Assisted living has helped to transform the ‘institutional’ model environment of nursing homes by focusing attention on an environment people actually could live in. Unfortunately the same degree of attention has not always gone to ensuring the quality of resident care is as good as the physical environment. Thus fueling the all too frequent newspaper articles detailing heartbreaking stories about poor resident care outcomes.

The blame falls not only on providers of assisted living, but also on states. In an effort to avoid the problems associated with federal regulation and oversight of nursing homes, assisted living has been regulated at the state level. Many states have been slow to develop regulations for assisted living and establish survey and oversight efforts. State budget issues are further eroding an already weak system creating a patchwork of poor care and protection for their vulnerable, elderly citizens.

Many of the tragic incidents cited in recent articles happened to assisted living residents with Alzheimer’s disease and other dementia. The problems in caring for this vulnerable population are typically rooted in staffing. All too often there are insufficient numbers of staff to meet promised resident care needs and staff frequently are not adequately trained or prepared to handle the challenging needs of individuals with dementia. This same issue plagues quality of care in nursing homes. A manicurist, for example, in New York must complete 250 hours of classroom training and preparation and pass a written and practical exam before they can begin working. A caregiver working in assisted living in New York only needs 40 hours despite the fact that they are responsible for much more intimate and complex care. Is it any wonder that there are care problems?

The remedy would appear to be simple – better train and prepare all staff. However, assisted living providers claim there is sufficient staff and they are adequately trained despite overwhelming evidence otherwise. There is a culture of denial among facility owners that pervasive care problems exist. Many owners and managers see adding enough staff and their training as a drain on corporate profits thus perpetuating a cycle of substandard care.

If it was easy to care for assisted living residents, they would most likely continue to live at home. It is not easy and is the most significant reason people move their loved ones into facilities. To admit residents and not have enough well trained staff simply invites disaster and essentially amounts to corporate malfeasance.

According to a study conducted by a fellow of the American Academy of Nursing, good quality care actually costs less than poor quality care in nursing homes to the tune of over $13 per resident per day. The savings come from: lower liability insurance and workman's compensation rates; legal fees from not having to defend against poor care litigation; and high costs associated with frequent staff turnover. Although the study was conducted in nursing homes, the general concept applies to assisted living also. This could amount to a cost savings for owners of over $350,000 annually for each Sunrise-sized facility.

Older adults will soon outnumber children for the first time in our nation’s history. Individuals 85 and older are currently the fastest growing sector of our population, and the tidal wave of aging baby boomers will soon follow.

National newspapers have provided the public with a window into serious problems for a very vulnerable sector of our population. If we don’t speak out to fix the present problems, we are doomed to live with the consequences in the future. Will we endure all too often substandard care in ‘chandeliered’ facilities or will we have the courage to speak out and demand change? The choice is ours.

Karen Love, a former assisted living administrator and family member of an assisted living resident, is the founder and chair of the Consumer Consortium on Assisted Living (CCAL). CCAL was founded in 1995.