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Federal Government Falls Short in Protecting Assisted Living Residents

February 6, 2018

(February 5, 2018)  A new report released today by the Government Accountability Office (GAO) reveals that lax federal oversight over Medicaid-funded assisted living services threatens the health and safety of the over 330,000 people relying on these services across the country.

The report shows that “critical incidents”, such as unexplained deaths, assault, abuse, neglect, financial exploitation, and other serious situations are not tracked and reported adequately or consistently. Additionally, there is no way for prospective residents and their families to evaluate the quality of various assisted living facilities because this information is not readily available.

Though 48 states provide Medicaid coverage for assisted living at a cost of more than $10 billion annually, more than half (26 states) could not report the number of critical incidents occurring in assisted living facilities.

“The GAO report only scratches the surface,” said Eric Carlson, a directing attorney at the non-profit Justice in Aging.  “Despite the significant federal Medicaid expenditures, the federal government generally defers to state assisted living licensing laws, and some of those state laws are grossly inadequate to protect the health and safety of the high-need residents that receive Medicaid funded assisted living care.”

Assisted living residents need significant assistance.  In most cases, Medicaid funding for assisted living is only available for persons whose care needs would qualify them for admission to a nursing home. As found by the GAO, 94% of the programs cover assisted living services for persons who need extensive assistance to dress, bathe, eat, or use the toilet.

Contrary to what would be expected for such high need residents, many states do not require any nurse staffing in assisted living facilities. The care is provided primarily by direct care workers whose caregiving education may consist solely of an initial training of 15 to 30 hours, and continuing education of 10 or so hours annually, leaving thousands of residents at risk.

The GAO’s findings are consistent with what Justice in Aging attorneys have seen across the country in working with older Americans and their advocates.  Federal legislation is needed to ensure that low-income people reliant on Medicaid receive the care and assistance that they need. Congress should set meaningful care standards, with penalties adequate to ensure compliance and to protect the rights of older Americans who rely on assisted living.

Justice in Aging is a national non-profit legal advocacy organization that fights senior poverty through law. Formerly the National Senior Citizens Law Center, since 1972 we’ve worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency. Through targeted advocacy, litigation, and the trainings and resources we provide to local advocates, we ensure access to the social safety net programs that poor seniors depend on, including Medicare, Medicaid, Social Security, and Supplemental Security Income (SSI). For more information, visit our website at




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