Staffing algorithms like one used by the nation’s largest senior living operator are exacerbating work shortages and often underestimating the amount of care that older adults need, according to a new investigation from the Washington Post.
The latest story, published Monday, centered mainly on a staffing algorithm used by Brookdale Senior Living (NYSE: BKD) known as “Service Alignment.” According to the Post, the algorithm helped lead to understaffing at the company’s communities, and in the process “failed to capture the nuances of caring for vulnerable seniors.”
“When Service Alignment was rolled out, the algorithm forced many Brookdale facilities to reduce their staff, documents and interviews show. At other facilities, where the algorithm suggested more staff was needed, Brookdale intervened,” wrote Post reporters Douglas MacMillan and Christopher Rowland.
The Post’s reporters based their story on interviews with more than 35 current and former Brookdale employees, court records and internal documents.
In a statement provided by a Brookdale spokesperson, the Brentwood, Tennessee-based company disagreed with the Post’s account.
“Service Alignment is a resource to help guide community leaders on staffing decisions, but local leaders have autonomy and discretion to adjust staffing levels as necessary to meet resident needs. It was created in the early 2000s as a way to identify best practices to meet the needs of residents. Service Alignment does not dictate staffing maximums or determine care costs,” the company’s statement read.
The Post’s investigation on Brookdale’s staffing algorithm is the latest in a series of stories called “Memory Inc.” casting a spotlight on the U.S. assisted living sector. A previous story, published in December, 2023, centered on thousands of cases since 2018 where senior living residents wandered away from their communities, resulting in nearly 100 deaths in that time.
That story sent shockwaves through the industry shortly after it was published, and prompted a U.S. Senate committee hearing in January.
Brookdale is the largest senior living operator in the U.S. with 652 communities nationwide.
Algorithm story adds to industry scrutiny
According to the Washington Post, Brookdale’s staffing algorithm has led to consternation at the community level. Managers “repeatedly complained that the company’s algorithm underestimated the amount of labor they needed to meet resident needs, according to court records,” the Post story noted.
Sometimes, the algorithm led to substandard care for older adults with dementia, the Post found after talking with a handful of the company’s former executive directors.
“Service Alignment failed to capture the complexities of working with seniors with cognitive decline,” the Post reporters wrote. “For instance, helping dementia patients take showers may take two or three times as long as other residents, because they often refuse to get undressed in front of caregivers they may not remember and need to be patiently guided through the process.”
The Post also detailed two civil lawsuits against Brookdale in Tennessee and California in which “a dozen residents or relatives of residents claim they suffered due to short-staffing caused by an overreliance on algorithms.” Sunrise Senior Living also is defending itself in a lawsuit by a group of customers with “similar concerns,” according to the Post.
Brookdale told the Post the claims were “inaccurate.” Brookdale also said that the staffing allegations are “largely derived from purported class action litigation that we and a number of other senior living providers have been facing over the last several years driven by plaintiffs’ attorneys seeking to earn fees.”
“Brookdale disputes the allegations and has been successful in defending against them to date,” the company’s statement read.
Brookdale is not the only company that has undergone legal and media scrutiny in the last 12 months over use of an algorithm. The UnitedHealth Group (NYSE: UNH) is facing a federal lawsuit over UnitedHealthcare’s use of an artificial intelligence tool in making Medicare Advantage claims denials for patients in extended care facilities.
In general, the senior living industry is facing increased scrutiny from multiple sides in 2024, including from the media and local and federal regulators. In response, industry associations, including Argentum, have said that such scrutiny is not warranted given senior living operators’ outsized impact on the health and wellbeing of residents.
“By relying on isolated events and anecdotal reporting, the Post mischaracterizes the experiences of the vast majority of the 1.4 million Americans who reside in assisted living communities today,” Argentum CEO James Balda said in a statement Monday, referencing the April 1 Post story.
“The Post fails to acknowledge that older adults who live in senior housing communities live longer, receive more healthcare services, and benefit from greater rehabilitative and preventive care than those who do not,” Balda continued. “In addition to fulfilling and often exceeding minimum state staffing requirements, Argentum and its members are committed to maintaining sufficient qualified staffing based on the needs of residents, which is central to the concept of person-centered care.”
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