I found an article in the Miami Herald about the horrible conditions & lack of regulatory oversight for Assisted Living Facilities (ALFs) in Florida. ALFs are supposed to serve the elderly and disabled, including the mentally ill. I’m trying to understand the incentives that make the police and the regulatory agencies not get involved with the abuse and neglect of residents who are injured or die as a result. The people running these abusive ALFs should be charged with assault or manslaughter. But it’s hard to make arrests or impose fines when an abusive ALF falsifies records as in the case with some of these facilities. It’s no wonder the folks at the drop-in center where I used to work prefer the streets to ALFs and homeless shelters. I remember when I interviewed one man at the drop-in center a few years ago he said he left the ALF he was living in because it was so abusive that he’d rather be homeless. So jails, and ALFs are the new asylums.
The Miami Herald did a wonderful job exposing the abuses at the ALFs. The articles about it were timely because the Florida legislature refuses to add more regulatory oversight for ALFs. People at ALFs aren’t well enough to vote so no one in the legislature has the incentive to improve the system. Florida State Senator Alan Hays of Umatilla states, “Many of these facilities are already strapped; they’re trying to balance quality care with their staffing needs and that sort of thing…I don’t want to do anything to take away from their ability to care for their residents.”
I’ve heard this one before. Somehow laws that increase oversight and accountability are interfering with care. I hear it again and again. The reason conditions are so terrible is because the owners of these facilities make more money by providing less care. It’s business as usual. According to the Herald’s article, the ALFs are guaranteed an average of $674 a month from Social Security and a daily stipend of $9.28 for residents with mental illnesses. So that comes to about $952.40 a month for each mentally ill resident. It’s not much so the owners have an incentive to provide fewer services in order to make more money.
The Florida Agency for Health Care Administration (AHCA) is the regulatory agency responsible for overseeing ALFs. They used to have strict standards that were once one of the most regulated in the country. The Miami Herald reports that “as the industry boomed, AHCA failed to keep up with the growth, with state agents taking longer to respond to dangerous breakdowns. A Miami Herald analysis shows it took inspectors an average of 37 days to complete complaint investigations in 2009, 10 days longer than five years earlier.”
If the laws are not funded they are difficult to enforce. ALFs are inspected once every 2 years. They could improve their funds through fines, but it costs the state even more to relocate residents if they shut a facility down. The Department of Children and Families (DCF) investigates abuse at these facilities, but unlike AHCA, they don’t have the authority to fine or shut these places down. AHCA is in charge of the Medicaid programs in Florida. An article by Reuters states that the Florida legislature refuses to accept funds from the federal government to expand Medicaid. And nowadays the regulations have been gutted to the point where the only requirements for running an ALF are a high school education and 26 hours of training.
It’s a good idea to look up inspection reports on AHCA’s website. View this video on how to look up ratings and inspection reports for Florida’s Assisted Living Facilities.
And if things weren’t bad enough, there’s another reason to look up Assisted Living Facilities on AHCA’s website. Some facilities claiming to be ALFs aren’t licensed. AHCA’s website lists licensed ALFs in your area so if an ALF isn’t listed on AHCA’s website, it’s probably not licensed.
The incentive behind all this is greed, pure and simple.