Assisted Living: A $10 Billion Industry With Little Oversight

It’s largely up to states to regulate these facilities -- many of which don’t even employ full-time nurses.

For millions of older Americans, there’s nothing stronger than the desire to age in place, maintaining their independence and avoiding intensive institutional care for as long as possible. Increasingly, assisted living is filling the gap between home and a nursing facility.

States spend a reported $10 billion in federal and state money per year on Medicaid beneficiaries in assisted living facilities, averaging $30,000 per patient, per year. But it’s not clear whether governments are getting their money’s worth in terms of quality of care and, critically, the safety and well-being of the facilities’ residents.

Answers to some of those concerns came in a February report from the Government Accountability Office (GAO), which found significant shortcomings in oversight of assisted living facilities across the country. Forty-eight states receive some kind of Medicaid funding for assisted living facilities, but 26 of those states do not report “critical incidents” -- including unexplained deaths, abuse, neglect or financial exploitation -- to the federal government.

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