2Sisters’ Response to Frontline’s Expose on Assisted Living

The recent “Frontline” Story on PBS has drawn national attention to Assisted Living, exposing a couple of terrible and tragic situations in a few communities while seeming to serve an indictment of an entire industry.

Because our business is all about helping families navigate the maze of options in senior living, and because we have literally served hundreds of seniors IN these residential settings, this blanket indictment cuts us to the core. We feel compelled to respond to and clarify the comments both made and implied in this television expose.


#1. Not all Assisted Living companies or communities are the same or even pretend to offer the same types of services. Even within an assisted living company, not all their facilities are managed equally. While it’s true the majority of assisted living facilities are not designed to manage the care of seniors with very high care needs, the majority do not promise or even attempt to.

#2. No one will deny there are instances of people being improperly cared for in an assisted living setting. .

What “Frontline” did not offer was equal time: one successful story from even one of the thousands of residents who currently thrive in assisted living communities across this country. The segment also did not make mention that tragedies like these occur in nursing homes (and even within at-home health agencies) with as much frequency.

#3. The cost of Assisted Living is very high, and many costs are often hidden. It is true, assisted living can be expensive, but the range of communities and their associated cost structures as well as funding sources continue to broaden every day. But even these pale in comparison to the cost of paying privately in a skilled nursing setting, which again, does not guarantee there will be no abuse or neglect, even with increased government regulation.

#4. Assisted Living; what does it really mean? The biggest misconception most people have about Assisted Living is what “assisted” really means. The assisted living “model” is NOT a medical model, but a residential model. It does not have the same government and regulatory obligations that nursing homes (medical model) have, when it comes to managing a person’s daily care needs.

This “Frontline” story focused entirely on residents with dementia; a much more complex medical condition that by its nature requires intricate, ongoing, specialized training and support of staff, administration and caregivers.

When considering an Assisted Living community with memory support, there is an entirely different set of questions that need to be asked; starting with the capabilities of the facility to support residents with dementia, to the ongoing training and support of the caregivers, and the exacting measures taken to keep residents safe and secure. These issues go far beyond, as the piece points out, chandeliers and cookies, but to the heart of whether or not the community and its culture are skilled and committed to caring for people with debilitating memory impairment 24/7/365.

#5 Fix the problem, don’t blame the entire industry. As in all residential settings, whether it’s an Independent or Continuing Care Community, Assisted Living, or Rest Home, for or even a not-for-profit, the issue is not whether problems will occur, but how quickly and effectively those problems are managed when they do.

Most Assisted Living Communities have active Resident Councils, ongoing meetings and channels for feedback on everything from activities and programs to mission statements. These administrators, managers, staff, and caregivers seek input, good and bad, as a way of insuring that what they say they do, they do, and what they promise, they execute.  Transparency is everything.

A properly run Assisted Living community can and will increase a senior’s level of independence and overall quality of life. We have seen first-hand how seniors thrive in these settings; emerge from lives spent alone at home, make new life  friends, learn new skills, try ventures they never dared to, and develop a sense of well-being and happiness that surprise, delight, and awe their families. We know this community, residential model works for many seniors and families.

The “FRONTLINE” Takeaway

 For us, the biggest takeaway from this “Frontline” expose is the importance of knowing what to ask when considering an Assisted Living community. According to those posted by aging expert Jason Bralow immediately following the “Frontline” expose, these are 7 basic questions to consider:

  • What are your needs?  What level of care do you need now and in the future?
  • Have you visited the facility?
  • Is the facility profit or nonprofit? And what are the implications of this type of ownership on the management of the facility?
  • What are the true costs involved in signing up for the facility?
  • What’s the admissions agreement?
  • Where is the facility?
  • What does the Ombudsman say?



While those questions are all good, at 2Sisters Senior Living Advisors we start here as we help our clients begin to think three dimensionally when it comes to considering Assisted Living; looking carefully at all the individual pieces, but never losing sight of how they all contribute to making up the whole.

When we tour communities with clients, we coach them on how to visit with all their senses on high alert; to pay attention to things around them with their eyes, ears, noses and sensibilities keenly tuned in to more than what the tour guide is telling them. They become sharply aware of how residents are being spoken to, as well as get a heightened feel for what’s actually going on.

Another dimension we provide our clients is liaising to our circle of trusted resources. We understand this is more than just moving from one place to another, and there are a lot of critical pieces to consider. We have a deep network of professional partners we bring into the conversation; from financial planners and clinical social workers, to move managers who are downsizing experts with empathy, and skilled elder law attorneys. We steer clients to the experts in their fields.

We encourage and coach for the use of behavioral interviewing questions to determine what protocols are used to handle certain situations, like frequent falls or if a resident goes missing, for example. We also inform our clients they have the right to view any facility’s most recent state health survey and although they cannot have a copy to take with them they can view it at the facility.

For example, we encourage our clients to understand the staffing ratios at each facility under consideration, the type and extent of staff training required as well as their compliance with that requirement.

Lastly, it is important to re-state, again, that assisted living facilities are social models of care, not medical. Assisted living facilities do not pretend to assume full responsibility for health and safety of their residents. Families or other responsible parties must continue to be a part of the care team and advocate for that resident throughout their stay in an assisted living facility but that should hold true in any care setting.

Alyson Tobin Powers and Michelle Tobin Woodbrey founded 2Sisters Senior Living Advisors in 2010. They spent their childhoods growing up in their father’s nursing home, where their earliest memories are having octogenarians as best friends. Their careers have been spent serving in every position from care givers, to activities directors and executive management in assisted living communities on both coasts.  Today, their free advisory service helps families and seniors navigate the maze of options in assisted living and memory care communities, independent and continuing care, nursing homes and at home care providers. They serve clients throughout Metro Boston through Cape Cod.

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