How California’s Assisted Living System Falls Short in Addressing Residents’ Health Care Needs

By | Alerts, ASSISTED LIVING, ISSUE BRIEF, Long Term Care, Nursing Homes


The Problem: Can You Spot the Legal Violations in this Job Announcement?

California’s assisted living policy is surprisingly behind-the-times. 30 years ago, the assisted living system was created in California for residents without significant health needs. Today, assisted living residents are much sicker than they used to be, but there’s no solid quality of care standards for the facilities to follow to meet this need within the law. This leaves facilities in the precarious position of trying to meet residents’ health care needs, like for medication administration, sometimes by finagling their own solution like hiring a “med tech” or “med aide” –terms not defined in California law and without state education and testing standards.

Read the full issue brief here, including a quick quiz on the surprising legal violations found in many assisted living job announcements.

How California’s Assisted Living System Falls Short in Addressing Resident’s Health Care Needs

By | ASSISTED LIVING, CA Health Network Alert, ISSUE BRIEF, Long Term Care


The Problem: A False Choice Between Community Living and Access to Health Related Services

“The false choice between the social model and health care expertise contradicts the goal of aging in place: to age with choice and independence, along with access to needed services.”

This policy issue brief, by Justice in Aging attorneys Eric Carlson and Fay Gordon, is the second in a series exploring how California’s current assisted living system addresses residents’ health care needs, and how the system could be modified to better serve residents. The first, Pretending that Medication is Always Self-Administered, focused on how some residents need their medication given to them, but, since the workers are not supposed to be administering medication, they must pretend that the medication was self-administered, a state of affairs that doesn’t serve workers or residents.

This latest brief highlights residents’ expectations for health and social services, and recommends that California reject the false choice between community living and access to health-related services by incorporating appropriate health care expertise into the assisted living model.

How California’s Assisted Living System Falls Short in Addressing Residents’ Health Care Needs



Across the country, assisted living facilities now provide services for residents with significant care needs, a noticeable change from 30 years ago when California adopted its quality standards. California developed its regulations on the premise that facilities do not provide, and residents do not need, health care services.

Decades later, this premise has perpetuated an odd work-around for administering medication: “assistance with self-administration.” The fiction of universal self-administration highlights an underlying disconnect within California’s assisted living regulatory system: the failure to adequately acknowledge resident’s health care needs.

This policy issue brief, a first in a series, explores the need to legitimate and regulate the practice of medication administration to protect residents, assisted living communities, and staff.

WEBINAR: Assisted Living Reform: Policies and Politics

Free Webinar
Assisted Living Reform: Policies and Politics
When: Monday, December 15, 2014 3 – 4 PM EDT

There’s a growing agreement around the need for assisted living reform. While health policy experts, caregivers, consumers, and their families recognize reform is overdue, political hurdles can get in the way of change. Speaker Larry Polivka, Ph.D, a prominent expert in aging and long-term care, will speak from personal experience on the need for assisted living reforms, and the hurdles that confront any reform effort.
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WEBINAR: The Changing Landscape of Assisted Living – Developments in the States


Free Webinar

When: Thursday, July 31, 2014 2:00 – 3:00 PM EDT

How good is assisted living? To a great extent, it depends on what state you’re in, as assisted living standards are dependent upon state law. This presentation included the results of a 12-state study on assisted living laws.

Also, hear from advocates engaged in state efforts to improve assisted living through the legislative process – California, where the RCFE Reform Act of 2014 is moving through the state legislature; and Connecticut, which has revamped its assisted living regulations to improve resident health and safety. The presentation also will announce a new California-focused reform project.

Eric Carlson, Directing Attorney, National Senior Citizens Law Center; President, Assisted Living Consumer Alliance
Tony Chicotel, Staff Attorney, California Advocates for Nursing Home Reform
Nancy Shaffer, Connecticut State LTC Ombudsman


Video Recording

Medicaid Payment for Assisted Living


The federal government should take a more active role in oversight of assisted living facilities in light of current common practice that allows facilities to kick out or refuse to admit Medicaid-eligible residents even though the facilities themselves are approved to participate in Medicaid.  In the absence of consistent federal oversight, states have developed widely varying rules that do not protect consumers adequately.

NSCLC explores this and other issues and makes recommendations for change in a series of policy issue briefs and white papers developed with support from the Commonwealth Fund. To access the series and listen to a Webinar on the topic, click here.