By Ed Dudensing, Mercury News, June 18 2020
Problems in California’s nursing homes are no secret. For years, the sprawling industry has attracted attention and lawsuits. Meanwhile, the separate assisted living business has largely flown under the radar, quietly gaining broad popularity as baby boomers continue to age.
With the spreading COVID-19 pandemic, however, the dangers that assisted living centers pose to the health of elderly Californians are coming into focus. Inadequate staffing, lack of trained medical personnel, lax infection control, and the use of dangerous psychotropic drugs to control behavior have for too long been systemic problems for the industry.
Now comes the highly contagious coronavirus, disproportionately infecting the elderly whose weakened immune systems and often serious underlying medical conditions put them at heightened risk of serious complications and death. While far lower than the skilled nursing industry, COVID-19 has infected more than 2,400 assisted living residents and staff statewide and killed more than 350, according to the California Department of Social Services.
The number of Californians age 65 and older is projected to increase to nearly 9 million by 2050, according to the Public Policy Institute of California. It’s no surprise that aging Californians and their families are drawn to the non-medical atmosphere and amenity-filled accommodations that assisted living offers.
Assisted living facilities may look like comfortable, well-appointed hotels with happy hours, movie nights and fine dining. But they are responsible for the care of growing numbers of patients suffering from dementia, heart disease, diabetes and other serious medical conditions.
Despite that, industry regulation and oversight have lagged, focusing on liability and licensing rather than quality of care. For example, on-site physicians and nurses are not required, nor are minimum staff levels per resident. Such weak oversight has been a boon to the industry, enabling operators to lower costs, maximize profits and grant large executive payouts—at the expense of quality care.
Perhaps at greatest risk are residents in popular “memory care” units who suffer from Alzheimer’s disease and dementia. A medical doctor is required to approve certain medications, but undertrained facility staff members often make critical decisions when faced with an unruly or uncooperative resident.
Such conditions can produce tragic results, like the choking death of a 77-year-old woman in a Sacramento assisted living facility after she was given the powerful psychotropic drug Ativan to chemically restrain her. A jury awarded the victim’s family—my client—a record $42.5 million in damages against the facility’s large corporate owner, Eskaton.
Gov. Newsom deserves credit for moving quickly to impose strict shelter-in-place restrictions. But there has been a lack of transparency in reporting on COVID-19 in assisted living facilities. And the Department of Social Service’s offer to pay some smaller assisted living facilities $1,000 a day to take COVID-19 patients could spread the infection to healthy residents.
Before the coronavirus struck, the assisted living industry largely avoided close scrutiny, even as advocates for the elderly raised their voices, sought legal remedies and demanded reforms. The COVID-19 pandemic has driven home the urgency for stronger oversight of both nursing homes and assisted living centers. It would be misguided and dangerous not to include assisted living in any program of comprehensive regulatory reform.
Let’s make California’s assisted living centers safer for residents and committed to delivering high-quality care rather than big profits. Then, when the next public health crisis inevitably strikes, we will be ready.
Ed Dudensing is a former Sacramento deputy district attorney who for the last 17 years has exclusively represented victims of nursing home and assisted living facility neglect.