January 25, 2024

At Hearing, Warren Calls for Robust Federal Role in Overseeing Assisted Living Facilities, Blasts Private Equity for Declining Quality of Care

Warren: “Assisted living facilities are governed by a patchwork of state laws without any meaningful federal oversight. That means there are no national standards that assisted living facilities are expected to meet.” Warren: “Private equity comes in, strips the assets, cuts staff, and sends quality of care down the tubes.”

Video of Exchange (YouTube)

Washington, D.C. —Today, at a hearing of the Senate Special Committee on Aging, U.S. Senator Elizabeth Warren (D-Mass.) questioned Richard Mollot, Executive Director of the Long-term Care Community Coalition, on the current state of assisted living facilities in the United States and called for a larger, more robust federal role in overseeing these facilities to ensure seniors in need receive high quality care. Presently, assisted living facilities have virtually no federal oversight.

In response to Senator Warren’s questions, Mr. Mollot identified both health and financial threats to patients at assisted living facilities, including the risk of financial exploitation from private equity. 

Senator Warren urged the Biden administration to require additional reporting on problems at assisted living facilities – an outstanding recommendation from a 2018 report she requested from the Government Accountability Office – and called on Congress to take a more active role in overseeing and regulating assisted living facilities. 

Statement: Assisted Living Facilities: Understanding Long-Term Care Options for Older Adults
U.S. Senate Special Committee on Aging
Thursday, January 25, 2024

Senator Warren: I appreciate that we're having this hearing. I appreciate your leadership on ensuring quality care for seniors in assisted living facilities. 

This issue is not a new one for me. In July 2020, my office released the findings from the first national survey of COVID-19 in assisted living facilities, revealing that about 7,000 residents had died from COVID in just the first half of 2020. In many ways, the threat of COVID in assisted living facilities was just as serious as it was in nursing homes. But these facilities received little help and little attention. 

Now, before that, in 2018, I released the first ever national assessment of quality care issues in assisted living facilities, which was completed by the Government Accountability Office at my request. That report revealed that over 20,000 serious health and safety problems occurring at assisted living facilities in just 22 states, from physical assaults to medication errors to unexplained deaths. 

In the years since my office did that work, new studies have revealed additional problems in assisted living facilities. 

Mr. Mollot, you lead the Long Term Care Community Coalition, which is dedicated to improving the quality and accountability of senior living facilities. Can you say a word about what kinds of threats seniors at assisted living facilities face and how serious the risk is?

Richard Mollot, Executive Director, Long-term Care Community Coalition: Thank you. 

I think there are two major risks, and both of them are serious. First, due to the increasing needs and vulnerability of people who go to assisted living, the risk of harm has gone way up. People are vulnerable, people are depending upon assisted living for significant dementia care, etc. And we just don't know if they're getting it. And we often don't know when terrible things happen, as you noted from that GAO report, which was so important. 

Secondly, due to the increased sophistication of operators — we have private equity, we have real estate investment trusts that are circling around in this industry — the risk of financial exploitation has gone up tremendously in recent years. 

Senator Warren: You know, and your keyword: We just don't know. 

These are serious problems that have been going on for years. But we hear so much less about what's going on in assisted living facilities than we do in other facilities, like nursing homes. 

So, Mr. Mollot, why do you think assisted living facilities receive so much less attention than, say, nursing homes?

Richard Mollot: That's a really interesting question. If I may, I think that, you know, in the seventies and the eighties we had some tremendous scandals in the nursing home world. And that led Congress to pay attention and finally to take action. And I think that's where we are with assisted living now is that we're hearing more and more of these stories. The GAO reports from 1999 and the  more recent reports that you mentioned, Washington Post and Times reports that Senator Casey mentioned, local news reporting from around the country. 

Over-and-over, we're seeing that these issues are coming up and now is really the time to take action.

Senator Warren: So with nursing homes we put in federal standards on this, got more federal oversight, but assisted living facilities are governed by a patchwork of state laws without any meaningful federal oversight. And that means no national standards that assisted living facilities are expected to meet. 

That is particularly worrisome, because private equity firms and real estate investment firms – REITs – have gone on a buying spree of senior and assisted living facilities. 

We know how their model works. Private Equity comes in, strips the assets, cuts the staff, and sends the quality of care down the tubes. 

So, Mr. Mollot, your organization has looked carefully at the data. And you've heard from the residents of these facilities. When private equity comes into an assisted living facility and slashes jobs. What impact does that have on the residents? 

Richard Mollot: Well, workers are the most important component of care in any setting, especially in nursing homes and assisted living. So that could be devastating for residents. 

But we know, I mean, unfortunately, we don't have a lot of data directly on assisted living. We have some on senior care in general and, of course, on nursing homes and other care settings. We know that when private equity comes into a sector, they often pillage it. 

Senator Warren: Yeah. In other words, more people will suffer when private equity comes in. 

We need to do more here. At a minimum, the Biden administration should require additional reporting on problems at assisted living facilities. In fact, that is a priority recommendation from the 2018 GAO report. While CMS is making progress on implementing this recommendation, they should finalize it quickly. 

This has gone on long enough without oversight.

And Congress must look at ways to improve accountability, transparency and quality of care in assisted living facilities.