Amid growth of assisted living, some renew calls for federal oversight

The number of assisted-living centers in the United States has jumped dramatically in the past 20 years, but there have been few efforts to systemically re-evaluate staffing or training guidelines necessary to properly serve residents.

CLEVELAND, Ohio — To work as an aide in an assisted-living center in Ohio requires empathy, compassion and very little training.

About 20 hours, to be exact.

In Kansas, it’s much different. Aides there must take a 90-hour class and pass a test. North Carolina requires aides to take 80 hours of instruction. But there are other states, such as Montana, that say training is needed, but don’t specify how much.

The number of assisted-living centers in the United States has jumped more than 150 percent in the past 20 years, fueled by an increase of residents with cognitive issues, a willingness of facilities to take more frail patients, and families who wish to avoid nursing homes.

But while the centers’ clientele has changed dramatically, there have been few efforts to systemically re-evaluate staffing or training guidelines necessary to properly serve residents. This has led some advocates of the elderly to renew the call for federal oversight of the facilities, much like nursing homes.

For instance, nearly half of the nation’s states lack extensive training programs for the facilities’ employees, with most requiring some form of a job orientation and less than a dozen hours of instruction.

When it comes to staffing, the differences are even more stark. Thirty-eight states leave the amount of personnel needed to care for residents up to individual facility owners.

In Ohio, facility owners must make sure “sufficient numbers of staff” are present to meet residents’ needs. That’s different than in South Carolina, where one aide or staff member must be present for every eight residents during the day.

"This is an enormous problem,” said Kristine Sundberg, the president of Elder Voice Family Advocates in Minneapolis. “[Federal oversight] would be better, of course. It would provide for greater consistency.”

But the nation’s leading voice for assisted-living centers disagrees, fearing federal oversight would push “paperwork over patients.”

“We believe that states are better equipped to help assisted-living centers adapt and customize the care needed,” said Rachel Reeves, a spokeswoman for the National Center for Assisted Living in Washington, D.C. "The states offer greater flexibility. They can see what is best for residents and deal with those issues.”

Industry officials also see a potential cost to federal oversight: The expense of hiring more staff could be passed on to residents.

Medicaid’s role in assisted living

Nursing homes rely on Medicaid, in most cases, to pay for the services for residents. In large part, that’s why the federal government oversees the facilities.

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By John Caniglia, The Plain Dealer