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Chet Strange

The chairman of the Senate Special Committee on Aging is launching a review of safety lapses in the assisted-living industry, saying an <a href="https://www.washingtonpost.com/business/interactive/2023/assisted-living-wander-patient-deaths/" target="_blank">investigation</a> by The Washington Post into the deaths of dementia-care residents who have wandered from facilities had revealed “horrific” neglect and a “violation of trust.”

In response to The Post’s finding that <a href="https://www.washingtonpost.com/business/interactive/2023/assisted-living-wander-patient-deaths/" target="_blank">nearly 100 seniors</a> have died over the past five years after leaving facilities unnoticed or being left unattended outside, Sen. Bob Casey (D-Pa.) sent letters Tuesday to the nation’s three largest assisted-living chain owners seeking information about their practices. The Post’s report is the first nationwide accounting of such deaths.

A hearing set for Jan. 25 will be the committee’s most substantive review of the assisted-living industry in more than 20 years, Casey said.

“It’s terribly disturbing,” Casey said of The Post’s findings. “It’s a basic violation of trust when you’re making assertions about a service you’re providing and you’re not providing that.”

In all, The Post documented 2,000 walkway incidents, called “elopements” in the industry, involving assisted-living residents suffering from Alzheimer’s disease and other forms of dementia. Many were housed in special “memory-care” units that charge families more for extra attention and security.

Among those who died, The Post found, most perished because of prolonged exposure to extreme heat or cold. Others drowned in retention ponds, were hit by vehicles, or wandered into woods, rivers and swamps.

The tally is certainly an undercount because nearly 20 states — including New York and Texas — don’t make records available to the public online.

Understaffed and neglected: How real estate investors reshaped assisted living

Since The Post’s investigation was published Dec. 17, readers have shared information about other deaths, pushing the count over 100. At least one person has died since The Post’s report: Ki Soon Hyun, 83, disappeared from the Mount Hood Senior Living facility in Sandy, Ore., on Christmas Eve, according to <a href="https://www.kgw.com/article/news/local/sandy-police-search-rescue-ki-soon-hyun-mt-hood-senior-living/283-1e3ba240-9275-4b75-aa8d-99018e35fb24" target=_blank>local media reports</a>. Her body was found on Christmas Day in woods a half-mile away. Based on an inspection a month earlier, state regulators had cited the facility for staff training failures and failure to conduct a state-mandated analysis to set staffing levels, records show. Oregon state officials have yet to release findings on Hyun’s death.

“It’s a heartbreaking thing, and we’re really sorry it happened, and we’re doing our very best to make sure nothing like this happens again,” said Amanda Gardner, the facility’s business office manager. She declined to discuss specifics or the state’s criticisms about staffing. “We’re working with the state and doing a full investigation internally.”

Unlike nursing homes, the nation’s 30,000 assisted-living facilities are not regulated by the federal government and no federal agency keeps track of deaths and injuries. More than 1 million people now live in assisted living — nearly as many as nursing homes — paying average fees of $6,000 a month. Over the past decade, the number of dedicated memory-care units has grown rapidly, driving the industry’s overall growth.

In marketing materials, facilities and corporate owners promise to keep loved ones with dementia safe from harm. Yet The Post found that state investigators frequently cited insufficient staffing and training as factors in the deaths. The Post’s reporting also revealed that<a href="https://www.washingtonpost.com/business/2023/12/17/assisted-living-industry-real-estate/" target="_blank"> profit-seeking by corporate investors</a> suppressed wages, leading to short staffing at some facilities.

The Post documented multiple instances of staff sleeping on the job, falsifying records, skipping resident checks, and ignoring alarms and automated texts indicating dementia-care-unit doors had been opened. The Post also found that relatives were not always told the truth about what happened to their loved ones.

Industry representatives have not disputed The Post’s findings. Rather, they have said the 100 walkaway deaths identified by The Post represent a tiny fraction of the growing population of residents. Argentum, an industry lobbying association in Washington, repeated those comments on Tuesday.

“The Washington Post’s reporting featured isolated incidents that assisted living communities take very seriously,” James Balda, Argentum’s president and chief executive, said in an email. “Our communities look forward to demonstrating to the committee that, as the nation grapples to care for our aging population, assisted living provides independence and dignity for seniors.”

Still, at least one industry group said in December that operators must work to avoid such incidents and that workers who do not follow protocols should be held accountable.

“Ensuring dementia care units are secure is a constant balance between adhering to what the resident and families want, what various regulations require, and the ability to maximize residents’ autonomy,” the industry lobbying group American Health Care Association/National Center for Assisted Living said in a set of “talking points” it sent to its affiliates in December responding to The Post’s investigation.

In letters to the CEOs of the three largest U.S. assisted-living chain operators — Brookdale, Atria and Sunrise — Casey asked for an account of how many elopements occur in their facilities and how families are informed of “falls, injuries, elopements, violent interactions with other residents, etc.” He noted that The Post documented seven such deaths in his state.

The committee also asked how the companies set staffing levels, if they have internal targets for staff ratios, and what percentage of their facilities meet these staffing targets. Additionally, they asked how costs are communicated to residents and families, including add-on charges as people get older and sicker, citing a recent series by the New York Times. The Post <a href="https://www.washingtonpost.com/business/2023/03/18/senior-care-costs-too-high/" target=_blank>reported on the high costs</a> of assisted living last February.

Senior care is crushingly expensive. Boomers aren’t ready.

“You have a set of cascading crises: the staffing problem, the oversight problem, a lack of information the family members need and, at a fundamental level, you have the quality of care problem,” Casey said. He said the committee will be considering what steps the federal government needs to take to improve conditions.

The Post’s count of walkaway deaths included three at Brookdale facilities and one at a Sunrise facility. The Post did not find any among Atria’s properties since 2018. Brookdale has declined to comment on specific incidents, but spokeswoman Jackie Dickson said the well-being of residents “always has been our top priority.”

“We look forward to reviewing and responding to Senator Casey’s letter on the assisted living industry with candor and transparency,” Sunrise spokeswoman Heather Hunter said in an email. Atria said that its residents are its top priority and that it planned to provide Casey the information he requested. Brookdale declined to comment.

“The assisted-living profession is committed to continuing to learn all that we can about dementia and the disease process to meet the ever-changing needs of our residents,” LaShuan Bethea, executive director of the National Center for Assisted Living, said Tuesday.

Government officials and advocates have been warning about safety problems and weak government oversight in assisted living for decades. In 2001, the Senate Committee on Aging commissioned a working group that spent two years producing a list of recommendations muddled by internal dissent and disagreement. Participants could not even agree on a definition of assisted living.

Twenty-one years later, no one in government knows how often facilities’ failings lead to deaths or injuries, although individual state inspection reports are loaded with anecdotes of bad care at facilities owned by large chains and small, individual operations.

Advocates said the lack of public, national-level data has hampered government accountability efforts. To gather its data, The Post scoured more than 160,000 inspection reports from about 30 state websites, made public records requests to all 50 states and the District of Columbia, and searched local media reports.

“The lack of transparency insulates them from attention because nobody has a foothold,” said Eric Carlson, director of long-term services and support advocacy at Justice in Aging.

Without federal attention, oversight has fallen to individual states, creating a patchwork of rules and spotty enforcement. The Post found that just two states — Alabama and Indiana — require minimum staff-to-resident ratios, mandate more than six hours of dementia training as recommended by advocates, and maintain a website that discloses inspection reports and enforcement actions to the public.

Industry executives have argued that assisted living is a social model of care, not a medical one, making local regulation more appropriate than rigid national standards.

“Consumer choice is the heart and soul of everything,” Maggie Elehwany, senior vice president for public affairs at Argentum, has said.

But the lack of improvement is frustrating to many observers. In 1999, Collette Appolito Laisure of Cleveland testified during a Senate committee hearing that she often could not find caregivers when visiting her mother at an assisted-living facility in Ohio. In a recent interview, Laisure expressed dismay that little has changed in 25 years.

“How do we continue to turn a blind eye,” she said, “to those that can’t care for themselves?”

Peter Whoriskey contributed to this report.

Everett McKinley Dirksen Award, awarded to Boston Globe Washington Bureau for 19-part "Broken City" series on congressional gridlock and dysfunction

Society of American Business Editors and Writers, Project Award, shared for coverage of the Medicare prescription benefit law

Edited Globe work recognized for the Merriman Smith Memorial Award (about the Iran nuclear pact) and as finalist for the Gerald Loeb Award (about business activities of retired generals) and finalist for the Goldsmith Prize for investigative reporting (about Massachusetts lawmakers’ pensions)

University of Arizona, BS in Journalism

Christopher Rowland joined The Washington Post business team in 2018 after serving as the Washington bureau chief for the Boston Globe, leading coverage of two presidential elections and overseeing national political enterprise reporting. He previously covered health care for the Globe in Boston.

Christopher Rowland

Memory-care and assisted-living industry will be investigated by Senate

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Assisted living facilities struggle with patient safety

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Senate to examine walkaway deaths in assisted-living facilities

In response to a Post investigation that found 100 fatalities since 2018, the Special Committee on Aging is demanding information from industry executives