Does mushrooming retirement residences in India will follow the same fate ?
Assisted-living homes don’t always deliver what’s expected
Elderly people who move into assisted-living residences pay as much as they would to stay at a fine hotel. They hope the food, accommodation and care will be top-notch because they plan to spend the rest of their lives there.
Their futures are less secure than they think.
Residents are vulnerable to sudden fee increases. They may be forced to move out, especially when — as frequently happens — facilities change hands. There’s little they can do if the care, food or activities are not as promised.
When new owners bought an Emerson assisted-living facility in December, one 90-year-old man who lived there with his wife was told he had to leave. The couple ended up forfeiting more than $8,000 in fees they had paid to get into the center just eight months earlier. The daughter of another resident says her father didn’t get the help he needed shaving and showering and wasn’t reminded to go to the dining hall for group meals, the high point of his life there.
“I need to know that he is happy and safe and that all his needs are taken care of,” says Marcia DeSalvo, an Emerson councilwoman whose 84-year-old father has mild dementia and lives at The Gardens at Emerson.
Her fears were heightened on one visit, when she found an elderly woman who had fallen on the floor and was unable to summon help because the alarm on her necklace didn’t work.
The owners of the center, Emeritus Corp., said their facility meets state standards. “We’re committed to resident care,” said Trish Miller, the company’s national director of resident risk. “We want to treat our residents as we would want to be treated.”
She supplied a Jan. 31 letter from the state Health Department, which said “no state deficiencies” were found during a recent inspection.
But the complaints highlight concerns about the burgeoning assisted-living industry.
The industry, dominated by large for-profit national chains, has grown explosively in New Jersey — from 11 facilities a decade ago to 218 today. The 19 facilities in Bergen and Passaic counties account for 2,000 of the 17,500 assisted-living “beds” in the state.
Overbuilding has led to stiff competition, bankruptcies — and complaints by residents. Last year, 250 complaints were filed to the state Health Department.
“Seniors and families of seniors often feel misled and deceived in their dealings with these organizations,” William Isele, the state ombudsman for the institutionalized elderly, wrote in a 2006 annual report. They are “some of the most complicated and time-consuming cases we have handled.”
The state was so concerned about these facilities it implemented new regulations in February to improve oversight.
Feeling like a pariah
Assisted living is midway between having help in one’s own home and being confined in a nursing home. A typical tenant is an 85-year-old woman who needs help taking her medications. She pays thousands of dollars a month out of her own pocket to the facility.
Residents have as much independence as possible, living in private apartments and socializing in common rooms. They get three meals a day in a communal dining room and receive help with housekeeping, as well as — when needed — assistance with dressing, eating and bathing.
That’s what Sydney and Sara Fried, Susan McTigue’s parents, expected when they moved from their home in Westchester County last May to what was then known as Cypress Gardens in Emerson.
They paid a one-time fee of $8,250, and agreed to pay a total of $284 a day — more than $8,500 a month — for care and accommodations.
But the center was sold and, a week before Christmas, 90-year-old Sydney Fried was told he had to leave within 30 days, according to both Fried and his daughter. They were told the staff could not care for his catheter, which has a dressing that needs to be changed daily
The catheter was nothing new: Fried had it when he was accepted in May as a resident. His medical needs hadn’t changed, he said.
He felt like a pariah. “You don’t want anybody telling you that you have to get out of your own home,” he said.
Sydney Fried does the daily New York Times crossword puzzle in ink. Sara, 88, is physically frail but mentally robust. They had moved into the two-room apartment to spare their daughter the emergency trips she’d made to New York to help them.
Their new home “was not what we expected,” McTigue says.
Her father, a contract-bridge player, chafed at the activities: “Bingo or Bingo,” he says.
“There was nothing for my parents to do, and the food was atrocious,” McTigue says. It got worse when the new owners took over, she said.
After being told he had to leave, the retired lawyer sent a letter to management asking for a refund of his $8,250, a rent-free month to look for another facility, and reimbursement for moving expenses, which exceeded $2,000.
Aging in place
William Conroy, an assistant commissioner for health-care facilities evaluation and licensing at the Department of Health and Senior Services, said assisted-living companies are required to continue to house and care for some residents even if they become needy enough to warrant nursing home care. The goal is to enable seniors to “age in place.”
But there are fewer medical staff members at an assisted living residence than at a nursing home.
There is also less regulation — a lot less. In large part, that’s because state and federal governments have less at stake than they do in nursing homes. Nearly everyone pays their own way at assisted-living centers, whereas the government picks up most of the tab for nursing home care.
Prices at assisted-living centers have climbed steadily. A report last October by an insurance-company research group found that rates in Bridgewater, one of two New Jersey sites surveyed, were the highest in the nation — at $5,200 per person monthly.
As the industry has grown, so have the number of complaints. “We feel we need to watch it pretty closely,” Conroy says.
Complaints about residents being told to leave are a particular concern, Isele said. “Assisted-living facilities are high on our priority list for monitoring,” he said in his report.
Some of the problems came after the rush of expansion from 1995 through 2001. Developers found that running an assisted-living facility was like managing an apartment building, a restaurant and a medical facility all in one.
Those “who thought they could just make the investment and didn’t have to do anything beyond that were in for a rude awakening,” says Paul Langevin, president of the New Jersey Association of Healthcare Facilities.
New Jersey suspended admissions to a chain of residences owned by Alterra Healthcare Corp. in 2002, because of “severe” concerns about conditions in their facilities. Alterra, which owned the Emerson residence, subsequently filed for bankruptcy.
The Marriott Hotel Corp. also got out of the business. In 2003, the company — which operated a dozen Brighton Gardens communities around the state — sold them to Sunrise Senior Living.
And, in December, Cypress Gardens in Emerson, as well as a facility by the same name in Wayne, were sold to BREA Emeritus LLC, a joint venture of a national assisted-living chain and real-estate investors.
Emeritus, the nation’s second-largest chain of assisted-living facilities, has not turned a profit since it was founded in 1993. It has an accumulated deficit of more than $200 million. The company’s focus, according to its most recent quarterly and annual reports, is to increase occupancy and “implement a systematic revenue enhancement program” — in other words, to attract more residents and have each one pay more.
‘Care has decreased’
When a facility changes hands, it’s a concern, Isele said in an interview. “You don’t know what philosophy the new owners will have,” he said.
For residents at The Gardens at Emerson, the sale meant each of them was reevaluated — and more than half received “upgrades” in the level of care they required, the regional director, Michele Hughes, told DeSalvo at a January meeting.
For DeSalvo’s father, that upgrade meant the cost of his care went up $188 to $4,900 a month.
The bill that went out in late December did not give her 30 days notice of the increase, as required. It did, however, warn of a $300 late fee if she didn’t pay on time.
More important, DeSalvo said, her father did not receive the increased care she expected at his new “platinum level.” “Care has decreased,” she complained to management. Her father, John Donovan, wasn’t reminded to go for meals, his main time for socializing. He didn’t receive help to get shaved or showered or reminded to get dressed for church on Sunday morning. His garbage was not emptied for days.
Staff turnover made it difficult to know where to address her concerns, she said. The building’s director, the nurse in charge of the wellness center, the activities director and several aides all resigned after the sale.
Both McTigue and DeSalvo filed complaints with the state. Other problems they reported to the state focused on the quality of the food, cleanliness and the failure to answer the alarm button of the woman who had fallen.
Conroy, the state health official, did not comment specifically on the complaints, but said: “If the family feels that [centers are] just basically price-gouging, and the fees are not based on an assessment, then the provider is in violation of our regulations.”
When the state investigated the complaints in January, “the surveyor was unable to identify a citable deficient practice,” according to a letter from Sandra Brownell, head of the health department’s long-term-care complaints and surveillance program.
McTigue said that reinforced her view that the regulations are “extremely lax.” Said DeSalvo: “If what I had seen was actually allowable, there aren’t any good state or federal regulations.”
But DeSalvo adds that since she voiced her concerns to Emeritus and to state authorities, her father’s care has improved. “I think The Gardens is finally shaping up into what I expected for my dad,” she said. “We have a way to go, but I am now much more confident that we will get there.”
The Frieds recently moved to an apartment at The Cupola, an assisted living facility in Paramus, where they are very satisfied.
Emeritus did not refund the move-in fee or pay the moving expenses.
E-mail: washburn@northjersey.com
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State weighs in
New regulations intended to improve the quality of care at New Jersey’s assisted-living facilities took effect on Feb. 5. They:
Miss Hendi LINGIAH
Clinical Psychologist
lingiah_hendi@yahoo.fr
lingiah_hendi@yahoo.fr