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The Time Has Come for Comprehensive Assisted Living Reform

Starting with the Propublica/Frontline series “Life and Death in Assisted Living” on July 29, deadly problems with assisted living facilities and the way they are overseen by the state have been exposed in several prominent media stories this year. The Propublica/Frontline collaboration initially focused on the Emeritus Corporation, the nation’s (and California’s) largest provider of assisted living housing. In investigating a number of horrible deaths in Emeritus facilities, the reporters found that a combination of profit-driven efforts to fill every bed with residents and undertrained staff to take care of them make a tragic mix.

The San Diego Union-Tribune and the Center for Heath Reporting issued a three-part series on deadly neglect in California assisted living facilities that exposed several deaths due to abuse or neglect. This series focused on the broken regulatory enforcement system that overlooks crimes against residents, is rife with bribery, and generally does not protect residents. The Center for Investigative Reporting also focused on problems with Community Care Licensing’s (CCL - a division of the state Department of Social Services that licenses and regulates assisted living facilities) investigation of abuse and neglect cases, even those involving deaths. This report found that up to 900 cases may have been closed by CCL staff, without any real investigation, to reduce their workload.

Most recently, a dramatic facility closure crisis in Castro Valley has demonstrated that CCL has abdicated its job as a consumer protection agency. The facility, Valley Springs, was owned and operated by a woman who had two other facilities that had been in severe financial and regulatory trouble. One of the facilities, Eden Manor in Oakland, had been on the brink of collapse in February 2013 with no heat, no food, and a building in foreclosure. The facility was ultimately saved when a new owner came in. Valley Springs was itself on the brink of collapse in October when CCL issued a three-day temporary suspension order. Unfortunately, CCL did not make plans for the safety of the residents and when the facility caregivers stopped coming to work, 19 residents were left under the 24-hour care of a single cook and housekeeper for three days until a 911 call led to a facility evacuation.

Problems in assisted living facilities and lax oversight by CCL is nothing new, but the surge in media attention reflects an industry and an agency that are increasingly failing the ever sicker and more vulnerable residents for whom they are supposed to care. To highlight the major problem areas and suggest statewide solutions, CANHR recently released a white paper entitled “Residential Care in California: Unsafe, Unregulated & Unaccountable.” You can read the report at The report calls for, among other things, a new model of care that recognizes the increased health needs of the typical assisted living resident, increased inspections, and more enforcement. See this issue’s RCFE Corner for more details about our recommendations.

The increased attention on assisted living has caught the eyes of members of the California legislature. A legislative hearing on assisted living is tentatively set for February 11, and we expect there will be several bills aimed at reform in 2014. CANHR will be focused on reform efforts and ensuring residents are protected from abuse, neglect, and violations of their rights, but we will need your help. Stay tuned for more news about assisted living reform and how you can participate in the effort. And send us your stories about your experiences with RCFE/Assisted Living care in California.