-Care and Consumer Protection Problems in Assisted Living Facilities

Given that the states vary in their licensing requirements for assisted living facilities and in their approaches to oversight, the type and frequency of quality-of-care and consumer protection problems identified by the states may not fully portray the care and services the facilities actually provide. Using available data and reports from state licensing, ombudsman, and APS agencies in the four states, we determined that 27 percent of the 753 facilities in our sample were cited for five or more quality-of-care or consumer protection related problems during 1996 and 1997. Most of these verified problems pertained to quality-of-care rather than consumer protection issues. In Florida and Oregon, the two states in which APS agencies have some responsibility for oversight of residents in assisted living facilities, resident abuse was also often cited.
Why GAO Did This Study

Pursuant to a congressional request, GAO discussed quality-of-care and consumer protection issues in assisted living facilities in California, Florida, Ohio, and Oregon, focusing on: (1) residents' needs and the services provided in assisted living facilities; (2) the extent to which facilities provide consumers with sufficient information for them to choose a facility that is appropriate for their needs; (3) the four states' approaches to oversight of assisted living; and (4) the types of quality-of-care and consumer protection problems they identify.

What GAO Found

GAO noted that: (1) assisted living facilities vary widely in the types of services they provide and the residents they serve; (2) they range from small, freestanding, independently-owned homes with a few residents to large, corporately owned communities that offer both assisted living and other levels of care to several hundred residents; (3) some assisted living facilities offer only meals, housekeeping, and limited personal assistance, while others provide or arrange for a range of specialized health and related services; (4) they also vary in the extent to which they admit residents with certain needs and whether they retain residents as their needs change; (5) given the variation in what is labelled assisted living, prospective residents must rely on information supplied to them by facilities to select one that best meets their needs and preferences; (6) in many cases, assisted living facilities did not routinely give consumers sufficient information to determine whether a particular facility could meet their needs, for how long, and under what circumstances; (7) moreover, GAO identified numerous examples of vague, misleading, or even contradictory information contained in written materials that facilities provide to consumers; (8) the states have the primary responsibility for the oversight of care furnished to assisted living facility residents; (9) all four states reviewed have licensing requirements that must be met by most facilities providing assisted living services, and state licensing agencies routinely inspect or survey facilities to ensure compliance with state regulations; (10) however, the licensing standards as well as the frequency and content of the periodic inspections vary across the states; (11) given the absence of any uniform standards for assisted facilities across the states and the variation in their oversight approaches, the results of state licensing and monitoring activities on quality-of-care and consumer protection issues also vary, including the frequency of identified problems; (12) however, using available inspection surveys and reports from the other oversight agencies in the four states, GAO determined that the states cited more than 25 percent of the 753 facilities in its sample for five or more quality-of-care or consumer-protection related deficiencies or violations during 1996 and 1997; and (13) state officials attributed most of the common problems identified in assisted living facilities to insufficient staffing and inadequate training, exacerbated by high staff turnover and low pay for caregiver staff.