Flawed System Leads to Fatal Care in Assisted Living

In San Diego, resident deaths resulting from poor care at assisted living often “fall through the cracks” with providers going largely undisciplined, according to an investigation by U-T San Diego and the California HealthCare Foundation’s Center for Health Reporting.

At least 27 San Diego County seniors have died since 2008 from injuries and neglect suffered in assisted living homes, U-T San Diego notes.

The county medical examiner investigates certain accidental deaths, including those in assisted living residences, however, the examiner is not required to notify the state Department of Social Services (DDS) of its findings, U-T notes. The department’s inspectors also do not monitor the reports, allowing suspicious deaths may “fall through the cracks” unreported.


The disciplinary measures when an accidental death occurs may not be much of a deterrent for providers to improve care.

Through an investigation with the California HealthCare Foundation’s Center for Health Reporting, U-T San Diego found that the top fine for a resident’s death is $150 if the state concludes the death was “caused or hastened by the facility’s lack of proper care,” compared with a $100,000 fine for a similar death at a nursing home.

The DDS regulatory actions “have more of an economic impact” and are more of a deterrent against poor care than the $150 penalties, according to California Healthline.


California is only two states nationwide where a social services agency oversees assisted living facilities, whereas elsewhere 37 states assign that job to their health departments, according to a 2013 survey by the National Center for Assisted Living cited in the article.

Another key finding from the investigation revealed that the number of complaints about poor care at elderly care communities increased by 13% in the past five years to nearly 3,000. Meanwhile, the number of penalties against such facilities declined by 30% during that time period to 6,787While the two data points are not necessarily correlated, investigators believe that those providing poor care are largely left unpunished in the state.

The subject of fatal care and neglect in assisted living has garnered national media attention, most recently with the PBS/Frontline special Life and Death in Assisted Living, which profiled Seattle-based Emeritus Senior Living.

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The investigative piece brought to light issues of training and staffing in assisted living communities, and the need for increased oversight into these long-term care facilities that support the elderly.

It seems that some oversight headway is already being made, as California’s DDS is changing the requirement that residential care facilities for the elderly (RCFE) undergo inspection once every 30 months, rather than the once every five years as dictated by state law.

“This type of crime is only going to get more widespread in the months and years to come,” said Deputy District Attorney Paul Greenwood in the U-T article. “We have a duty to clean up the RCFE industry, to highlight the good ones and target the bad ones.”

Read the U-T San Diego article.

Written by Jason Oliva

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