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ASSISTED LIVING FACILITIES IN MICHIGAN

The Problem: Michigan has witnessed a significant growth of unlicensed/unregulated assisted living facilities adding to consumer confusion. In Michigan, both licensed adult foster care homes and homes for the aged as well as unlicensed settings hold themselves out as assisted living facilities serving older persons. At least one nursing home closed and re-opened as an assisted living facility with some of the same residents. Other evidence of The Problem includes:

• There is no commonly recognized definition, in law or otherwise, for assisted living facilities and assisted living services.
  
  
• Assisted living facilities varying sizes and types of services pose consumer confusion.
  
  
• Many Michigan assisted living facilities obtain care services from unregulated home health agencies.
  
  
• The information provided to the public by assisted living facilities is inadequate, confusing, and misleading, and sometimes potentially fraudulent.
  
  
• Complex and confusing variations exist in pricing of assisted living services and facilities. Costs to consumers range from $12,000 to $40,000 per year, depending on the services and accommodations provided.
  
  * Additional services generally cost residents more, such as medication administration, transportation and activities of daily living or nursing care above the minimum. When resident's private funds are exhausted, many have to leave with limited available alternatives.
  
  
• Public financing for residents in assisted living facilities is limited or non-existent. Thus assisted living facilities are unaffordable for low and moderate-income older persons.
  

Quality of care problems in assisted living facilities mirror those in nursing homes and include:

1. Inadequate care - lack of access to physicians and other needed medical care and treatment;
   
   
2. Inadequate staffing - insufficient numbers of staff and insufficiently trained staff; and
   
   
3. Questionable methods of handling medications, not providing residents their prescribed medication, providing them the wrong medication, or storing medication improperly.
   

The promise of Aging in Place is not kept by many assisted living facilities since:

1. Many facilities are ill-equipped to care for residents when residents; needs decline or change; and
   
   
2. Many facilities discharge residents who become bedridden, require ongoing tube feeding, need a ventilator, require IV therapy, or develop significant memory or judgment problems.
   

The local and state responses to allegations of abuse, neglect, exploitation and endangerment in assisted living facilities are fragmented.

The Extent of the Problem:

• The Assisted Living industry is now over a $15 billion enterprise nationally.
  
  
• As of the beginning of 1998, there were an estimated 11,472 assisted living facilities nationally, with approximately 650,000 beds and 558,400 residents.*
  
  
• In Michigan, the following types of facilities serve people who are no longer able to live in their own homes. As of September 2003 there are:
  
  
• 4,248 licensed and regulated Adult Foster Care Homes with 32,759 beds.
  
  
• 190 licensed and regulated Homes for the Aged with 14,571 beds.
  
  
• 456 licensed and regulated nursing homes, county medical care facilities and hospital long term care units with 52,078 long term care beds.
  
  
• There are numerous unlicensed and unregulated assisted living facilities.
  
  
• A random informal sampling of 34 facilities advertised as assisted living facilities revealed the following:
  
  
• 13 reported they were licensed as Homes for the Aged.
  
  
• 7 reported they were licensed as Adult Foster Care Homes.
  
  
• 5 reported they were unlicensed.
  
  
• 1 reported it was licensed as an assisted living home.
  
  
• 1 reported it was licensed as a hotel.
  
  
• 7 reported they have a continuum which includes licensed and unlicensed areas.
  

Possible Solutions:

• Enact legislation that would define the term "assisted living facility" in plain language, and would distinguish the term from licensed long term care facilities.
  
  
• Amend consumer protection and contract laws to lessen the potential for exploitation by requiring assisted living facilities to provide consumers with important information and documents upon which appropriate admission decisions can be made and to require full and clear disclosure of marketing information and contract terms.
  
  
• Clarify oversight by Adult Protective Services and other state agencies.
  
  
• Modify the Medicaid Program to allow for payment and reimbursement for services and residential care in licensed assisted living facilities for persons who are eligible for nursing home care.
  
  
• Enact minimum standards to ensure accountability in regulated assisted living facilities:
  
  
• Require private accreditation tied to public funding and capacity to operate assisted living services.
  
  
• Require registration of assisted living facilities in a central registry.
  
  
• Require periodic and unannounced state inspections.
  
  
• Require licensure of home health agencies.
  
  
• Require licensure of assisted living facilities.
  
  
• Expand and appropriately fund the Ombudsman Program to maintain a consumer database that coordinates information about assisted living facilities and to increase the visits Ombudsman can make to assisted living facilities to resolve consumer complaints.
  
  
• Fund data collection and evaluation.
  

Citizens for Better Care acknowledges that many older Michiganians view assisted living facilities as viable, home like settings to meet their long term care needs. Each assisted living facility, however, is unique and has varying strengths and limitations to meet persons' long-term care needs. Citizens for Better Care recommends that these facilities be regulated and mandated to provide clear and comprehensive consumer information so that Michiganians have the ability to make appropriate choices for their own and family needs.





CBC Action Sheet #1





* A National Study of Assisted Living for the Frail Elderly. Catherine Hawes, Ph.D., et al. U.S. Department of Health and Human Services, April 26, 1999.

* Michigan Department - Consumer and Industry Services, Adult Foster Care licenses, 11/03.