Warren, Gillibrand, Wyden Call for New Watchdog Investigation into State Oversight of Assisted Living Facilities, Quality of Care Provided to Seniors
Federal Medicaid program covers assisted living services in many states; initial GAO investigation revealed inadequate state oversight of over 20,000 serious health and safety problems at assisted living facilities
Washington, D.C. – U.S. Senators Elizabeth Warren (D-Mass.), Ron Wyden (D-Ore.), and Kirsten Gillibrand (D-N.Y.), the Ranking Members of the Senate Banking, Finance, and Aging Committees, wrote to the Government Accountability Office (GAO) requesting a new investigation into the quality of care provided at assisted living facilities, and whether the Centers for Medicare and Medicaid Services (CMS) and state Medicaid agencies have improved their ability to protect hundreds of thousands of seniors and people with disabilities in assisted living facilities that participate in Medicaid.
“A new GAO report could provide legislators and the American public with a stronger understanding of why assisted living facilities were so rarely held accountable for neglecting the safety of their residents,” wrote the senators.
In 2018, GAO reported on this issue, revealing that the majority of state Medicaid agencies did not track serious health and safety problems occurring at assisted living facilities participating in Medicaid. In the 22 states that did track these problems, over 20,000 serious health and safety problems occurred, from physical assaults to medication errors to unexplained deaths. The report also found that state agencies defined critical incidents in different ways, limiting the collection of information. GAO concluded that CMS may be unaware of widespread problems affecting Medicaid beneficiaries at assisted living facilities due to a lack of clear federal guidance on reporting issues. A separate investigation by Sen. Warren revealed that there were an estimated 7,000 deaths from COVID in assisted living facilities during the first year of the pandemic.
Since then, reporting has highlighted the extent of threats to the safety of individuals in these facilities. In 2023, the Washington Post revealed that since 2018, thousands of assisted living residents have “wandered away…or been left unattended for hours outside,” leading to nearly 100 documented deaths and even more residents unaccounted for as a result of “failures by administrators and front-line caregivers” to prevent these incidents.
At a January 2024 hearing before the Senate Aging Committee, experts described the necessity of strengthening national standards for assisted living facilities. Witnesses testified that a number of issues, including inadequate and inconsistent training, improper communication from operators and state agencies, and limited data collection contribute to subpar conditions and poor-quality care at the facilities.
In May 2024, CMS finalized rules to ensure state Medicaid programs are subject to nationwide incident management system standards requiring them to consistently monitor health and safety problems at assisted living facilities that participate in Medicaid. The new rules also include a requirement for states to submit annual critical incident reports to CMS. The new critical incident management system will take effect in 2027, at the earliest, underscoring the need to understand the state of care in these facilities before then.
“Given GAO’s previous findings on the need for improved oversight of assisted living facilities, and new findings about residents’ health and safety, we request that GAO provide an update on this issue,” concluded the senators.
The lawmakers asked for the scope of the GAO’s investigation to cover how oversight of the facilities has changed since the 2018 report, the types of deficiencies and critical incidents identified at the facilities in recent years, how CMS is implementing the updated monitoring and reporting requirements for state Medicaid programs, and the extent to which additional oversight in these facilities is necessary.
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