Assisted Living Facilities – The Reality Behind the Sales Pitch

On July 30, 2013, the PBS program FRONTLINE, aired “Life and Death in Assisted Living.” The program looked beyond the beautiful reception rooms and well-cared-for common areas and delved into how assisted living facilities are failing our most vulnerable people. The program exposed the Emeritus Corp.’s (Emeritus’) campaign, which emphasized its bottom line over meeting the needs of its residents. FRONTLINE interviewed several ex-employees who stated Emeritus urged employees to go after patients with cognitive impairments like Alzheimer’s and dementia because they could charge more for their care.  Emeritus targeted these people because they generally paid for their care out their own bank accounts instead of using government programs like Medicaid.

One of the ex-employees was a former executive who complained to the Emeritus corporate office that the facility she worked at lacked sufficient staff with adequate training to care for residents with cognitive problems.  Even more distressing was that the facility was perpetually understaffed to meet even residents’ basic needs, such as bathing, toileting, and passing out medication. She stated she was terminated after exposing these issues to the corporate office. Several residents with cognitive problems died while living in Emeritus facilities and the causes of death included the ingestion of an industrial cleaner, the development of several pressure sores that were hidden from a family, and a fall from a second story window. Emeritus was sued by the families and it paid out huge settlements and judgments.    

Assisted Living Facilities

Assisted living facilities are different from skilled nursing facilities and hospitals because federal law does not regulate the industry. Assisted care facilities are regulated by individual states and regulations vary from state to state.  Assisted living facilities offer housing, meals and care to people who can no longer live independently but who do not require 24-hour medical care.  Approximately one million senior citizens reside in senior care facilities and that number is expected to double by 2030, according to the Small Business Development Care Network (SBDCN). The assisted care facility industry is expected to continue growing because of the 77 million baby boomers who are living longer and who are expected to retire over the next 20 years. 

The Wall Street Journal published a recent article that discussed the “10 things that assisted living facilities won’t tell you.”  They include: (1) they are a short-term solution; (2) if they don’t like you, they will ask you to leave; (3) “ailing residents are cash cows;” (4) rates are not firm; (5) a facility locks the doors to the dementia ward and rarely offers the activities mentioned in the brochures; (6) the advertised amenities are not always available; (7) it is not a charity; (8) the facility pays people to refer residents to it; (9) ratings for a facility are not the same as ratings for skilled nursing facilities; and (10) a facility does not want to take Medicaid as payment since it will receive less per resident and Medicaid comes with government oversight.   

Forbes magazine reported that assisted living and other residential care facilities are taking on more residents that would normally be in nursing homes; approximately 33 percent of residents will need emergency room care during their stay.  According to a study from the National Center for Health Statistics, 42 percent of residents have some form of dementia, 33 percent have heart disease, and more than 50 percent suffer from three or more chronic illnesses. 


The website  offers information that helps family members assess if an assisted living facility is appropriate for their loved one.  Families need to honestly answer these questions when choosing a facility:  

  • Staff:  Do they have time to speak with you or does it feel rushed? Do they appear genuinely interested in you? Do they interact warmly with current residents? How do they handle emergencies?
  • Residents: Do they appear happy? Do they enjoy interacting with one another? Do they seem like people you’d enjoy getting to know? Are there hobbies or groups on site that look interesting to you?
  • Families also should also note: Does it feel homey? Does the facility offer interesting activities? Is the food appealing? How are health problems handled and how does the facility handle both emergency and non-emergency problems?  Is the facility in compliance with state and local licensing requirements?