How does one assess the quality of care provided in a specific assisted living residence? This is a concern held by many families and especially by those who are seeking care in less expensive assisted living residences. While there is no substitute for visiting the community, doing so only provides one view. Furthermore, as tours are most commonly given by marketing directors, a visitor is likely to only see the highlights of the community.
Fortunately, there are options to help families determine the quality of care their loved one will receive. Unfortunately, accessing this information is not always easy and the data can be inconsistent and confusing. There are three methods by which one can evaluate the quality of care and the quality of life in general in assisted living. In this article, we examine the pros and cons of each approach as well as the “how-to’s”. Our recommendation is families pursue all three approaches to gain a well-rounded view.
|Approaches to Assessing Assisted Living Quality
|-Fast and easy access to information -Easy to compare residences -Reviews are available for most residences
|-Reviews are not very detailed -False reviews exist if not verified
|State Assisted Living Records
|-Data is not biased
|-Time consuming to access reports -Difficult to understand data -Comparing residences is nearly impossible -Very focused on the negative
|Long Term Care Ombudsmen
|-Information provided by humans
|-Difficult to reach / slow access -Focused on the negative
In the absence of officially provided state data, which is well formatted and understandable, family reviews can serve as a good proxy to assess assisted living quality. The largest advantage of family or 3rd party reviews of assisted living communities is, by far, the ease of access to the information. One can simply visit any of number of websites that offer reviews and search for their community of choice. Reviews are available for nearly all residences with the exception of minor adult foster care home with 1-4 residents. Reviews are easy to understand and it is simple to compare several residences to determine those that provide the best care. The primary drawback of family reviews is that they not very detailed. Reviews tend to be brief. One must take caution to find a site that verifies its reviewers because false reviews abound.
Assisted Living Review Websites
Caring.com – Recommended. This site has a large number of reviews, is free to use and verifies all its reviewers.
Yelp – Typically reviews are more in depth, but most communities have not been reviewed. Best used as a secondary source.
Angie’s List – highly verified, in depth reviews. Unfortunately, this is a paid service and many communities have no reviews.
Assisted living records maintained and provided by the states have one large advantage, and unfortunately, multiple disadvantages. The advantage is that the data in completely verified. However, because only complaints are collected and violations tracked, the view tends to be biased towards the negative. A wide range of types of data may be provided such as inspection reports, violations, citations, complaints, investigations and plans of correction. As of 2016, 36 states and Washington DC were making assisted living quality data available to the public online.
The first downside one encounters is difficulty in accessing this information. Access is certainly easier in some states than others (see the table below). But in all states that make the information available, a clunky and confusing database search is required. If information is available, it can be difficult to understand. Violation codes may be used without definitions, scoring scales might not be provided and inspection reports may be hand-written and scanned. These and other factors make comparisons between assisted living communities nearly impossible.
If one is looking for positive information about the communities, the state records are not the place to look. Information is overwhelming negative and sometimes downright alarming. This is due to the fact that vast majority of information the state collects is from inspections, enforcements and complaints. Should a search encounter a lack of information from the state, the meaning is ambiguous. It might be interpreted positively as a lack of complaints and violations means there is nothing to report. On the other hand, it could mean that state inspections are infrequent. For example, California only requires one inspection every 5 years. A third possibility is that it is simply a reflection of shoddy record keeping. Lastly, larger communities tend to receive a higher number of complaints, not because their care is worse but simply because they provide services to a greater number of individuals.
State assisted living databases are best used when one has already selected a community and they just want to make certain that that community has no major history of resident neglect. The table below lists what information each state provides online and links to that state’s database.
|Report Access Link
|Publishes deficiencies by date online
|Does not publish information online
|Publishes surveys and enforcements if available
|Does not publish information online
|Does not publish inspection information online. Inspections occurs only every 5 years.
|Publishes surveys and investigation reports online
|One can view a list of organizations that have been penalized
|Publishes annual survey and complaint investigations
|One can view inspection reports and any deficiencies
|Provides inspection reports and complaint investigation reports
|Does not publish information online
|One can view complaints and inspection reports by community
|Complaints and citations are published online. Search by community name or location.
|One can see the number of complaints and inspection reports
|One can view “Report Cards” by residence that contain the number of complaints and their inspection reports.
|One can view Deficiency Reports and Plans of Correction by residence. Be forewarned that their database can be very slow.
|Kentucky does not publish assisted living quality information online yet
|No information published about inspections or violations
|The state does not make assisted living quality information available online
|Inspection reports and citations are available by residence
|Surprisingly, MA does not publish assisted living quality information online. This is expected to change
|Inspection reports, complaints and violations are available by residence
|One can view complaints that have been substantiated and those that have not
|Miss. does not publish assisted living quality information online
|Violations and plans of correction are available by residence
|MT does not publish information about assisted living quality online
|One can search by residence for violation records and plans of corrections
|Nevadans can view assisted living citations by name or city
|One can submit complaints and view violations online
|One can view inspections and violations by residence
|One can view citations and complaints however their online database is only working intermittently.
|One can view violations by date of inspection. Difficult to use because one does not know the last date any community was inspected and must review multiple pages until they find their desired community
|One can search by location or name and see list of violations or “demerits” any residence has received.
|ND does not make information on assisted living community care quality available online
|Ohioans can search by residence name or location and view “Quality Measure Reports” and an adjusted “Resident Survey” score.
|One can view Inspection Reports and any deficiencies for which a residence was cited.
|One can search by location or residence name for complaints, and can see whether or not they were substantiated. Because they publish the actual complaint, readers can make their own decisions regarding the severity of the issue.
|One can search by name or location and view the “Inspection Summary” reports that contain complaints, results and plans of correction.
|RI does not publish assisted living quality information online
|One can view sanctions taken against residences however in order to find information on a specific community one must search backward through multiple pages.
|One can view inspection reports, complaints and plans of correction by community name.
|One can view a history of disciplinary actions taken against providers, but the webpage lacks of the ability to search and, therefore, one must painstakingly review all past actions to find their community of interest.
|One can search by residence name or location and view complaints, inspections and violations
|No information about assisted living quality is available online
|One can view inspections, violations and complaint investigations by community
|One can view inspections, violations and complaints by community or by location
|One can view violations and other reports by residence.
|One can view deficiencies and plans of corrections by residence
|WV does not publish assisted living care quality information online
|One can view reports, deficiencies and plans of correction
|One can view deficiencies and plans of correction. Violations may be difficult to interpret as violation codes may be used.
LTC Ombudsmen are state employees charged with investigating complaints in residential care and providing information to help families find quality care. The big advantage of Ombudsmen is that one can speak with a real human about the quality of care provided in an assisted living residence. The downside is that many Ombudsmen are simply overwhelmed by requests and gaining access for an in-depth conversation may be difficult.
There are over 1,100 persons working in the ombudsman program nationwide. Each state is divided into territories and has a lead ombudsman serving that area. One can find their local ombudsman here.