An investigative report delving into the assisted living industry and issues associated with staffing and training aired Tuesday night on PBS Frontline, with serious implications for the public’s view of senior care and assisted living communities in particular. Industry groups are responding to the piece, including Emeritus, the assisted living provider profiled in the documentary and accompanying web and print series.  

Frontline and ProPublica spent a year investigating the assisted living industry and focused solely on Emeritus, the nation’s largest assisted living provider with 482 properties and about 42,000 residents, in its four-part Life and Death in Assisted Living. 

The segment outlines three wrongful death that occurred at Emeritus communities in the past few years, including one which recently received media attention after a jury found the company guilty of elder abuse and awarded the plaintiffs $23 million in punitive damages. 

“When you’re dealing with this many residents, particularly a population that can have unpredictable behavior or is frail—it’s a high-risk population to begin with, and we will have situations from time to time. But they’re the vast minority,” said Emeritus CEO Granger Cobb, who acknowledged the tragic nature of the incidents, during the documentary. “That really is the exception to the rule.” 

More than 750,000 American seniors reside in assisted living communities, which are regulated on a state-by-state basis as opposed to nursing homes, which are federally regulated. 

Assisted living is “the rock that no one wants to look under,” Catherine Hawes, a professor at Texas A&M with assisted living industry expertise, says she’s heard regulators say.

“We’re creating an industry with a million people in it, who are becoming more frail, that’s poorly regulated by the state. That’s why I talk about it as a ticking time bomb,” Hawes said in the documentary. “We’re going to see more deaths, more injuries.” 

Karen Lucas, an Emeritus spokesperson, characterized the tone of the series as unbalanced and said that Frontline/ProPublica reporters resisted attempts to be connected with residents and families happy with the care they were getting at Emeritus communities. 

“The tone is sensationalized and lopsided and we are disturbed and disappointed by the program. It does a terrible disservice to our viewers hoping to learn more about senior care,” Lucas said, pointing out that reporters did not conduct on-camera interviews with “any of the dozens of employees they independently sought out to interview, who had great things to say about Emeritus.”  

“When rare and isolated accidents occur in assisted living, just as they may occur at home, it is a tragedy and we are heartsick,” said Rick Grimes, CEO of industry trade group the Assisted Living Federation of America (ALFA), in a statement. “Our members are dedicated to their residents, families and team members and work tirelessly every day to maintain standards of care and integrity with zero tolerance for neglect, abuse or exploitation.” 

While ALFA says the public should have easy online access to information from state governments about assisted living communities, Grimes notes that state websites are just one of many sources of information, along with family members and potential residents doing their own research, seeking references, visiting several different communities multiple times, and asking for the community’s state citation record. 

Frontline/ProPublica focused its investigation on California, the state with the most assisted living communities, because of the lack of national industry data, the news outlet said.

Emeritus, according to the documentary, had the most consumer complaints per bed than any of its major competitors. These complaints included staffing shortages and taking in seniors “too sick” to live in its buildings, and the investigative team said it also identified more than two dozen “questionable deaths” that were never reported on.

Some of the charges leveled against the assisted living industry is that communities are taking in frail elderly people they are not equipped to care for—especially those with memory impairments.

The tragedies highlighted in the series took place between around 2007 to 2009, and Frontline/ProPublica emphasized Emeritus’ rapid growth in that time fame with the acquisition of Sunwest Management’s 144 senior living properties and a merger with Summerville Senior Living, adding 81 communities to its portfolio. 

Shortcomings at Emeritus communities are isolated, Lucas said, adding that deficiencies in state inspections have trended “significantly” downwards in the past five years. 

“We stand behind the quality of care throughout our 20-year history, and that includes the time period of the Summerville merger and the Sunwest acquisition,” she said. “In both cases, we committed the resources to facilitate a smooth transition… We increased our training staff to 46 [and] by the end of 2011, our enhanced training programs were fully implemented for our 30,000 employees. We also now have better systems in place to measure its effectiveness and monitor the learning outcomes.”

LeadingAge’s preliminary response to the documentary has touted not-for-profits as better care providers.

“Data from the Centers for Medicare and Medicaid Services (CMS) show that not-for-profit providers are substantially better than for-profit ones,” was one talking point LeadingAge provided on its website for members. “This not-for-profit difference is evident across levels of care.”  

The strongest trend, according to LeadingAge, is in staffing ratings, as 18.5% of non-profit nursing homes receive a 5-star rating for staffing from the Centers for Medicare & Medicaid Services (CMS) as opposed to less than 5% of nursing homes run by for-profits. 

“While comparable data for assisted living organizations does not exist, similar conclusions can be drawn,” says LeadingAge. 

Being a for-profit company is “absolutely” compatible with providing excellent care, Emeritus contends:

“We do it by focusing on care and service to our residents and their families. In serving those in our care with excellence, we achieve the customer satisfaction that naturally results in revenues,” says Lucas. “From this, we can give our communities the resources they need to care for each resident as well as the business results necessary for our continued operation and growth.”

Whether they’re run by a for-profit or not-for-profit, assisted living residents report overwhelming satisfaction with the communities they reside in, according to an independent survey of 500 residents commissioned by ALFA and conducted by third-party pollsters. 

Nine in ten residents said they feel safer in their assisted living community than living on their own, the survey said, while 93% said they are satisfied with their assisted living community. 

A 2011-2012 survey of assisted living satisfaction conducted by the National Research Corporation among residents in more than 1,500 communities revealed similar results: both residents and family members gave assisted living communities an overall positive rating more than 90% of the time.

“The true story of assisted living won’t be found in television programs like Frontline,” said ALFA’s Grimes. “It’s found in the everyday stories of our residents, and the safe, engaging, and active lives they lead every single day.” 

Written by Alyssa Gerace