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Understaffed, under-regulated assisted living facilities have been caught using dangerous processes to meet residency goals. 

Watch Life and Death in Assisted Living on PBS. See more from FRONTLINE.

The facility was dangerously understaffed, and went to great lengths to cover up Mrs. Boice’s serious bed sores for months instead of sending her to a hospital.  Her family sued, using the court to expose the corporation’s dangerous policies.

This ProPublica and Frontline collaboration explored the operations of Emeritus, one of the country’s largest assisted living companies.  Their investigation uncovered details of a disturbing company policy that resulted in the neglect and in some instances, the death of Emeritus residents like Mrs. Boice.

What are assisted living facilities?

Originally established as an alternative to traditional nursing homes, assisted living facilities are targeted at those who can no longer live on their own, but who don’t need intensive medical care.

More than 3 decades after the first facility opened, there are still no consistent federal standards for assisted living facilities.

A lack of federal oversight has led some states to draw up their own laws to protect seniors in assisted living. For example, in California, elderly persons who require serious medical treatment – like those with severe bedsores– are required to be transferred to a hospital or nursing home.

Nurses … or salespeople?

A few years ago, potential investors were looking closely at Emeritus. The company’s directors wanted to make Emeritus look more profitable to the investors.  They implemented a new company goal: pack the facilities full. Do it as quickly as possible.

To meet the corporate goal of 100% occupancy, Emeritus care facilities began admitting many new residents they were not staffed to care for. They admitted new elderly residents without a standard doctor’s report, or a care plan.

Bringing in new residents wasn’t enough: Emeritus wanted to keep people from leaving. In order to meet their corporate goals, the nursing staff was told they should retain residents as long as possible.  Residents who became ill or who should have been sent to a hospital, or who needed nursing home care, were stuck in assisted living facilities.

Worse, in further attempt to cut costs, nurses were replaced by unskilled workers with limited medical backgrounds.

“Emeritus was intensely focused both on persuading people to move into its buildings and dissuading them from moving out.  They did not want paying customers to, as they put it, go out the back door.”

Emeritus was able their focus from patients to profit because there is no real federal oversight of multi-state corporate assisted living facilities, or even guidelines for what constitutes an assisted living facility.


  1. Gravatar for Rich

    You write "in California, elderly persons who require serious medical treatment – like those with severe bedsores– are required to be transferred to a hospital or nursing home."

    What you don't tell your readers is there is no consequences for violating the CA regulations. For example the maximum fine for a wrongful death citation is $150. The citation sits in a folder in the Community Care Licensing office. These citations are NOT available on line. There is no letter grade system for eating establishments. There is no practical way for a consumer to research and determine a good vs. a bad facility.

    Regulations without any consequences for violations only provide a false sense of security and no regulations would actually be better than regulations without meaningful enforcement.

    Also citations like complete isolation are cleared by regulators just by the facility claiming they educated their staff. The facility can then continue to isolate the same resident and regulators will not do anything because they have told the facility what the facility needs to do. The regulators don't care that the facility continues the violation after being educated.

    California actually has good regulations, the problem is the existing regulations are not enforced.

  2. Gravatar for Tom D'Amore

    Excellent point: existing state regulations are not useful without enforcement. Thank you for your comment.

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