Quality of Long-Term Care

Assisted living is usually defined as a residential-care setting for persons who can no longer live independently and who require some supervision or help with activities of daily living (ADLs), but who may not need the level of skilled care provided in a nursing home. National definitions and regulations of assisted living do not exist, thus assisted living varies considerably from state to state. Most definitions specify that assisted living provide personal care and supportive services twenty-four hours a day; including some health care, meals, and housing in a congregate residential setting serving primarily an older population. The intensity of services, the range of disabilities for which services are provided, the type of living arrangements, and many other aspects of assisted living vary a great deal, often within, as well as between, states.

The ability of residents to age in place as their health declines or their needs change is determined largely by admission and discharge criteria. There is considerable variation across the states in these criteria, some of which comes from state regulations, some from the facilities' choice of whom to serve, and some from the particular services an assisted-living facility chooses to provide or make available.

Frequently identified quality problems in assisted living include facilities providing inadequate or insufficient care to residents; insufficient, unqualified, and untrained staff; and not providing residents appropriate medications—or storing medications improperly. In addition, state regulations on assisted living generally focus on three main areas: requirements for the living unit, admission and retention criteria, and the types and levels of services that may be provided.

Regulations that ensure the safety and quality of care in assisted living are limited. Regulations in most states set the parameters for assisted living, but owners and operators define the practice. A 1999 GAO report also found that assisted-living facilities have quality problems related to incorrect, incomplete, and misleading information provision; inadequate care; insufficient staffing; and medication errors.

In 1996, several organizations representing consumers and providers formed the Assisted Living Quality Coalition (ALQC) to address issues of quality improvement in assisted living. The goal was to develop an assisted-living quality framework by promoting the highest possible quality of life for older adults and those with disabilities by advocating for an assisted-living philosophy of independence, privacy, dignity, and autonomy.

During its deliberations, the ALQC sought the counsel and advice of numerous individuals and organizations representing consumers, providers, state regulators, ombudsmen, third-party payers, and investors. The coalition also examined a variety of approaches to promoting quality, including traditional state regulation, accreditation, contracts, and quality indicators. The coalition's report, published in 1998, includes guidelines for states developing standards. As of 2001, however, there had been no federal action on the coalition recommendations.