Will Assisted Living Scrutiny in Calif. Impact Other States?

California assisted living communities have repeatedly made headlines in the last several months for all the wrong reasons, raising the question of whether one state’s regulatory woes could trigger federal oversight for the industry. 

The short answer: not likely. Assisted living experts say the state’s problems aren’t expected to have broader national implications at this point, despite a headline-grabbing, multi-series Frontline/PBS investigative report on California’s assisted living industry and U-T San Diego’s ongoing, locally-targeted investigative series

Part of that is because California’s assisted living industry has some unique factors, says David Kyllo, executive director of the National Center for Assisted Living. Those factors include the state’s size, its economic issues (read: budget deficit), and a “huge” volume of small group-homes licensed under the same Residential Care Facility for the Elderly category as larger, more professionally-run assisted living communities.  


“A lot of the issues are happening in those smaller group homes, although not all,” Kyllo explains. 

In part because California’s large size, there are more than 8,000 licensed or license-pending assisted living communities in the state, according to its Department of Social Services. Around eight in 10 of those have capacity for six or fewer residents, according to an Overview of Community Care Licensing presented to the Calif. Senate Human Services Committee in February. In contrast, Florida, which also has a number of smaller group homes included in its assisted living category, has 3,035 licensed assisted living communities. 

California currently has nearly $27 billion of debt, although that’s projected to drop beneath $5 billion in the 2016-17 fiscal year, according to a recent budget deal. The preponderance of communities licensed as RCFE paired with state-wide budgetary issues has translated to state surveys occurring few and far in-between, according to Kyllo. 


California’s survey system has two tiers: “regular” surveys, and “complaint” surveys which happen when people file a complaint about what’s happening in a community. Regular surveys occur around once every five years, Kyllo says, while inspections are conducted more frequently when triggered by complaints. 

Across the nation, most states’ legislation call for annual inspections of licensed assisted living communities. In reality, surveys typically occur every one to two years, says Kyllo—in other words, more regularly and frequently than in California. 

“Everyone has known that the [state regulatory] attention would be coming. It’s a California issue, and California needs to address it,” he says.

That’s exactly what is happening, says Sally Michael, president of the California Assisted Living Association, the state chapter of the Assisted Living Federation of America. She says the state’s focus on industry issues shows its support for non-institutional options.

San Diego County recently announced plans for an assisted living prosecution unit to monitor communities that don’t maintain certain care and quality standards, while California lawmakers recently proposed 12 senior living reform measures targeting assisted living. 

“The attention California is giving to residential care demonstrates the value of state-based oversight,” Michael said in an email to SHN. “State-based licensure and regulation allows oversight to be more responsive and closer to the consumer, as well as responsive to each state’s long-term care system.” 

CALA is working with LeadingAge’s California chapter in addition to the Alzheimer’s Association and other stakeholders to ensure legislation supports the resident-centered model of care assisted living seeks to provide. 

Like Kyllo, Michael doesn’t believe the California situation necessarily will impact other states’ assisted living industries. 

“[A]ppropriate funding and attention to oversight are critical to the licensing authority for assisted living communities, regardless of what state they’re in,” she said. “In addition, an ongoing conversation with all stakeholders is key to making sure that the needs of the residents are met. “

CALA’s legislative priorities are to raise minimum staff and administrator training requirements, increase transparency for consumers by giving them online access to reliable and current licensing information, and ensure annual inspections, Michael told SHN.

“Assisted living continues to be dynamic, adapting to provide quality, innovative care to residents,” she said. 

Written by Alyssa Gerace