Nearly 9,000 Residential Care Facilities for the Elderly (CFEs), known as assisted living facilities, exist in California with a capacity of almost 225,000 beds—equaling the population of Chula Vista and more than 186 U.S. cities. These facilities are the least-regulated class of care facility in California, resulting in an enormous variability in quality. Some offer exemplary care, while others are seemingly in business for profit alone. Facilities provide a non-medical housing alternative for individuals 60+ requiring assistance with activities of daily living. With facility inspections conducted only every seven years, the best advice is to make sure that you do your research beforehand. But what should you be looking for?
Find a facility that looks good by visiting its website, taking a tour of the place, and talking with the administrator. These are good starting points, but in themselves might not be enough. You also need to be aware of specific issues:
It is not mandatory to have liability insurance when providing 24/7 care and supervision to frail elders in these facilities. Owners usually carry property insurance but frequently opt not to protect against the risk of injury, harm, or death to their client caused by their actions, or omissions. If there are accidents, there is no recourse for compensation.
The state requires only that staff be ‘sufficient in numbers’ to provide care consistent with residents’ needs. In small facilities, which are the majority, the facility will usually have two staff members on duty during the day, but at night, it drops to one. The state requires facilities serving dementia residents with a penchant for wandering, to field only one “awake” caregiver.
The law also allows facilities to assist residents with medications, to retain clients on hospice or with other medical conditions, and those who are permanently bedridden. Yet facilities need only hire unskilled caregivers, and still be in compliance with the state laws.
With an increasing aging population and a concomitant increase in frail older adults, these types of facilities will become more attractive. With the economy eroding personal investments, it is likely that the attractiveness of services to frail older adults might be tainted primarily by considerations of cost. But because these facilities provide non-medical care, the competition is not for stringently-regulated nursing home care—but for “aging-in-place” with fulltime care. To help with these decisions, Chris Murphy, a SDSU graduate gerontology student, is developing a website that allows you to evaluate these facilities on the basis of no-compliance reports and other outcomes.
San Diegans need tools like this that will allow them to judge the quality of care in these emerging assisted living cities. In the meantime there are a number of thoughtful approaches to choosing a facility. Be nosy. When you visit the facility watch what's going on, who’s on duty, and ask questions. Ask to check the medication log for your resident to make sure medications are being given and in the right dose. And finally do not hesitate to complain. If anything is suspect, call the local complaints number (619) 767-2300. Improving tools that allow us to be more vigilant will positively influence the care older adults receive in San Diego.
Mario Garrett PhD is a professor of gerontology at San Diego State University. He can be reached at mariusgarrett@yahoo.com © Mario Garrett 2010
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