Assisted Living communities are taking in an increasing number of dementia residents, but memory care services might not always be keeping these older adults safe and secure.

That’s according to a Dec. 13 New York Times article produced in collaboration with Kaiser Health News. The article –“Dementia Patients Fuel Assisted Living’s Growth. Safety May Be Lagging” — relied on a Kaiser Health analysis of assisted living inspection records in the three most populous U.S. states: California, Florida and Texas.

Kaiser’s analysis found:

— 45% of assisted living communities in California violated at least one state dementia regulation in the past five years

— One in every 11 assisted living communities in Florida were cited for not meeting regulations aimed at keeping residents from wandering away since 2013

— Almost a quarter of assisted living communities that take memory care residents in Texas violated one or more state dementia regulations over six years

The article also spotlighted two high-profile cases of alleged dementia resident mismanagement, one being the tragic incident where a Brookdale Senior Living (NYSE: BKD) resident with dementia was killed by an alligator after wandering away from her community in 2016. Commenting about the incident to the Times, a Brookdale spokesperson said “our everyday focus and priority is to keep residents safe” and added the resident’s death was an “unfortunate accident.”

Taken alone, these details and statistics are sobering. But the analysis might be missing some crucial nuance to understanding the larger issue at hand, according to David Schless, president of the American Seniors Housing Association (ASHA).

“Caring for residents with severe dementia is complex and involves a balancing between freedom, quality of life and absolute safety. The obsolete way of addressing this challenge many years ago in nursing facilities — with heavy medication and/or physical restraints — is no longer acceptable,” Schless told the organization’s members in an email. “Assisted living communities, which pioneered a more humane residential model of care, work hard every day to maintain this balance for the optimum benefit of residents.”

Additionally, some states fail to aggressively enforce assisted living regulations, putting residents and operators at risk, Schless wrote.

“States have a legal and moral obligation to safeguard the health and safety of all residents in assisted living and when they fail to conduct timely licensure inspections or impose strict sanctions when circumstances dictate, they do a grave disservice to all of us who care about the welfare of seniors,” he explained.

The New York Times article has reverberated throughout the senior living industry since it was published, and ASHA wasn’t the only industry organization to weigh in on it. Stricter federal rules for assisted living providers may not always be the right answer, according to the National Center for Assisted Living (NCAL).

“As we continue to learn more about Alzheimer’s and other forms of dementia, there is always room for improvement,” NCAL said in a statement to Senior Housing News. “However, we should remain cautious about additional requirements or regulations that run counter to person-centered care. Policymakers, providers, family members and other stakeholders must come together to focus on ways to improve care and ensure well-being while still empowering, not limiting, residents living with dementia.”

There has been some appetite on the federal level to standardize regulations for assisted living providers and identify key best practices and policies. In general, the shift from a hospitality-based model for assisted living into one that includes more health care options has heightened regulatory scrutiny for assisted living providers. A recent report from the Long Term Care Community Coalition (LTCCC) identified key best practices and policies for assisted living communities to self-regulate and ensure the safety and dignity of their residents. That report also detailed breakdowns in tracking critical incidents that can impact the licensing and certifications of assisted living communities, whether or not they receive federal or state payments.

Written by Tim Regan

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