[Congressional Record Volume 146, Number 154 (Thursday, December 14, 2000)]
[Extensions of Remarks]
[Page E2185]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        IMPROVING QUALITY OF CARE IN ASSISTED LIVING FACILITIES

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Thursday, December 14, 2000

  Mr. STARK. Mr. Speaker, the Institute of Medicine will shortly 
release a publication entitled, ``Improving the Quality of Long-Term 
Care.'' A committee of our nation's leading experts in the area of 
long-term care compiled information on quality in various long-term 
care approaches, including assisted living.
  The report finds that there are few studies of outcomes and quality 
in assisted living facilities, primarily because of the lack of a 
uniform definition of this category of facilities. Assisted living 
facilities can have enormous variation in services and environment, and 
the varying definitions from state to state make comparisons difficult.
  The report also finds that the small body of research that does exist 
illustrates that ``residential care facilities, including assisted 
living, present a mixed picture in terms of both quality of care and 
quality of life. Some offer individualized, high-quality care in 
facilities that afford privacy, dignity, and individualization. 
However, others appear to lack adequately trained staff, and offer 
neither sufficient amount of care nor privacy and `homelike' settings. 
Also, there are indications that consumers may receive too little 
information to make informed choices regarding these facilities and the 
services provided.''
  Many consumers are drawn to the philosophy of assisted living, a 
model developed to combine the care of other long-term care settings 
with an environment promoting dignity and independence. This upcoming 
IOM report, though, highlights the disconnect that exists between the 
philosophy of assisted living and its implementation. It references a 
study that found only 11 percent of facilities provided high levels of 
both privacy and service, the philosophy of assisted living. On the 
contrary, the majority of assisted living facilities, 65 percent, 
offered low levels of service (e.g., no full-time registered nurse on 
staff) and 40 percent offered low levels of privacy.
  Another disconnect between assisted living philosophy and practice is 
the concept of ``aging in place.'' Despite the marketing claims of 
consumers being able to live out their lives in their assisted living 
homes, consumers are finding out they may not be able to obtain needed 
services or be allowed to stay if they develop conditions that require 
more care. The IOM report references a survey of assisted living 
facilities that found 76 percent of assisted living facilities would 
discharge anyone who needed skilled nursing care for more than 14 days, 
and 72 percent had already done so within the past 6 months.
  The wide variation in definitions of assisted living facilities also 
poses problems for states in developing regulations that ensure 
quality. Some states view assisted living as an alternative to nursing 
home care while others view assisted living as a model for people with 
less serious conditions than nursing home residents. These differing 
perceptions as to what constitutes assisted living leads to varying 
standards from state to state. In my view, there needs to be a more 
consistent approach to ensuring quality and protections for the 
residents in these facilities.
  IOM provides further support for the need to focus on quality of care 
in assisted living facilities. I introduced H.J. Res. 107, calling for 
a White House conference for conducting a national dialogue on this 
issue and for developing recommendations. I hope that my colleagues 
will join me in ensuring the safety of our nation's elderly in their 
assisted living homes and make this an important effort of the 107th 
Congress.

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