Assisted Living Industry Struggles to Accommodate Growing Dementia Population

The rapidly increasing population of dementia patients in assisted living facilities is challenging not only the facilities providing the care, but also the safety of the other non-afflicted seniors who reside there.

Originally, assisted living facilities were created as an alternative to nursing homes. They were designed for those who were independent, but in need of some assistance with daily living tasks, such as cooking, bathing, or housekeeping. Because these facilities do not provide medical services, they are not covered by Medicare or Medicaid. Unfortunately, that also means they are not regulated by the federal government. Instead, each state is responsible for monitoring assisted living residences. Regulation and enforcement vary widely among the states.

According to the Kaiser Family Foundation, nearly one-fourth of this country’s assisted living facilities provide dementia care or provide special “memory care” wings. Four out of 10 residents at some facilities suffer from dementia. Studies show that many of these facilities are ill-equipped to house residents with dementia and are often in violation of state regulations regarding dementia care. In California, the Kaiser Foundation found that 45 percent of all assisted living facilities violated one or more of the state’s regulations regarding dementia care. In 2017 alone, three of the 12 most common citations issued in California involved dementia care.

Other states with large senior populations offer similar statistics. In Florida, one in 11 assisted living facilities have been cited for failing to prevent dementia tenants from wandering away from a residence. In Texas, almost one-fourth of the facilities accepting residents with Alzheimer’s failed to comply with one or more dementia care state regulations, including ensuring that staff was adequately trained to manage residents with dementia.

The failure to address the needs of dementia patients can put nonafflicted assisted living residents at risk. According to the Centers for Disease Control and Prevention, more than half of the residents in assisted living facilities are 85 or older. Each year, one in five residents experiences a fall, one in eight visits the emergency room, and one in 12 are required to stay overnight in a hospital. When a senior living population combines regular residents with those suffering from dementia, those risks increase. One 2016 study found that 8 percent of assisted living residents with dementia were abusive or physically aggressive toward staff and other residents. More recently, news stories have cited incidents involving injury and sometimes death.

Whether these problems result from the lack of state regulation or due diligence on the part of assisted living facilities, there is no doubt that there is big money in dementia care. The National Investment Center for Seniors Housing and Care says monthly costs for residents with dementia averages $6,472 a month compared to $4,835 for those without. Perhaps that’s why the construction of memory care units now outpaces all other types of senior housing construction.

However, the increased need for dementia care does not excuse assisted living facilities from complying with the law and meeting appropriate standards of care for all residents. For many seniors, residing in an assisted living facility is still preferable to a nursing home.

When searching for assisted living facilities, it is important for seniors to ask the following questions:

• Does the assisted living facility house people suffering from Alzheimer’s and other forms of dementia?
• If yes,
• Are those residents housed in a different wing or integrated with the general population?
• Are dementia residents “locked down” or otherwise secured to ensure their safety and the safety of other residents?
• Is there adequate staff to address the needs of regular residents, as well as those suffering from dementia?
• Has staff been specifically trained to manage residents who suffer from dementia?
• Are activities combined for regular and dementia care residents? How are such activities supervised?
• Has any resident ever been disturbed, threatened, injured, or killed by a dementia resident under the facility’s care?
• Has the facility been cited for failure to comply with state regulations regarding assisted living facilities or dementia care in the past five years?
• How did the facility address those citations?

State regulations regarding assisted living facilities are intended to protect all residents. The right questions will ensure that those who reside in assisted living receive the attention and care they deserve.

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