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by A.C. Thompson

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Part 1

The Emerald City

Part 2

They're Not Treating Mom Well

Part 3

A Sinking Ship

Part 4

Close the Back Door

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Behind the Scenes

How This Series Was Reported

Emeritus Response

A Media Strategy to Thwart Federal Oversight

Profiles

Those Lost and Those Left Behind

Part 1

Part 2

Part 3

Part 4

Documentary

How It Was Reported

Profiles

A Media Strategy to Thwart Federal Oversight

Life and Death in Assisted Living, Part 4 “Close the Back Door”

by A.C. THOMPSON, ProPublica and JONATHAN JONES, special to ProPublica, Aug. 1, 2013

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Inside Room 101 at Emerald Hills, a covert campaign was under way in the fall of 2008. Potentially lethal bed sores were spreading across Joan’s body, and workers were trying to improvise help.

The workers at Emerald Hills lacked both the skills and the legal authority to treat Joan. But they were nonetheless determined to try. Jenny Hitt, a young woman with no medical training who was in charge of handing out medication in the facility, said she and her coworkers rubbed cream into Joan’s wounds, known as pressure ulcers.

“We knew we weren’t supposed to do it,” said Hitt. “We knew we weren’t licensed or medically trained to do it.”

One ulcer began eroding the skin on Joan’s right buttock.

“At first, it was just like a small, round red spot,” Hitt said. Then, she said, the skin started to deteriorate. “The area started to become like a hole.”

Peggy Stevenson, the lone nurse employed by Emerald Hills, told the workers to act secretly, according to Hitt. “She said, ‘Just don’t let anybody know,’” Hitt recalled.

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And so the Boice family was kept in the dark, even her husband, Myron, who lived in another room at the facility; so, too, were the more highly trained nurses who had been sent into the facility to deal with what they had been told was a limited threat: a wound on Joan’s foot.

An ulcer formed on Joan’s right heel. Another on her left heel. The ulcer that had previously erupted on the inside of her right foot opened up again.

Susan Reuther spent a lot of time in Room 101. Her mother was Joan’s roommate.

“They told me, ‘This is the worst — we don’t know what to do,’” Reuther said of the workers. “It would take them maybe an hour, an hour and a half, just to roll her over.”

Officials with Emeritus deny that any such improper care took place. Stevenson, when asked years later about Joan’s care, said she could remember nothing about her treatment, and did not even recall who Joan was.

But records suggest Joan’s situation wasn’t unique. Under California law, seniors with serious bed sores, the kind that require sophisticated and urgent treatment, are not supposed to stay in assisted living facilities. The reasons aren’t hard to understand: Assisted living facilities, dreamed up three decades ago as a less restrictive and institutional alternative to nursing homes, don’t have the trained personnel or resources to treat potentially life-threatening conditions.

Yet regulators have repeatedly cited Emeritus for housing residents with severe bed sores.

At a facility in Whittier, investigators discovered a person with a bacteria-ridden pressure ulcer near the base of the spine so deep it needed surgery. A wound care expert said the ulcer was teeming with “numerous” strains of bacteria, a sign the person had “probably gone a couple of months” without treatment, according to a state report.

Investigators cited a facility in San Diego for housing a resident with advanced sores on the right hip and both feet. One of the ulcers “was also gangrenous,” state records show. The person was “suffering from severe malnutrition” and was besieged by Clostridium difficile, an aggressive brand of bacteria that can be lethal.

A woman at a facility outside Sacramento was killed by an infection linked to five pressure ulcers. The state fined Emeritus, saying the woman should have been moved to a setting more appropriate to her needs.

Joan Boice, after a career teaching school, had spent the early part of her retirement volunteering with children eager to read and write. Her marriage to Myron had lasted decades, and her children had gone on to lives of accomplishment.

But Eric Boice, one of Joan’s two sons, had few illusions about his mother’s long-term future when he had helped move her into Room 101 at Emerald Hills in September 2008. Her dementia, a problem for years, had become more severe; she could not really talk; moving around was difficult.

Eric had worked for more than a decade as a police officer. He could stare at an unpleasant truth.

“We knew that my mom’s disease was progressive,” he recalled. His chief concern, then, was making sure his mom was “treated with the utmost dignity and honor and respect.”

The Boice family had paid handsomely to make sure that happened. In less than three months, the family had paid more than $12,000 to cover Joan’s room, care and meals.

“Retain the Residents as Long as You Can”

A May 2008 memo from a senior nurse at Emeritus to two other supervising nurses in California included an agenda for an upcoming strategy meeting:

• Sales
• Occupancy
• Back Door

To those outside of Emeritus, a publicly traded company that has expanded dramatically in recent years, the memo’s third agenda item might have been inscrutable. But within the company, people knew what it meant. Emeritus was intensely focused both on persuading people to move into its buildings and dissuading them from moving out. They did not want paying customers to, as they put it, go out the back door.

Around the company, the subject came up regularly. And the emphasis on the policy aim could be explicit and emphatic.

“KEEP THE BACK DOOR SHUT!” shouted a 2009 email from a nurse named Nicole Jackson, who oversaw Emeritus facilities in Northern California.

In an internal 2010 company newsletter, Emeritus touted the success of employees in San Antonio, Texas: “These dynamos really have grown occupancy this year due to closing the back door! They’ve decreased their move outs by 4 per month!”

In an email sent the same year, Budgie Amparo, the nurse who served as head of quality control for the company, thanked Emeritus nurses around the country. “I would like to recognize our nurses for their unbelievable focus” on “the back door,” he wrote.

Emeritus employees at all levels describe a company consumed. Former nurse Doris Marshall said that “closing the back door” was one of her chief responsibilities. “It meant to retain the residents as long as you possibly can,” she said.

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The company tracks move-outs closely at each of its hundreds of facilities, gauging the trends and patterns from region to region.

Its officials describe the zeal for retention as benign — nothing more than a good-faith effort to please customers and adjust services and care for residents whose needs change over time. A resident may dislike the meals or squabble with the ornery guy in the apartment down the hall. Perhaps a person can’t quite afford the monthly fees.

Emeritus wants “to ensure that the residents do not choose to move out because they are dissatisfied,” the company said in a written statement. “We do monitor move-outs so that we can identify and correct any issues and enhance resident satisfaction.”

But some people who have worked for the company, as well as some families who have endured painful episodes at Emeritus facilities, said the pressure to “close the back door” has led to dangerous lapses in judgment. In some cases, former employees said, the company failed to move out residents who should have been sent to nursing homes or other medical institutions.

ProPublica and PBS Frontline sifted through thousands of pages of regulatory records from seven states — Texas, California, Iowa, Mississippi, Georgia, Ohio and Florida. Since 2007, inspectors in each state have cited Emeritus for housing seniors who should have been moved out.

Regulators in Iowa faulted an Emeritus facility near Des Moines three times in less than two years. One case involved a 77-year-old with Alzheimer’s who repeatedly attacked other residents, groped female residents, and eventually had to be hauled out of the building by police officers. Another case centered on a resident with severe dementia who flipped over tables in the dining room and urinated on them, according to a state report. Nearly two months before state investigators showed up, a doctor had determined the resident needed a “higher level of care” and had passed that message on to the facility.

Iowa law bars facilities from renting rooms to people who are “sexually or physically aggressive.”

Regulators in Mississippi, Georgia and Texas have repeatedly cited Emeritus for housing wheelchair-bound seniors who could barely move at all. At a facility in Smyrna, Ga., investigators concluded that 15 of 35 residents shouldn’t have been there. The state labeled the violations an “imminent and serious threat to resident health and safety.” In Clinton, Miss., the number was 10 of 81, according to the state.

Emeritus disputed some of the findings by Mississippi’s regulators.

“We have no interest in preventing people from moving out,” said Emeritus founder and chairman Daniel Baty.

Emeritus does set precise move-out targets for all of its buildings, however. One such target was articulated by an Emeritus vice president in a 2008 memo sent to employees in California. The executive wanted fewer than 3.5 people to move out of each facility per month, apparently including those who died.

The emphasis left staffers confused and fearful, according to interviews and sworn testimony. Next to none of the workers at a place like Emerald Hills had the medical background to assess the changing conditions of the residents.

Emeritus workers said the corporate push to “close the back door” made them hesitant to transfer patients to nursing homes or hospitals. They understood their decisions were being closely watched and that there could be consequences if they missed their marks on occupancy and revenues.

“Don’t let anybody move out unless they were deceased.” Lisa Paglia, former regional sales manager for Emeritus, on what “keep the back door closed” meant.

Nancy Cordova ran the Emerald Hills facility while Joan Boice was there. She later testified that the “close the back door” policy left her feeling pressured into housing “high acuity” clients – those with serious health problems -- and uncertain about where the line should be drawn in any given case.

A 2008 email suggests that facility directors like Cordova wound up looking to senior executives to make determinations on who was truly sick or challenging enough to open the back door for. In the email, Cordova asks her superiors about a small roster of people considering moving out of Emerald Hills. One wanted round-the-clock care. A second was more complicated: The resident had Parkinson’s disease, a degenerative disorder of the central nervous system, and needed three or four people to help get her in and out of bed.

“Just for added fun,” Cordova wrote of the resident, “she has severe hallucinations that are disturbing to her and the staff.”

It is unclear what the supervisors told Cordova to do.

Lisa Paglia, a former regional sales manager, said, in her view, “keep the back door closed” could be translated into another, more blunt, phrase:

“Don’t let anybody move out unless they were deceased.”

“I Don’t Know How She Sat”

At Emerald Hills, Joan, her sores multiplying and worsening, became ever more isolated.

She sat for hours in her wheelchair. She seemed smaller. Depressed. She rarely ate or drank much. Her weight dropped. The muscles in her right arm had seized up due to inactivity, locking at the elbow.

The ulcers on Joan’s heels deepened. They began to blacken as the skin died. The sore on her buttock was chewing through her skin and into the fat beneath.

Joan groaned. She frowned. But she couldn’t speak.

Danielle Woodlee, who served as a kind of concierge at Emerald Hills, was struck by Joan’s deterioration. “It was almost like a movie,” she remembered. “I mean, the decline, it was just horrible.”

And Emerald Hills still hadn’t told the family what was going on underneath Joan’s clothing.

Joan’s physician would later say that Emerald Hills never informed her of many aspects of Joan’s deterioration – that she had fallen and been taken to the hospital, that she had become confined to her wheelchair, or that she was losing so much weight.

“It was almost like a movie. I mean, the decline, it was just horrible.” Danielle Woodlee, who worked at Emerald Hills, on Joan Boice's health.

One Saturday morning, Eric showed up at Emerald Hills with Joan’s morphine, prescribed for the pain caused by a problem with her spine. He couldn’t find any Emeritus employees save Woodlee. He stalked through the memory care unit. He looked in the medication room, and the nurse’s office.

“I couldn’t find anybody,” he said.

After 20 or 30 minutes, Eric Boice left the drug with Woodlee, the concierge. The episode made him furious.

If he had seen Joan’s medication charts, his fury likely would have been exacerbated. The charts showed that on some days nobody gave Joan her morphine at all.

Eric began looking for the facility’s nurse and managing director every time he came to Emerald Hills. He could never find them. Woodlee later said there was a reason for it: She helped the senior officials hide out in her office when they knew a Boice family member was coming for a visit.

November became December. It was then that Emerald Hills formally notified the Boices of Joan’s true and now dire condition. Peggy Stevenson contacted Kathleen Boice, Eric’s wife. In an email, Stevenson said that because of Joan’s deteriorating health, she needed to be transferred to a nursing home.

Kathleen was stunned. “This was the very first time we had ever heard anything like that,” she said.

Three days later, Joan was admitted to a nursing home about a half-mile from Emerald Hills. Kathleen sat with her as a nurse examined her skin.

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The nurse started with the first ulcer Joan had developed, on the side of her right foot. “It was an oozing, open sore,” Kathleen said. “There was another sore on that foot, back by the heel, and it was black. Then they took off her other sock.”

“There was a sore. It took up her whole heel. And it was black and oozing red. And not to be rude, but it smelled so bad. It was putrid. You could tell it was decaying.”

The nurse put Joan in a hospital gown. Kathleen saw more wounds, including a fluid-laden blister bulging on the inside of one arm. “Then they took off her diaper. And there were two spots on her right hip that were red. It looked like the skin was starting to come off. There was a similar spot on the left side,” Kathleen said.

Joan grimaced when the nurse touched her. Kathleen held her hand.

“I thought we were about done,” Kathleen said. “And they rolled her over and then we found the one that was on her sit bone.”

It was huge. And black. And oozing.

“It was more putrid than the one on her heel,” Kathleen said. “I don’t know how she sat. It was horrible.”

Kathleen phoned her husband, who had left the nursing home to drive his father back to Emerald Hills. “She scared me,” Eric Boice said of his wife. “She couldn't talk. She was just sobbing. And I — and I didn’t know if she had been in an accident. I didn’t know what happened. She just started to say like, ‘The sores … the sores are all over her.’”

On Valentine’s Day, 2009, Joan died. Myron, her husband of some 50 years, was dead nine months later.

California regulators eventually cited Emeritus for improperly housing Joan despite her serious bed sores.

Joan’s death set off some agonizing soul-searching for her family.

Eric Boice was haunted for years. His mother visited him frequently in his dreams, he said. In those dreams, she was healthy and lucid and able to communicate. They talked. And Eric told her he was sorry “for not being the voice that she needed, for not demanding more of the people that we trusted with her care.”

Eric also heard from Emeritus.

Its collections department sent him a bill. Apparently, Eric hadn’t given the company sufficient notice when his mother went to the nursing home at the beginning of December. Emeritus wanted $14,175 to cover Joan’s rent and fees for December, January and February.

“Malice, Oppression, Fraud”

The Boice family sued Emeritus not long after Joan’s death, and in late 2012 the trial was looming. It was then, the family says, that Emeritus made an offer to settle the case: more than $3 million.

There were several standards terms in the proposed deal. According to Eric Boice, the company demanded that the family return the extraordinary array of internal records their attorney, Lesley Clement, had obtained from Emeritus: spreadsheets, memos, emails, policy directives, budgets, personnel files.

Emeritus would admit no wrongdoing under the proposed settlement. None of Joan’s relatives would ever be able to talk publicly about the case. And the transcripts of 160 hours of depositions of company officials would remain under seal forever.

Eric Boice said the family ultimately decided to reject the offer. “We would not have been able to share my mom’s story,” Eric said, adding: “That was part of the bargain for the money.”

Emeritus declined to discuss details of any proposal but did not deny its existence.

Weeks later, the case went to trial and Joan’s story unspooled over two acrimonious months inside Courtroom 45 in downtown Sacramento. Nearly 40 witnesses took the stand. There were dozens of exhibits. The Boice family was there throughout, as were a team of Emeritus lawyers and two senior executives.

“Emeritus is not a health care provider. Emeritus is a real estate acquisition company,” Clement said in her opening statement on Jan. 7, 2013. “Emeritus should never take any elders into the buildings that it acquires because they don’t have the staff, they don’t have the training, and they don’t have the supervision to provide the care that Emeritus advertises.”

For Emeritus, the risks were not confined to the trial inside Courtroom 45. Headlines about an unfavorable jury verdict can linger on the Internet for years, scaring off would-be customers across the country. Emeritus mounted a vigorous defense.

“The diseases of aging are despicable sometimes,” Bryan Reid, the lead lawyer for Emeritus, told the jury that day in January. “There will be no dispute that what the Boice family had to go through was not pleasant.”

Joan Boice’s death, he argued, was not caused by neglect, but by the very serious illnesses she suffered from when she arrived at Emerald Hills, including dementia. If Joan had been neglected, why hadn’t her family taken action? Why hadn’t they reported any alleged neglect to the authorities? Why had they not moved her out?

“It will be clear at the end of this trial, I believe, ladies and gentlemen, that Emerald Hills fulfilled its obligations,” Reid said in his opening statement. “Its staff did what they were able to do as part of this team that was shepherding her through her journey.”

As Clement called witnesses and introduced internal company memos and emails, she hammered at what she argued were the company’s broken promises: Emeritus didn’t have the adequate staff it had advertised; that staff wasn’t properly trained, as the company had boasted; the company’s fixation was with occupancy rates, sales and containing costs, and not on care.

Dorothy Ting, who had run an Emeritus facility in Fairfield, Calif., testified that the seniors in her facility’s memory care unit ate out of metal dog bowls because the company would not spend the money on more appropriate dishes.

Nancy Cordova, who ran the Emerald Hills facility during Joan’s stay, was asked a pointed question by a member of the jury. Was it fair to say, the juror asked, that Cordova, responsible for 80 or so residents, many of them with dementia, was “in over her head”? “I think that would be fair to say,” answered Cordova.

One of the trial’s most dramatic episodes involved the testimony of Budgie Amparo, a senior Emeritus executive and the highest-ranking company official with any kind of medical background. Amparo, a registered nurse, had described himself as the person ultimately accountable for the safety and well-being of the thousands of elderly men and women living in the company’s vast portfolio of buildings.

However, Clement’s questioning of him, both before the trial and on the stand, called into question whether his career experiences in nursing were sufficient to shoulder that responsibility.

Amparo, who earlier under oath had described himself as the “pillar of quality” at Emeritus, testified that he had earned a master’s degree in nursing by taking online classes offered by the University of Phoenix. He had done no clinical work as a part of the program. Amparo also had to admit that he had failed his board exams at least twice before finally gaining his accreditation as a registered nurse.

In Courtroom 45, Clement explored with Amparo one of the aspects of Emeritus’s operations that she regarded as particularly questionable: the requirement that nurses who worked for Emeritus were responsible not only for medical care, but for filling its buildings with new residents through sales.

“Since when were nurses supposed to be sales and marketers, sir?” Clement asked Amparo.

“They are not,” he said.

“Since when are nurses supposed to be worried about meeting financial goals of Emeritus?” Clement persisted.

“They are not supposed to,” Amparo said.

“Isn’t that what Emeritus requires, according to their job description?” Clement asked, referring to one of her exhibits.

“That’s what the document says, yes,” Amparo replied.

In the end, the two sides fought most bitterly over the question of Joan’s death — what had caused it and who was responsible.

Clement hired Dr. Kathryn Locatell, a forensic geriatrician, to provide expert testimony. Locatell pointed to Joan’s dramatic decline at Emerald Hills — in particular her dramatic weight loss and festering bed sores, which can be prevented or minimized with proper attention — as signs of neglect. Locatell testified that these factors had been critical in Joan’s demise. She estimated that Joan could have lived another three to five years if she had been properly treated at Emerald Hills.

Emeritus’s lawyers countered that the staff at Emerald Hills had worked tirelessly to tend to Joan. And they pointedly asked why, if Joan had been so neglected, no one ever made a formal complaint about it – not the Boice family, not the outside nurses who saw her, not her own doctor.

A neurologist hired by Emeritus ascribed Joan’s death to her advancing Alzheimer’s and a string of strokes. “She was having a series of small and accumulating strokes” in the left side of her brain, Dr. Richard Tindall testified, “leading to progressive weakness and inability to use her right side.” “This was one stroke on top of another, on top of another,” he added.

On the last day of February, the lawyers summed up their cases. Clement reminded jurors of the company’s slogan.

"‘Emeritus is committed to your family.’ Remember that? Remember their promise painted on the walls of their buildings, on their website?” she asked. “‘Our family’s committed to yours.’ But the evidence is, the truth is, Emeritus is committed to your family’s money. That’s what they are committed to.”

She continued, “Emeritus told Joan, ‘Trust us,’ and Emeritus told you to trust them. Trust their officers, their directors, their managing agents, and yet when they came into this courtroom they lied to you. They lied to Joan Boice. They lied to her family, and they lied to their own employees.”

Reid staunchly defended Emeritus’s ethics and its record. He said Clement had distorted facts, misrepresented the company’s policies and enlisted a bunch of disgruntled former employees to make false allegations. It amounted to a stock formula for litigating an elder abuse case, he said.

“The tragedy is the vicious allegations,” Reid said. “It’s not the care.”

“I don’t feel that with this loss Emeritus is doing anything different.” Eric Boice on the outcome of his family's case against Emeritus.

On March 1, the jury got the case, and after two days of deliberations, its members filed back into Courtroom 45. They had reached unanimous verdicts on more than a dozen questions, finding the nation’s largest assisted living company had acted with “malice, oppression and fraud” — and that its negligence had caused Joan’s death. The jury awarded the Boice family $3.875 million for pain and suffering — a figure that was automatically reduced to $250,000 under California law.

There was more work to do, however. The jury convened again to settle on a number, a dollar figure Emeritus would have to pay in punitive damages. The figure came back: $22.9 million. Two jurors had actually wanted to award more.

Emeritus promptly appealed, asking the trial judge, Judy Holzer Hersher, to reduce the punitive damages or order a new trial.

It would be three months before Judge Holzer Hersher handed down her ruling. But on June 10, she denied the company’s appeal in all respects. The award was lawful, she ruled. Clement had proved her case. And the evidence had shown that the company’s most senior officials were well aware of the troubles at their facilities, including Emerald Hills.

Eric said he is glad the family took the case to trial. He is grateful for the $23 million total jury award, but says Emeritus’s refusal to acknowledge any wrongdoing or failure or error has caused a kind of ambivalence to grow in his mind.

“Technically, yeah, we won and Emeritus lost,” Eric said. “But to me it’s bigger than that. It’s more about right and wrong. And I don’t feel that with this loss Emeritus is doing anything different. I honestly don’t think they have changed their practice, their business as usual.”

The jurors, in calculating their award, appear to have sent a message to Emeritus about its business practices. They came to the $22.9 million in punitive damages by adding together the 2011 compensation for Emeritus’s chairman and chief executive officer.

And then the jury took a step to make sure Emeritus didn’t forget Joan Boice, the Illinois farm girl who had come to California to chase a dream, and who, in an effort to hang onto her dignity near the end of her life, signed on with Emeritus Senior Living.

The jury tacked on 81 cents to the award — Joan’s age when she moved into Room 101 at Emerald Hills.

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Last month, the White House told ProPublica it was still “looking into” the apparent massacre.

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A parallel investigation began by the Senate Foreign Relations Committee in 2010 also never made headway. The committee staffer leading that investigation was former CIA officer John Kiriakou, who is currently serving time in federal prison for revealing the name of an undercover officer to a reporter.

In letters from prison to ProPublica and an interview published recently in Salon, Kiriakou said that Secretary of State John Kerry, who was then chairman of the committee, personally called off the investigation. The State Department declined to comment, but a former Senate aide to Kerry called Kiriakou’s account “completely fabricated.”

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When Emeritus’s top public relations official fired off a passionate call to arms – an email beseeching the company’s employees to blunt the impact of PBS Frontline and ProPublica’s investigation of the assisted living business by posting positive things about the company and the industry on Frontline and ProPublica’s website and Facebook accounts – she surely didn’t mean for it to be sent to ProPublica.

But that’s what happened, notwithstanding the attempt by an Emeritus employee to take back what clearly was an inadvertent forwarding of the email.

Here it is:

Subject: Emeritus

From: Wilburn Gardens-ED

Date: July 31, 2013 10:23:41 AM EDT

To: feedback@propublica.org

OK, everyone, it’s our turn now.

The broadcast has aired. Frontline has told their story. Now it’s time to tell ours. And folks, let’s tell it LOUDLY.

I am asking you, right now, to take five minutes, go online to one of these websites (or cut and paste to all of them, for that matter), and write just one sentence that speaks to your incredible community, your amazing staff, your wonderful residents and families that you care for, the job that you love and the difference that you make.

There’s a great quote: “Never underestimate the power of a small group of committed people to change the world. In fact, it is the only thing that ever has.”

If you don’t think your one post will matter, it does. A LOT.

We have only to be proud of what we do. Now is OUR time to flood the internet with the sounds of OUR united voices. Shout out about the exceptional care your team delivers 24 hours a day, 7 days a week, 365 days a year, for your residents and their families who trust and believe in you.

Please. Do it now.

ProPublica

http://www.propublica.org/

Frontline

www.Frontline.org

Frontline Facebook page

https://www.facebook.com/photo.php?fbid=10151535403996641&set=a.491930816640.259623.45168721640&type=1&theater

ProPublica Facebook page

http://www.facebook.com/propublica

Your work is love made visible. You are an example for us all.

~Karen

Karen Lucas – VP, Product Development and Communications

Emeritus Senior Living | 3131 Elliott Avenue, Suite 500 | Seattle, WA 98121

Russell Williams – Executive Director

Emeritus of Wilburn Gardens | 3500 Meekins Drive | Fredericksburg, VA 22407

Our Family is Committed to Yours.®

"The essence of profound insight is simplicity…" -Jim Collins

“If you lose the power to laugh, you lose the power to think…” -Clarence Darrow

See original document >>

Jason M. Breslow, FRONTLINE

Finding reliable data on assisted living isn’t easy. Federal and state statistics can be hard to come by, and it’s often simpler to search for restaurant reviews on Yelp than it is to locate ratings and reviews for a local assisted living facility. So where do consumers begin if they’re considering sending a loved one to assisted living? We put that question to several experts. Here is what they had to say.

1. What Are Your Needs?

Assisted living isn’t for everyone, so it’s important to understand what level of care you need and how that may change with age. Experts say that is especially true when it comes to seniors with dementia.

Consider this 2009 study led by researchers at Johns Hopkins University: It found that 46 percent of assisted living residents suffered from at least three chronic conditions, yet only 54.5 percent of facilities surveyed in the study had a registered nurse or a licensed practical nurse on staff. As the survey authors note, “Some residents with multiple, complex medical conditions present a challenge that some [assisted living facilities] may not be prepared to manage.”

Assisted living facilities can have limited medical staffs — no doctors and often no nurses — so while many people may shudder at the thought of a nursing home, for some seniors, it may be the better option.

“So many people have heard their mother say, ‘Promise me you’ll never send me to a nursing home.’ And a lot of people make a mistake in choosing assisted living because it looks nice rather than what the person really needs,” says Catherine Hawes, director of the Program on Aging and Long-Term Care Policy at Texas A&M University.

2. Have You Visited?

If you have settled on assisted living, it’s important to visit prospective facilities multiple times. Experts recommend visiting at different times of the day — meal times are a good place to start.

It’s not enough to just tour the building with the director, they say. Instead, take time to talk to residents and staff for a sense of the facility’s culture and environment. Ask about available services and about what staffing is like throughout the day and at night. It doesn’t hurt to inquire about turnover either, as that can be a good indicator of how reliable services will be, as well as how well the staff understands residents’ needs.

For residents with dementia, it’s also important to understand how the facility manages their care and safety. For example, what kind of programming is available? Are the doors locked at night for residents who wander?

Checklists for visiting an assisted living facility are available from several organizations, including the AARP, the Alzheimer’s Association, California Advocates for Nursing Home Reform and the Assisted Living Consumer Alliance, among others.

3. For-Profit or Non-Profit?

It’s also important to consider whether the facility is a for-profit, or not-for-profit institution, as that may influence how resources are allocated for care.

About 82 percent of residential care facilities are private, for-profit facilities, CDC data shows, with about four in 10 belonging to a national chain. Such for-profit chains, says Hawes, often have “requirements for a return on revenue that mean that they’re always pressing for higher occupancy and for constraining variable costs, and the variable costs are staffing and food, and to some degree, activities.”

From 2006 to 2011, for example, profit margins at privately owned assisted living facilities went from 3.5 percent to 6.4 percent, according to research from Sageworks, a financial information company. Those gains corresponded with drop in payrolls from 45 percent of sales in 2004 to 38 percent in 2012.

That doesn’t necessarily mean that you should dismiss for-profits and focus your search on non-profits only because, as Hawes notes, there are good and bad facilities in each category. But experts say the funding model can have an influence on another significant factor: cost.

4. What Are the True Costs?

Assisted living can expensive, and because it is not covered by Medicare, for many seniors, the cost can be prohibitive. In 2012, the average monthly base rate in an assisted living facility rose to $3,550, according to a survey by MetLife. In several states, base rates can run as high as $9,000 a month.

The sticker price, however, often won’t account for the fees a facility charges for additional services. Some facilities will charge a resident extra for meal delivery, for example, while others add on fees for services such as transportation to and from the facility, or laundry and housekeeping. Likewise, fees for bathing assistance, dressing assistance and medication management can add thousands of dollars a month to the base rate.

5. What’s in the Admissions Agreement?

Admissions agreements can be lengthy and complicated, so experts advise taking your time to read them carefully. Occasionally buried in the fine print is language requiring 30 days notice to stop billing for services, even if the person staying there has died, says Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

Another red flag are so-called negotiated risk agreements. These clauses are often offered as a way for residents to make preferred choices about their care, even if they present some risks. For many in the industry, they are seen as a way to help seniors preserve a sense of independence. But as McGinnis warns, if something goes wrong, “You have signed away your right to sue.”

Liability waivers, another common part of admissions agreements, can present the same problem.

“To me, that is a sign that the facility may not have either the ability or the commitment to meeting your needs,” says Nina Kohn, a professor of law specializing in elder law at Syracuse University.  ”If you’re confronted with a contract with that kind of liability waiver, I think it’s reasonable to say, ‘I’m going to cross out that provision.’ See how the facility responds.”

If any part of the admissions agreement is unclear, consult with an elder law attorney, suggests Kohn. The American Bar Association also provides a checklist for choosing an assisted living facility.

6. Where is the Facility?

It’s nice to find a residence that’s close to friends and family, but experts caution against letting that be the deciding factor.

“It is really important to have a place that’s easy to visit, but it’s more important to find a facility that’s really good,” says Hawes of Texas A&M. “Don’t choose a facility that’s five minutes closer to you, or 10 minutes closer to you just because of that. Make sure that you’re getting the best facility for what your loved one needs, and be realistic about what they need.”

7. What Does the Ombudsman Say?

Because data on assisted living facilities can be hard to come by, experts recommend contacting the long-term care ombudsmen for your local area. These officials can offer additional checklists or information on any citations against a facility, as well as answer any additional questions you may have.

In terms of citations, Karen Love, president of the Center for Excellence in Assisted Living, says to look out for any medication administration violations. She also suggests asking “Have they been cited for not having staff trained, if it’s a state requirement, and have they gotten dinged for not having enough staff, again if that is a state requirement?”

The National Long-Term Care Ombudsman Resource Center provides a map on its website with contact information for ombudsmen in all 50 states.

by Blair Hickman

Assisted living in America is a growing, multibillion-dollar industry. Nearly 750,000 people live in facilities across the U.S. But is it safe?

Our new investigation with FRONTLINE went behind closed doors and found a world where profits appear to be trumping quality care. We found several instances of understaffed facilities, and direct mandates from management to prioritize sales over healthcare.

And though nursing homes have federal regulations, assisted living facilities are loosely monitored; states are responsible for setting and enforcing the rules. 

Should the government revamp oversight for these facilities? Are some facilities better than others? What factors should you evaluate when choosing a facility for your parents? What questions do you have about assisted living or your loved ones?

Today at 2 pm ET, join ProPublica reporter A.C. Thompson and the film’s producer, Carl Byker, for a live chat on these questions and more. Cheryl Morgan and Eric Boice, who were both in the film, will also join the chat, and Next Avenue senior editor Richard Eisenberg will be asking questions.

Feel free to leave your questions below in advance, and come back at 2 pm today for the live discussion. A transcript will be available after the chat. 

<a href="http://www.coveritlive.com/mobile.php/option=com_mobile/task=viewaltcast/altcast_code=5115c7f379" _cke_saved_href="http://www.coveritlive.com/mobile.php/option=com_mobile/task=viewaltcast/altcast_code=5115c7f379" >Life and Death in Assisted Living Chat</a>

The Huffington Post reports that McDonald's could double its workers wages by raising the price of a Big Mac by 68 cents. It went large on the Internet on Tuesday. Unfortunately, what it originally claimed was a study by a University of Kansas researcher turns out to be something—a term paper, maybe?—given to Huffington Post by a KU undergrad. And...

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On Tuesday, the Massachusetts Institute of Technology released a report, produced by an internal "Review Panel," on the school's actions during the prosecution of Aaron Swartz, which ended in January when he committed suicide at 26. Swartz was facing a trial for allegedly using MIT's network to download reams of scholarly articles from the online resource JSTOR, a violation of...

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Competition for government contracts tends to drive down prices for taxpayers. But when bidding requirements are narrowly-crafted, as the New York Times showed in an insightful piece Monday, competition may be stifled and operating costs pushed up. The Times account concerned replacing presidential helicopters, all of them at least 30 years old, but the points it made can help reporters...

by Kara Brandeisky and Stephen Suen

Since Edward Snowden leaked documents detailing the NSA’s surveillance programs, the Director of National Intelligence acknowledged that part of his congressional testimony was “erroneous.” But that’s not the only questionable comment by administration officials.

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This story has been updated with a roundup of Emeritus employee responses. 

Emeritus Senior Living, the country’s largest assisted living company, has crafted detailed plans to respond to PBS Frontline and ProPublica’s investigation of the company and the assisted living industry.

Saying the report could lead to “the call for more stringent regulation,” the company emailed an eight-page strategy memo to the leaders of the nation’s major assisted living chains, asking them to put up a “united front.” Karen Lucas, the company’s vice president for communications, said Emeritus developed the media strategy in conjunction with trade groups and other assisted living firms.

“Everyone is working together to make sure we’re educating the public,” Lucas said.

Emeritus has also developed a response plan for the employees who run the company’s roughly 500 facilities, telling them to comment on Frontline’s website and Facebook page and on ProPublica’s Facebook page. The company also instructed workers to encourage residents in Emeritus facilities to post positive comments on Yelp, Caring.com, and Google “to offset the potential negative backlash created” by the investigation.

ProPublica and Frontline have obtained the strategy documents, which are posted here:

Email from Granger Cobb,
Re: Frontline Broadcast

See original document >>

Emeritus Strategy Memo: Frontline Industry Response Materials

See original document >>

Emeritus Response Plan
for Employees: Frontline Checklist for Eds

See original document >>

Email from President & CEO Granger Cobb:

Subject: Frontline Broadcast

From: Granger Cobb

Sent: Monday, July 15, 2013 3:35 PM

As many of you are aware, Frontline will be airing a story on the assisted living industry on July 30. The title of the program is “Life and Death in Assisted Living.” As the largest assisted living provider, Emeritus is going to be featured in the story; however, this is an attack on our entire senior living industry. We believe Frontline is using the isolated incidents in this story to promote stricter and more nationalized regulation for the industry and to suggest that for-profit corporations and caring for seniors are somehow incompatible.

In the hopes that we present a united front, I have attached materials that include key industry messages developed with input from experts at ALFA and ASHA as well as our own team. To ensure the public remains confident about residing in or having their loved ones reside in assisted living, it is critical that we present a consistent message.

Please take a moment to read the attached, modify as you see fit, and share with your teams as appropriate. We are trying to balance the need to prepare staff, without drawing more attention to the story than it might otherwise garner on its own. As an industry, we care for one of the most fragile populations in society. We need to get our message across – that assisted living fills a consumer driven niche by creating a place where seniors can retain their independence, dignity, and quality of life, while having access to care and assistance as needed. We know that residents in assisted living communities have a satisfaction rate of greater than 90 percent. This is the message we need to be telling – that, as an industry, we care for more than 1 million seniors, providing them with the resources to lead purposeful, fulfilling lives and that we accomplish this with a very high degree of customer satisfaction.

I have received messages of support from many of you regarding this story, for which I am deeply appreciative. I am convinced that if we stand together, we can successfully counter the picture Frontline is trying to portray of our industry and tell the wonderful stories of compassion and nurturing our residents experience every single day.

If you have any questions or concerns about the Frontline story, I encourage you to contact me. Thanks for your support.

Granger

Granger Cobb– President & CEO

Emeritus Senior Living | 3131 Elliott Avenue, Suite 500 | Seattle, WA 98121

(206) 298-2909 | Fax: (206) 204-1547 | gcobb@emeritus.com | www.emeritus.com

Our Family is Committed to Yours.®

Emeritus Strategy Memo:

Frontline – Assisted Living Response Materials

What we know

The Frontline Documentary that will be examining the assisted living industry will air on Tuesday, July 30 on PBS. In an average week, more than 4.6 million people watch Frontline.  Among the 285 PBS stations airing FRONTLINE, there are 459 total weekly plays. Programs are often picked up by NPR and other mass media public radio and TV programs. FRONTLINE's audience tends to be affluent and well-educated. They are more likely to hold executive or professional employment positions than the general population.

For the last year, Frontline has been investigating a few unfortunate and tragic resident incidents that happened several years ago at four of our Emeritus communities, and by interviewing disgruntled former employees. They also sat in the courtroom during the trial in California that resulted in an adverse jury verdict.

Content predictions

Because of the direction of that research and additional information we’ve received from the reporters and producer, Emeritus and the Assisted Living industry as a whole will not be presented in a positive light.

Frontline is likely using these incidents to suggest tougher and more nationalized regulation for the entire industry.  We also believe their story will hit on these themes:  

• Ineffective regulation of Assisted Living at the state level
• Inadequate disclosure / visibility for the public
• Putting profits over people, as evidenced by:
  • Understaffing and insufficient training
  • Heavy focus on sales rather than quality
  • Inadequate investment in care in order to service debt, finance growth, and satisfy investors
  • Violating regulations by admitting residents improperly
  • Violating regulations by not transferring residents as required

Industry impact

We believe Emeritus will be heavily featured in this documentary; however, this broadcast could contribute to a loss of public confidence in (and the call for more stringent regulation of) the entire assisted living industry.

Response preparation

In preparation for any questions or concerns your communities may receive as a result of the story, the Emeritus Communications Team has prepared key messages related to these themes for you to customize and use in any media statements or talking points required for inquiries about the Frontline program. Our hope is that by communicating similar messages, the entire industry will put forth a united front by disseminating consistent information to all our constituents.

In addition, we’ve provided some tips and guidelines on handling media inquiries or responding to the story via online channels.

If you have any questions about the Frontline story or the Emeritus response plan, please don’t hesitate to contact Karen Lucas at 206-204-3038 or MaryBeth Dagg at 206-554-1908.

Handling Media Inquiries About the Broadcast

Please be aware that after this Frontline broadcast, your company and/or communities may get media inquiries to comment on the story or any of the issues being brought to light in the broadcast.  Make sure staff is prepared to handle these inquiries. 

As experts and leaders in the senior living industry, it is important that your voice be heard. Please consider responding to any media requests. 

In-Service Community Staff

At the community level, make sure staff, especially anyone who answers the phone, is in-serviced on your media protocols.  Here are some procedural tips for handling calls that may be useful to them:

1.  If the media calls, indicate that the Executive Director is with a resident and that they will get back to them before the reporter’s deadline or as soon as possible.

2.  Obtain the following information while they have the media on the phone:

• Reporter’s name
• Affiliation
• Phone number and email address
• Deadline (very important)
• Any questions he/she needs answered

Write down the questions and tell them that the appropriate person will get back to them before their deadline.

Media Response Do’s and Don’ts

To help you for a media interview or response, whether it’s on paper, via phone or in front of a camera, here are some do’s and don’ts to keep in mind.

Media Response Do’s

1. Do prepare and approach your response/interview from the public’s viewpoint.
2. Do prepare three to four key talking points and continue to hit those points throughout your response/interview.
3. Do assume every word you say will be quoted.
4. Do keep to the facts and keep answers short and to the point.
5. Do be confident.  You are the expert.
6. Do make your delivery conversational. Be comfortable and be yourself!
7. Do provide examples, or make comparisons to make your point, when relevant.
8. Do cite sources when necessary.
9. Do be honest.  If you don’t know an answer say, “I don’t know that answer.  We will get back to you on that.”
10. Do ask them questions, for clarity or to confirm they’ve explored all the angles.
11. Do express concern to show you care, but don’t be emotional.
12.  Do watch your local news to see examples of how other companies/people handle media responses.  See what works/what doesn’t.

Media Interview Don’ts (with tips)

1. Don’t ever say "no comment." This is your chance to tell your side of the story. If you haven't had a chance to review the story or issue. Say "I'd very much like to comment on this as soon as I've seen the story/gathered more information. You can also ask a reporter if you can follow up with an answer before a certain day/time. In most cases, there is always something you can say about an issue, even if it’s just encouraging the reporter to take a broader look at the topic or see it from a different angle.
2. Don’t conduct an impromptu interview if a reporter contacts you directly.  Before submitting a statement or participate in an interview, prepare thoroughly with written talking points and a practice Q&A session with a colleague. Again, set yourself up with three to four key points you’d like to communicate during the interview.
3. Don’t ever trust that anything you say or write to a reporter is “off the record.” Everything you communicate to a reporter can be quoted, even if they assure you they won’t use it.
4. Don’t ever argue with a reporter. The media is looking for relevant sources and compelling interviews to add value to their stories. Building positive relationships during a difficult interview may make them consider coming back for a more positive story.
5. Don’t talk too much and go off on tangents. Try speaking in soundbites and, when appropriate, make comments that are two to three sentences long.
6. Don’t answer mechanically. Be loose and conversational.
7. Don’t speculate or exaggerate. Stick to the facts, or you might have to back up your statements at a later date.  Be comfortable saying, “I don’t know,” or “I can’t speculate on that.”
8. Don’t disparage your competition. This will say more about your own ethics and practices than it will about the other company. If a question comes up about your competition, let a reporter know you can’t speak for other businesses, then transition back to your message.
9. Don’t feel like you have to answer every question. With practice, skilled interviewees can respond to a question by bridging the answer back to one of their three key points they’ve identified earlier.  If nothing else, it’s fine to say, “I’d be happy to answer that after all the facts are in/after our day in court/after we receive a judgment on that/once we’ve had a chance to review all the research/once we complete our internal investigation, etc.
10. Don’t miss the loaded question. Skilled reporters have a knack for delivering leading and loaded questions.  Keep an ear out for questions that include incorrect assumptions about the topic or your business.  Also, beware the reporter who slips in a hard ball after delivering several easy pitches.  Keep aware, don’t be caught off guard, and ask them to rephrase the question for clarity, if needed.  Correct them if they make incorrect allegations as part of their question.

Set the Story Straight on Social Media Posts

We want to encourage Industry leadership to post a comment if you feel like you can add value or clarification to the story. We’ve included posting guidelines below if you would like to express your opinions on the coverage.

The story will be posted on the Frontline website at www.frontline.org.  Additionally, on the Frontline Facebook page, they will post a “So, what did you think?” question for people to comment about the story: http://www.facebook.com/frontline?fref=ts. The story link will also be on the ProPublica Facebook page at http://www.facebook.com/propublica?fref=ts.

Posting Guidelines

1. In posting, it is appropriate to state what company you work for in what capacity, although it is not necessary to give your name.
2. Be extremely professional, courteous and articulate. 
3. The best response is not defensiveness, but by explaining a specific personal story the benefits of assisted living to seniors and families. Expressing disappointment in the coverage is acceptable.
4. Demonstrate that you have intensive experience working with this very fragile population, and explain some of the challenges if you feel appropriate to what you wish to say.
5. Other posters’ comments may be hostile and accusatory, but please do not respond with anger or insults. Keep it professional.
6. Only post once. If your comment is disputed or criticized, just let it go. 
7. Thank you to all of you who are willing to share your knowledge with the public through these venues on such an important issue.

KEY INDUSTRY MESSAGES

Who Benefits from Assisted Living (AL)

Seniors

During much of the 20th century, seniors who were no longer able to live independently could arrange for care to be delivered in their home or they could be admitted into a nursing home. The first choice could be expensive (or a burden on family member caregivers) and fraught with the risks associated with a lack of training and oversight.  The second choice generally resulted in a loss of independence, dignity, privacy, and a diminished quality of life. In institutional settings like the traditional nursing home, the senior’s life was subordinated to the rules and schedule of the institution. The assisted living movement changed that.

Assisted Living meets the needs of seniors who:

• Are unable to, or choose not to, live at home, yet do not need 24/7 skilled nursing care. 
• Live alone without adequate assistance available to them to eat healthfully, manage medications, perform their activities of daily living, manage safety issues, or stay socially active.
• Want to live independently in their own apartment while having the peace of mind of knowing care is available should the need arise.

Caregivers/Spouses/Adult Children

There are 20 million working, unpaid caregivers in the U.S.  Forty percent of family caregivers have symptoms of depression according to an Assessment of Family Caregiver report.  Assisted living meets the needs of caregivers who:

• Need peace of mind that their loved one’s safety, health and emotional needs are being met while they work or attend to their own children.
• Are seeking more quality time with their loved one rather than only spending time providing the daily tasks of caring for their loved one.

Staffing and Training

• Assisted living communities have staff available 24/7 to provide assistance, care, activities and social engagement for residents.
• Assisted living communities are staffed based on the level of care and service needed by the residents. 
• Residents are evaluated upon move-in to determine the amount and type of personal care they need as well as how they typically enjoy spending their day. 
• The caregiver-to-resident ratio can vary by community, by resident acuity and/or by state regulations. Each community plans their staffing according to state regulations and the specific needs of their residents to ensure that the need of each resident is met. For example, if a 40-apartment AL community serves a very independent group of seniors, there would be fewer caregivers than a community with 40 residents in need of greater assistance. 
• When planning appropriate staffing, the number of staff on each shift is one consideration; but it is just as important to have staff with the right skills, training and experience.
• Our staffing levels are in compliance with state regulations and in some cases exceed those regulations depending on the level of care required by residents at each individual community.
• Our community leadership has the authority to increase staffing levels at any time to meet the needs of residents.
• Turnover varies across assisted living. Communities pay competitive wages, seek people who want to work with seniors, and offer substantial training; however, caring for seniors is difficult work. 

Business & Investments

• Assisted Living is a consumer-driven resource available to seniors and their families. It is a highly competitive industry with a variety of options available; therefore, senior living communities have every motivation to provide residents with quality care, services and experiences in order to retain them as customers.
• Residents sign a residency agreement prior to moving in to a senior living community. This agreement is similar to an apartment rental agreement and generally renews annually.
• Residents and family members who are not completely satisfied can choose to move to another community – usually with only 30 days’ notice. 
• Assisted living operators understand that the key to financial success lies in delivering a very positive customer experience.  If a community does a good job of providing care and service with a high degree of customer satisfaction, they will enjoy high occupancy and be able to charge a fair rate. The financial investors and lenders believe the senior living sector will continue to grow in order to meet increasing demand as the senior demographic expands and the consumer becomes better educated as to senior living options.

Safety Issues

• Assisted Living providers care for one of the most fragile populations in society – and it is a profession fraught with numerous daily risks.Professionally managed AL providers understand and manage those risks 24/7.
• Professionally managed AL communities work to maximize safety and minimize the chance of human error.
• Yet, even when every reasonable precaution has been employed and policies and safety codes have been strictly followed, accidents will sometimes occur.
• AL communities have systems in place to help reduce the chance of falls and injury that may result due to falls.  And, if a fall does occur, staff is available 24/7 who can respond to assist the resident. 
• Accidents and misconduct issues in AL communities are reported by staff to supervisors, who then notify the proper authorities. There are multiple ways to report issues both to company authorities and to state and federal authorities.
• Following an accident, there is an internal investigation, the incident is reported to the state, and steps are taken to minimize the possibility of a similar occurrence. 
• Balancing a resident’s safety with their right to independence and choice can be challenging. Assisted living communities offer a higher level of support and safety, while preserving the quality of life that comes from a residential environment with private apartments. 
• Like all Assisted Living communities, we have a zero tolerance policy on abuse. Neglect and abuse is not tolerated in any of its forms – physical, emotional or financial – and is dealt with swiftly and aggressively.
• Complaints are taken seriously by Assisted Living communities. Every provider has a complaint resolution process.  In addition to the providers, each state has a complaint system in place.  Additionally, most states require assisted living communities to make their state inspection reports available to consumers for review.  

Family Education Re: Safety Issues

• Family education and awareness as to what is provided in an AL environment as well as the limitations of an AL environment is essential. The AL environment cannot eliminate risks; however, it seeks to minimize risks, while maximizing quality of life.  This balance should be made clear to residents and families prior to move-in.
• Families need to understand that AL communities don’t provide one-on-one care and are not a full-security lock-down environment.
• Families should understand how a community employs fall management systems and take recommendations for ambulation assistance equipment seriously. They should also know that even with comprehensive fall management systems in place, 100% fall prevention is extremely difficult to achieve in any environment.
Alternative Care Options
• Before the assisted living sector existed, the only option seniors had were boarding homes with limited or no supportive services or nursing homes at twice the cost of assisted living and with a much more institutional environment.
• For millions of Americans, nursing homes are still the only option due to rules in many instances requiring seniors to go to nursing homes if they are receiving Medicaid.  For others, nursing homes are often the only place seniors can go for short-term rehabilitation due to Medicare reimbursement requirements.
• Professionally managed AL communities are not in competition with these other options, but we are a newer and growing alternative for those seniors who cannot or do not wish to live alone any longer. 

Regulatory Issues

• Assisted Living communities are licensed and regulated in each of the 50 states.
• We think state regulations are important; for example, we welcome state inspections to give us a report card on how we are doing.  It’s important for us to get this feedback from a third party so we can continue to improve and address any problems that arise.
• State regulatory agencies have been evolving to keep up with the increasing popularity of assisted living as a preferred choice for senior living, and the economic realities of these options. 
• Unless state regulation determines otherwise, residents of assisted living communities can generally stay if the resident, the resident’s family, the resident’s physician, and the community all agree assisted living is the best option for the senior. 
• Regular unannounced inspections are performed by state regulators to ensure communities are in compliance with state requirements and standards. 
• Professionally managed AL communities regularly perform internal inspections and not only meet, but most often exceed, the standards set by the state.  
• Policymakers are working to improve regulations from state to state.  When one state improves or changes regulations, other states learn from these experiences and make improvements in their own states.
• Each state has a resident bill of rights that is enforced and AL communities must preserve these rights while providing daily care and service for the resident.

Proposed Federal Regulation

• From time to time, federal regulation of AL communities is proposed as a way to fix the problems of the industry. Federal regulation, if imposed, would increase costs for consumers without increasing quality of care. 
• We believe the states are in a better position to determine what their respective citizens want and to be responsive to that. The Federal government would have to take a one-size-fits-all approach that would limit choice and increase costs to the consumer. We do see the federal government playing a role in promoting and celebrating the fact there are market-based options for seniors and their families to turn to offering quality care and advancing quality of life.
• Federal regulation of assisted living would stifle innovation and would not allow for the flexibility assisted living communities require to continually adapt to consumer preferences. 

Emeritus Response Plan for Employees:

Frontline Checklist for EDs

(All Emeritus Communities)

Managing this type of media exposure requires your full attention and commitment to all the action items below. Whether your community was mentioned in the story or not, your community can be impacted.

IMMEDIATELY AND ONGOING

• Solicit positive comments and reviews from your residents and families and have them post on Caring.com, Yelp, Google and other review sites to offset the potential negative backlash created by the Frontline story. Look for this button on E & Me for Online Review tools.
• If you have something positive going on in your community – a resident's 100th birthday, an Alzheimer's Association fundraiser, a community outreach program, or a free seminar for the public – send a press release to the local media using the release templates on E & Me. If you don't have something going on, plan something!
• Launch staff appreciation initiatives and recognize employees for their good work. Post compliments in public places or the staff break room.
• Anticipate extra attention and scrutiny from regulators and make every effort to ensure your communities are in full compliance.
• Be positive and keep your staff focused the great job they do every day.

WEEK OF MONDAY, JULY 22

• Hold an all-staff meeting to discuss broadcast and its impact- distribute the following:
  • FAQs for families and residents
• In-service staff on media protocols
  • Review FACT SHEET Crisis Communication and the Media
• Hold management staff meeting to discuss and distribute the following:
  • Media statement
  • Tips to respond online

WEDNESDAY, JULY 31

• Respond to resident/families inquiries using FAQ document
• Respond to story online at:
  • Frontline's website www.frontline.org
  • Frontline's Facebook page http://www.facebook.com/frontline?fref=ts
  • ProPublica Facebok page http://www.facebook.com/propublica?fref=ts
  • Emeritus Facebook page(only if someone posts a negative comment) http://www.facebook.com/pages/Emeritus-Senior-Living/82009373317?hc_location=stream
  • Online review sites where story is mentioned
• Launch professional referral outreach efforts, targeting top 20 referrals:
  • Start the conversation with:
    "There was a story about Emeritus on Frontline last night/week and I wanted a chance to talk with you about it." Then, use your FAQ to guide the conversation.
  • Use the same FAQ provided for families and residents.
  • Bring them a meaningful leave-behind that is personalized for your unique community - i.e., something made by the residents or the chef's special snack/dessert.
  • Share specific success stories of the residents they have referred

 

Frontline
Q & A for Emeritus Communities
July 31, 2013

I heard Emeritus was part of a big media expose on the assisted living industry. What happened?

• Yes, Emeritus was featured on a recent Frontline program on the assisted living industry.
• It included accounts of some isolated and unfortunate incidents that occurred at other Emeritus communities many years ago.
• They were the rare exception to our company's outstanding record of serving hundreds of thousands of seniors over the last two decades.
• We were very disappointed by the broadcast, which did nothing to represent the dedication and commitment of Emeritus caregivers.

Can you tell me the details of these incidents?

• The story featured two tragic accidents that happened 4-5 years ago, and two families who were dissatisfied with the care we provided.
• I am not familiar with the details and so can't tell you any more than that.

What has the company done to fix the problems?

• Emeritus works hard to ensure that there are safeguards, systems, and policies and procedures in place to prevent these types of incidents.
• From time to time, a breakdown in these systems has resulted in an accident or care that doesn't live up to our high standard.
• Our communities work tirelessly to prevent foreseeable risks at our communities. When we fall short, we hold ourselves accountable and we fix the problems.
• Despite the picture Frontline has tried to portray, Emeritus continues to stand firmly behind, and believe strongly in, its employees and the quality of care they provide.

Emeritus has to pay millions in damages as a result of the California trial. Does this mean resident rates are going to go up?

• Absolutely not. Resident rates will not be tied to the damages.

How can I be confident something like this won't happen to my loved one?

• I hope you have seen how passionately we feel about providing outstanding care to your loved one and that you can tell that our residents are like family to us.
• We have extremely strict policies that are designed to ensure quality care, prevent risks and minimize error as much as possible.
• We also have very robust customer service systems in place to ensure that the residents' and families' needs are being met.
• Every year, we receive thousands of letters, e-mails and comments that credit us with improving and transforming lives for both our residents and their families.
• In addition to our annual inspection surveys, these letters are just one of the many testaments to our commitrnent to quality care and safety.
• Please know that the staff and leadership at this community are always available to you if you need to discuss any concerns or issues about the community or the staff.

 

ALL OTHER COMMUNITIES' MEDIA STATEMENT

Contact: ED Name
Community phone #

MEDIA STATEMENT

Statement for the Media by (ED name, ED title, Community name)

We have seen the recent Frontline program on the assisted living industry which included accounts of some isolated and unfortunate incidents that occurred at other Emeritus communities a few years ago. They were the rare exception to our company's outstanding record of serving more than a half million seniors over nearly two decades.

Despite the picture Frontline has tried to portray, Emeritus communities work tirelessly to provide the highest level of care to all residents. We also work hard to prevent foreseeable risks at our communities. When we fall short, we hold ourselves accountable and we fix the problems.

Emeritus Senior Living receives literally thousands of letters and emails each year from residents and families commending the care they receive at our communities. In addition to our annual inspection surveys, these letters are just one of the many testaments to our commitment to quality care and safety. Emeritus continues to stand firmly behind, and believe strongly in, our 30,000 employees and the quality of care they provide to our residents at our more than 480 communities in 45 states.

Update, August 2, 5:49 p.m.: Several current and former Emeritus employees did, in fact, post responses to our story. And we saw a spike in comments on July 31, when Emeritus sent a motivational email about responses to employees. Several had positive things to say about Emeritus, and some asserted that our investigation's findings were true. To make things easy, we rounded up their responses below.

[View the story "Emeritus Employee Reactions" on Storify]