About Rob Schenk: Rob’s law firm Schenk Smith is based in Atlanta, Georgia, and is focused on representing individuals injured in nursing homes and assisted living facilities. He’s also the co-host of the Nursing Home Abuse Podcast. A bi-monthly video podcast dedicated to educating families on nursing home care.
In this episode, Steve and Rob Schenk discuss:
1. In Episode Six, you refer to assisted living facilities as the Wild Wild West. What exactly did you mean by that?
- Primarily the fact that if you and I are talking about nursing homes, there’s going to be uniformity with regard to how they’re regulated from state to state. Assisted living facilities, what we’re calling assisted living facilities. There is no uniformity and regulation and guidelines across the country. Every state handles things differently and I believe that it’s the wild wild west, because that, in turn, causes a lot of, quote-unquote, brand confusion. What are you getting out of these facilities? it’s a gray area, in my opinion.
2. What is the difference between a nursing home and an assisted living facility?
- A nursing home is defined by the federal government and doesn’t differ from state to state and it’s essentially a facility that provides skilled nursing care according to those guidelines. Because an assisted living facility is different from state to state, there’s no broad definition. However, typically, there are no skilled nursing services provided at an assisted living facility, like there is in a nursing home. An assisted living facility is a facility that typically only provides what’s called personal services and assistance with daily living activities.
3. Are administrators advising people that there are no skilled professionals at the assisted living facilities?
- Well, hopefully, so by way of example, in Georgia, there are state regulations about who is even qualified to go into assisted living facilities. So it’s the facility’s obligation to do an assessment to determine if this person can even come in or needs proper 24-hour skilled nursing care. Also, from that, they’re required to tell them the services that they’re going to get there. But you know how that works. I mean, like, if you ever made a huge purchase, like a house or car, whatever the case may be, you’re signing 16 different pages. A lot of times these are decisions that aren’t made weeks in advance. These types of things grandmother fell, and now she can’t do the things herself. We got to get her into a place quickly. So there’s a lot of moving parts to sitting down in that admissions office and talking about these things that go over overlooked.
4. Would it be fair to say that for the most part people that are going into assisted living facilities, their health care concerns are not as serious, as ones that are going into nursing homes?
- That’s a fair assessment. I think that’s kind of the concept behind the assisted living facility. Ideally, it’s for someone who only needs assistance with what we would call ADLs. For the most part, ADL is being activities of daily living. So, if your grandmother needs help with personal hygiene, toileting, transferring locomotion, these types of things, otherwise, she’s okay. Then that’s probably the candidate for assisted living facilities across the country. That’s usually what it is. What you’re finding though, is that these are individuals that need more than that. They need somebody that has eyeballs on them and can tell whether or not that is a wound that is a pressure ulcer or that this person has a cognitive impairment such that if there was some type of issue, they would not be able to find their way out of the building. On our podcast Will and I talked about how people think that it’s Driving Miss Daisy? Like it’s something where it’s a perfectly capable lady that just needs a friend. That’s oftentimes not what you get in assisted living facilities. That’s kind of the idea is that you have someone that can pretty much take care of themselves in some activities, but just needs a little bit of help from somebody that doesn’t necessarily need to be qualified as a nurse.
5. So, in assisted living facilities where you’ve got somebody who’s maybe making a little over minimum wage, who’s got a high school diploma, how are they going to be able to detect that type of wound or that type of problem since they have no training?
- That’s exactly right. That hits a particular issue about the differences between the two. In a nursing home, the staff is obligated to assess skin and for by way of example, skin integrity risk, and based on that assessment, put in place a care plan, and revise the care plan as they have observed it to be working or not working. In the state of Georgia, you have to do an assessment in an assisted living facility. But it’s not as in-depth because you’re not obligated to do anything with regard to skin integrity, preventing pressure ulcers and things like that. Therefore, these things will happen, particularly if the person shouldn’t be in there. So that level of care isn’t quite the same and it’s not the obligation to provide that care is not the same.
6. Is it that the problem is that while they’re in there as they continue to age or that things happen, the adequate staff that has the qualifications to diagnose or to treat are just not there?
- Yes and no, I think that to the extent that any assisted living facility advertises memory care, and such that the public believes that well, my grandfather has Alzheimer’s and is only lucid five minutes a day and can’t recognize me and believes that they’re living in 1976. That person, in my opinion, is not going to get the correct level of care in an assisted living facility. They’ve kind of progressed out of that level. But yet, assisted living facilities are advertising care for these types of people. In my opinion, there is no difference between an 87-year-old person with advanced Alzheimer’s in an assisted living facility versus a nursing home, they’re under the same level of risk for fall, skin integrity, these types of issues. So that’s what creates the gray area. That’s what creates the problem. That’s why it’s kind of like the Wild West. At what point does someone graduate from an assisted living facility to a nursing home and I don’t think that most assisted living facilities can determine that appropriately.
7. Is it true that half the people with COVID or who have serious consequences from COVID come out of assisted living facilities and nursing homes?
- That’s exactly right. It’s a vulnerable population. Now, I’m not saying that you can’t have an intermediary between somebody living independently at home and needing 24-hour skilled nursing. I think we can all agree that that’s okay to have in the middle spot. I think the issue that needs to be addressed is there needs to be heightened care. They need to have a set parameter for who is working in these places
8. In your opinion, why has the assisted living facility industry basically been left untouched, and unregulated?
- 99.9% of nursing homes receive Medicare or Medicaid money, and that allows the federal government to regulate the facility. So nursing home A, in whatever state, if they want to receive Medicare funding reimbursement for taking care of these people, they have to follow these rules. That by and large is not the case for assisted living facilities. I’m not quite sure how it is across the states but Medicare and Medicaid are not paying for assisted living facility stays.
9. Would you agree that it is like an insult to injury when the state does come in when there are deaths and they cite the facility for a lack of safety safeguards for the residents and only fine them $150?
- I would absolutely agree. I think that’s why it’s important to always have a strong civil justice system because if we can agree that a citation or regulation is not going to act as a deterrent, then certainly a large verdict would.
10. To the best of your knowledge, are infections more prevalent in nursing homes, assisted living facilities, or elsewhere?
- I actually don’t have an answer to that. All I can tell you is that the federal regulations regarding infection control that would apply to nursing home facilities are pretty stringent. Each facility has to have hand hygiene protocols when PPE should be used, these types of things. There should be an infection control preventionist that oversees those policies. With assisted living facilities that’s not the case. Now, each state might have infection control, you know, regulations for assisted living facilities, but in Georgia, they’re not very strong in my opinion, and they’re not really enforced. So whether or not there’s led to some, you know, wide gap between infections and assisted living facilities and nursing homes. I don’t know. I don’t know the answer to that.
“It’s simple online research, depending on what state you’re in, almost all states have some type of database where you can look up the facility and you can look up whether or not it has been cited.” — Rob Schenk
To get the rest of the story about assisted living facilities: go to http://www.injuredseniorhotline.com/podcast to hear the rest of the episode.
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Show notes by Podcastologist: Kristen Braun
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