Bait and Switch: When You’re Not Getting the Care You Were Promised in Assisted Living

Q. When my friend, Vicki, was shopping around for assisted living facilities for her mother, one in particular stood out to her. The lovely marketing materials showed beautiful landscaping, rooms that resemble those at a classy Marriott hotel, and lively group activities. The facility boasted that they had 24/7 licensed nurses on-site and promised a certain number of trained aides to assist seniors with medication management and with activities of daily living.

Vicki told me that the contract specified a lot of the same things as the marketing materials, but after her mom lived there for a little while, she came to realize that the facility was nothing like the way it was described. There seemed to be a shortage of nurses and aides available for her mother. Is this common in assisted living facilities in this area and across the country? How can I prevent this from happening to my dad? My father will need assisted living soon, which is why I checked in with my friend and I’m checking in with you. Thanks so much for your help!

A. Your friend is not alone in her unfortunate experience. Many people all over the country feel like they are victims of bait and switch. They expect a certain level of care at assisted living facilities for their loved ones, but often receive inferior services and less staff than expected. Currently, class action lawsuits are underway against three major assisted living companies for these and other reasons.

“These places do set very high expectations,” said Sheryl Zimmerman, a health services researcher at the University of North Carolina School of Social Work. “Everyone’s website sounds like Utopia.”

Why Some Assisted Living Facilities are Not Living Up to Expectations

For older Americans, assisted living offers a compelling promise. Your aging parent can live in an apartment with hotel-like services and receive help with medication, bathing, and other tasks of daily living, if needed.

Unlike nursing homes, many assisted living facilities are falling short when it comes to quality though. Here’s why: whereas nursing homes are regulated at the state and federal level, oversight of assisted living facilities is uneven at best. A good assisted living facility can be an excellent choice for someone who can no longer live on his or her own, while a bad one could put your loved one at risk, so you need to be careful which one you choose. But deciphering which is good and which is bad can be difficult with the lack of reliable rating systems for them.

Consumer Complaints and Lawsuits are on the Rise

Not surprisingly, consumer complaints about assisted living are on the rise, according to long-term-care ombudsmen, trained advocates who operate in all 50 states. More than 55,000 complaints were filed last year alone. Most frequently, complaints included understaffing, delays in response to calls for assistance, and threatened eviction. About 80% said their state government doesn’t provide sufficient regulatory oversight for assisted living facilities.

In a recent NY Times article, Paula Span describes how lawsuits are currently underway against three major assisted living chains, including Sunrise, Aegis Living, and Oakmont Senior Living. Two settlements were already reached in 2016, totaling $13 million from Emeritus Corporation (since merged with Brookdale Senior Living) and $6.4 million from Atria Senior Living.

Kathryn Stebner, the trial counsel in the Sunrise case indicated that “(p)eople are paying more, but they’re not getting more care. Administrators make staffing decisions financially, based on budgets and return on investment. When assessments show increasing needs, the suit alleges, fees rise but staffing ratios may not change.” She believes that “(t)he business model is fraudulent, and it’s putting people at risk.”

How the Industry is Responding

In a statement, Sunrise denounced the claims against them and called the lawsuits “baseless” and “categorically false.” The industry’s own surveys also disagree with the basis for the allegations, showing high rates of satisfaction with assisted living, says Rachel Reeves, a spokeswoman for the National Center for Assisted Living, an organization that represents the country’s assisted living and other long-term-care communities.

Of course, the marketing and sales people are trying to fill apartments, so they claim they’ll take care of your loved one for the rest of his or her life. They’re also likely to tout high-end amenities, such as wine cellars, libraries, and calendars crowded with cultural events.

To get a true picture of how things really are at an assisted living facility, it’s smart to do your own research and take everything they say with a grain of salt.

Researching A Good Assisted Living Facility for a Loved One

Families can find it difficult to make informed decisions about assisted living, as there’s no equivalent of the federal inspection findings and quality rankings at Nursing Home Compare. State websites are typically inadequate substitutes, a recent study found. Luckily, there are some resources available to help you research assisted living facilities. It is also a good idea to visit before you commit. Please see my article on this subject for things to look out for and questions to ask when you visit.

A Place for Mom provides a list of assisted living state licensing websites across the United States, ranking each state based on the amount of available information online and the usability of the websites that provide that information. To check for assisted living violations, the A Place for Mom website also allows you to click on your state to find out how to obtain inspection reports.

Here are some additional resources:

If you would like information about an assisted living community’s background but cannot find it on your state website, you can call your local Area Agency on Aging (AAoA) and make an appointment to speak with your local Long-Term Care Ombudsman. They can often provide this type of information over the phone or via mail. You can locate your local AAoA office at

Assisted Living is Costly and Might Not Be Enough

Many people who move into assisted living these days need more help than they did years ago. They’re older and they’re entering with more chronic diseases. In fact, more than 40% have moderate or severe dementia, a study in the journal Health Affairs reported. For these people, with the issues described above such as staff shortages, assisted living may not be enough and nursing home care may be a better fit.

It is always wise to plan ahead for when the need for nursing home care arises. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life.

To begin long-term care planning — whether Medicaid Planning and/or Veterans Planning, and/or planning with hybrid insurance coverage, please call us now to make an appointment for an initial consultation:

Elder Law Fairfax: 703-691-1888
Elder Law Fredericksburg: 540-479-1435
Elder Law Rockville: 301-519-8041
Elder Law DC: 202-587-2797

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About Renee Eder

Renee Eder is the Director of Public Relations for the Farr Law Firm, and gives the voice to the Critters of Critter Corner. Renee’s poodle, Penny, is an official comfort dog who she and her children bring to visit with seniors who are in the early stages of dementia at a local senior home once a month.

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