February 05, 2018

GAO Investigation Finds Over 20,000 Serious Health and Safety Incidents in First-Ever National Assessment of Quality of Care in Assisted Living Facilities

Link to report (PDF)

Washington, DC - United States Senators Elizabeth Warren (D-Mass.), member of the Special Committee on Aging; Orrin Hatch (R-Utah), Chairman of the Committee on Finance with jurisdiction over the financing of assisted living and member of the Special Committee on Aging; Susan Collins (R-Maine), Chairman of the Special Committee on Aging; and Claire McCaskill (D-Mo.) today released a new report completed at their request by the Government Accountability Office (GAO) on the oversight of and quality of care provided to Medicaid enrollees in assisted living facilities. The GAO report - the first-ever national assessment of oversight and quality of care in these facilities - found that 26 states could not report to GAO the number of "critical incidents" - serious health and safety problems that could include physical assaults, sexual abuse, unexplained death, unauthorized use of restraints, medication errors, and inappropriate discharges or evictions - occurring in assisted living facilities in their state. But the 22 states that did track this information used different definitions of critical incidents, further complicating effective oversight of such facilities.

The senators requested the report in July 2015 to better understand federal and state oversight of these facilities, which increasingly receive federal Medicaid dollars but are not subject to the same federal rules as nursing homes. GAO found that in 2014, State Medicaid agencies reported spending over $10 billion in federal and state funds on assisted living services, providing care to 330,000 people.  GAO's report is the first analysis to provide information on the total number of Medicaid beneficiaries living in assisted living facilities and the federal expenditures associated with their care.  

"Seniors and people with disabilities deserve to live safe, healthy, and full lives. But this report finds that thousands of seniors face serious health and safety risks in their assisted living facilities," said Senator Warren. "Medicaid spends billions of dollars to provide this care - and we need to make sure we have the information necessary to ensure accountability. I plan to pursue legislation to address these groundbreaking findings."

"Our nation's seniors, who depend on Medicaid for long-term care services and support, must be safe and protected wherever they call home. And, given that each year the Medicaid program spends billions on assisted living facilities to ensure beneficiaries receive the high-quality care that they deserve, we must be vigilant that these programs are working as intended," said Senator Hatch. "Today's report underscores the importance of improved reporting at assisted living facilities and starts the conversation on how we can make it better. Americans choosing this option for their care, as well as their families and caregivers, should be confident that the safety, health and well-being of its beneficiaries is our top priority."

"With more and more Americans living in assisted living facilities supported by billions in Medicaid dollars, the federal government must help ensure that our seniors and disabled residents receive quality care. Yet, the GAO uncovered a number of troubling issues at some assisted living facilities across the country, ranging from serious health and safety risks to fragmented data that make oversight difficult. I will continue to work with my colleagues to support policies that improve the well-being of seniors who receive care at these facilities," said Senator Collins.

"Our seniors deserve high quality, safe care when they and their loved ones choose an assisted living facility. This report shows a troubling breakdown of that care and safety, and a failure to protect far too many elderly and disabled folks in this country. I'm looking forward to working with my colleagues on both sides of the aisle to turn our deep frustration at these findings into action, to better protect our seniors and ensure they're getting the best care possible," said Senator McCaskill.
While federal Medicaid dollars help fund certain assisted living services in many states, oversight of care in these settings is primarily conducted by the states and differs from the federal regulations that apply to nursing homes. The GAO report found that states had inconsistent definitions of what events qualified as a critical incident; more than half of states could not report to GAO how many critical incidents occurred in assisted living facilities in their state; and, in many cases, when states did identify a significant problem at a facility, that information was not made available to the public. GAO's report makes several recommendations to the Centers for Medicare and Medicaid Services to improve reporting and oversight related to Medicaid spending in assisted living facilities.