Lack of appropriate food at assisted living facilities an example of broad concerns, WA ombuds says
Citations for issues in assisted living facilities throughout Washington highlight what state officials say are broader concerns about care for aging adults.
Patricia Hunter, the Washington State Long-Term Care Ombuds, told McClatchy in an interview that trends inspectors are seeing in assisted-living centers — which provide room and board and help with activities of daily living as well as limited nursing services — are concerning.
“I think these are questions and standards that we should be asking ourselves throughout the nation and throughout the state: What do we need to change in order to make sure that the bottom floor is raised?” Hunter said.
Data provided by the Washington State Department of Health and Social Services showed that between Jan. 1, 2021 and Dec. 6, 2023 there were more than 5,000 citations issued at assisted living facilities in the state for various violations in regards to medication services, infection control and negotiated service agreements.
Citations regarding the monitoring of patients’ well-being were on the top 10 list of citations provided by the department.
One example
Green Lake Senior Living Ocean Shores offers several options for living arrangements including independent living, assisted living and memory care, according to their website. It is operated by Greenlake Management, which owns and operates multiple facilities throughout the state, including in the Tri-Cities area, Gig Harbor and Renton, according to the Washington Department of Revenue website.
The facility was recently cited for multiple food concerns and other issues.
Public records obtained by McClatchy showed that this is not the first time in recent years that the facility has been cited for similar issues. In 2022, the facility was cited for multiple food concerns as well as for failing to “ensure staff members followed the infection control practice standards to prevent the spread of infection.”
Hunter said that her concern about the most recent citations at the site has to do with “the quality of care and quality of food in terms of nutrition and the facility’s ability to meet the basic standards.” She said that what really jumped out from the report was the lack of diabetic diets available for residents.
The summary report issued by DSHS from an investigation in July and August showed that “based on observation, interview, and record review, the facility failed to provide a lack of alternative options to diabetic residents.”
Other food issues cited in that investigation include menus not being approved by dieticians for certain residents, lack of alternative food options, and cross contamination in the cooking process.
The Ocean Shores site was also cited for similar food issues in February, according to the investigation summary report.
Hunter said that in long-term care, food is like “medicine.”
“Many of these people have serious chronic illnesses and they need good nutrition,” she said. “If they’re diabetic, they need to have a diet that is going to impact their health, impact how they feel, and impact things like heart health.”
Food is also a social activity, she said, but some residents at the facility instead cook alone in their rooms because of the poor food quality in the dining room. Some residents were even making trips to a local food bank because of a lack of fresh fruits and vegetables and other foods. Others purchased food from the grocery store while still paying for food served at the facility.
“And that to me is not right, that is a wrong thing,” Hunter said.
Other issues were cited as well.
Documents show that Ocean Shores was fined $300 by DSHS for failure to “ensure safe medication systems were implemented for one resident.”
“This failure placed the resident at risk for harm due to medication being administered without a physician order to address their health conditions,” the document noted.
The document added that was a recurring deficiency also cited in late 2022 and early 2023.
The facility was also cited for failure to report a positive COVID-19 case, failure to have an adequate amount of personal protective equipment, and failure to practice “handwashing and removal of PPE with contamination.”
Additionally, a claim of bullying by one resident against another resident was substantiated in the report.
McClatchy attempted to contact the Ocean Shores Assisted Living facility multiple times to learn what measures are being taken to fix its issues and prevent future citations, but the spokesperson for the facility did not return phone calls.
Citations and enforcement
Rebecca Kane is the regional administrator for residential care services under the branch of DSHS that oversees the regulation and licensing for assisted living facilities, nursing homes, and adult family homes.
Kane told McClatchy in an interview that assisted living facilities get “licensing visits” every 12 to 18 months. During those visits, investigators, who are almost always nurses, check for quality of care and whether or not basic needs are being met. In between visits, DSHS can investigate complaints as well.
When there are concerns that a facility isn’t meeting requirements and there is enough evidence, DSHS can issue a statement of deficiencies, Kane said. Facilities are then given a time frame to fix the issues and must submit a plan for doing so.
Kane said the goal is to get investigators to check back on those issues promptly after that time is up, and if the problems haven’t been fixed, or additional issues have cropped up, the facilities can receive additional citations. DSHS can also levy fines, or have facilities hire outside consultants to help them fix their issues.
DSHS notifies the Office of Financial Recovery, which then makes sure fines are paid.
Enforcement also can go as far as putting in a “stop placement” order, meaning the facility can no longer admit new residents until issues are addressed. If issues are severe enough, licenses can be revoked. Revocation is rare and extreme, but sometimes necessary, Kane said.
“We do try to allow them to have a chance to fix these things because we need places for our vulnerable adults to live,” Kane said. “We’re trying to get them to stay in compliance with those minimum standards so that the residents are cared for adequately.”
According to the data provided by DSHS to McClatchy, 300 civil fines were imposed on assisted living facilities in Washington between Jan. 1, 2021, and Dec. 6, 2023.
Additionally, 23 stop placement actions were imposed during that time period, and the state revoked the license of one facility in Washington.
A spokesperson for DSHS told McClatchy in an email that while they don’t want to speculate on one common denominator behind citations and enforcement actions at assisted living facilities, the agency is “committed to working with facilities to remedy any area where they may not meet the minimum licensing requirements and following up to ensure they remain in compliance.”
Hunter said that private-pay residents are charged a base rate at assisted living facilities and they can pay for additional amenities or services.
Medicaid will pay, depending on the assessment and care plan of the resident, she said. It will pay for care, care-related services and some supplies. The resident pays a fee for the room and board that depends on the resident’s income.
For example, if someone receives $3,000 a month in Social Security benefits, they would pay “at most” $2,900 a month for their room, Hunter said.
Legislature considers action
The 2024 legislature has before it SB 5640, which would establish an independent living residents’ rights work group.
Sponsored by Sen. Sam Hunt, D-Olympia, this bill passed unanimously off the Senate floor last Wednesday. The legislation would create the Independent Living Residents’ Work Group to study and make future recommendations to the Legislature for a Bill of Rights for those who reside in assisted living facilities.
The bill was introduced during the 2023 session but did not make it to the debate floor.
