3 Major Concerns

Residing, whether briefly or for an extended time, in a senior living facility has many challenges. This is especially true in regards to facilities providing nursing care.  Solutions to these problems are consistently being discussed by the government and other stakeholders. However, many of these issues are difficult and extremely costly to solve. For example, staffing and regulation of facilities are problems consistently faced by senior living. Fraud and abuse are also issues that seem to plague this industry. Let’s take a closer look at these issues.


Staffing is a major issue for senior living facilities. First, it has been reported that shortages in staff are expected to reach crisis level in the years to come. This is due to difficult working conditions and low wages, which is affecting the ability to recruit and keep quality staff. In addition, the demand for high quality care continues to increase, while the number of capable (and caring) individuals is in short supply. The shortages will only get worse as the need grows exponentially as us Baby Boomers move into the 70s and soon into the 80s. (Alas, those of us who loved the music of the 60s and 70s are realizing we are in our 60s and 70s!  How did that happen?) When senior living facilities struggle with adequate (and caring) staffing, patient care suffers. The ratio of residents to caregivers in a facility directly affects the quality of care.  While every industry faces the challenge of doing more with less staff, it seems senior living facilities are moving in that direction more aggressively.
Family members of those residing in senior living facilities frequently tell me stories of how they have had to advocate on behalf of their loved ones with management to increase basic care and sadly, at times, to stop neglect. I’m always pleased to hear stories of clients receiving GREAT care at various facilities.
This issue of shortages in capable and care staff is daunting, but facilities in various states are seeking to find options to solve this common problem. Developing partnerships with universities is one option some large facilities are using to attempt to solve the issue of quality staffing. These facilities seek to partner with internship programs in nursing to entice students to look at the facilities as a viable employment option. These partnerships also strive to make continuing education more affordable for facility staff. Finally, the universities and facilities are working together to improve training and refine curriculum to better prepare students for working in senior living facilities.

Fraud, Abuse and Neglect

Fraud, abuse are MAJOR issues in senior living facilities. These problems often relate back to the issues with staffing, but fraud is also perpetrated through the business offices of facilities. Seniors fall prey to billing fraud where they are billed for services, prescriptions, and medical care in excess and in ways that are confusing. The facility then pockets the extra money. Billing Medicare and Medi-Cal (aka Medicaid) for more advanced services is just another way facilities take advantage of their residents.

California Advocates For Nursing Home Reform (CANHR.org) believes that theft of senior living residents property continues to be one of the most prevalent (and unreported) problems in California nursing homes. Thefts include everything from jewelry to clothing, radios, CD players, dentures, eyeglasses and hearing aids. The theft of a personal item (whether it is an expensive or inexpensive watch or ring or an article of clothing) can undermine the psychological well-being of residents and cause them to feel overwhelmed by a sense of having been violated.  In some cases, such as when dentures are stolen, the theft can jeopardize a resident’s life.

Senior fraud can also occur when workers befriend seniors and then take advantage of the often-lonely senior by accepting gifts or convincing them to change their financial plans.

Physical abuse is also a problem with senior living facilities. The use of restraints and drugs to control patients is reported as a major problem. Senior abuse also involves hitting, sexual abuse, and mental abuse.

Unexplained weight loss, dehydration and/or bedsores may be a sign of neglect, albeit unintentional due to a staffing shortage or intentional because of an abusive staff worker.

There are many ways to report fraud and abuse of seniors. If there is a risk of immediate harm, call 911! To report abuse in a nursing home, see CANHR’s Fact Sheet – How to File a Nursing Home Complaint.  For additional sites and information about reporting elder abuse or fraud, see CANHR’s Fact Sheet – Recognizing and Reporting Elder Abuse.

Elder law attorneys can also help families decide on the best route in dealing with fraud or abuse. Most importantly, families must be involved with their senior loved ones and keep tabs on finances and the care received.

Regulation and Oversight
Regulation and oversight varies from state to state and varies by facility type. Nursing homes are considered medical facilities and much of the funding comes from Medicare and Medi-Cal (aka Medicaid). Therefore, nursing homes are generally more regulated because they are under state and federal regulations. Assisted living facilities where residents generally private pay and are considered non-medical have minimal regulation by the government. While each state has their own regulations for assisted living facilities, most states have not kept up with the changing tide of assisted living facilities. These facilities are dealing with residents with illnesses and therefore are providing more medical care for their residents. However, many do not have medical personnel on site.

Most states require inspections, but these very from once a year in some states to once every 5 years in others. Very few states have adequate oversight of these facilities and many have staff that is inadequate and lack appropriate training. As these facilities garner more negative attention, many states are beginning to look at more suitable ways to oversee and regulate senior living facilities.

The problems with senior living facilities are daunting. The majority of wwners are constantly looking for ways to improve these facilities and the care they provide. With the number of senior adults who will need care on the rise exponentially, these issues must be dealt with or there will be a crisis of care and options for senior living.

If you have any questions about something you have read or would like additional information, please feel free to contact us.


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