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PBS Ombudsman

'If Your Mother Says She Loves You, Check It Out'

The headline above is an old journalistic cliché warning reporters that things are not always as they seem. As applied to a new investigative documentary, produced by Frontline in partnership with ProPublica, and titled "Life and Death in Assisted Living," that line might be re-written to say: "If the director of an assisted living facility says he or she loves your mother or grandmother, check it out."

The program also brings another journalistic cliché to my mind. It's the one that says, essentially, that the fact that thousands of airliners land safely every day is not a story. The one that doesn't is the story. So the program does not attempt to focus on assisted-living facilities (ALFs), generally, but rather on the largest operator in the country, Emeritus Senior Living, a for-profit company which has "the ability to house some 37,000 elderly Americans in more than 400 facilities," according to Frontline.

The program is well-worth watching. Like many of Frontline's offerings, it hits nerves, deals with touchy issues that touch on the lives of millions of Americans, and provokes both thought and controversy. To his credit, the top executive at Emeritus, CEO Granger Cobb, goes on camera to respond to questions from the Frontline/ProPublica correspondent, A.C. Thompson.

The program has attracted a fair amount of attention.

An online review at the AARP site calls it "essential TV viewing." A review in the New York Times addressing the broad field of assisted-living care and not any one facility in particular, says of the program that "critics have pointed out that unlike federally regulated nursing homes, assisted living is governed by a hodgepodge of state laws; some provide decent oversight, while others remain quite lax." So the program, the review says, "doesn't really break new ground . . . but it's important nonetheless" because some of "these reassuring-looking residences" are not what they seem and that viewers "learn from this documentary how vigilant they need to be."

The online edition of the business journal Forbes published two pieces on the program, one urging readers not to miss it and the other offering lessons that can be learned from it. And an article posted on the Senior Housing News site lays out both sides of the arguments surrounding this issue with details on how the industry is responding to and firing back at the Frontline/ProPublica partnership.

In the aftermath of the broadcast, Emeritus posted a lengthy rebuttal to points raised on the air.

One important, educational aspect of this program is that it makes clear the many big and crucial differences between assisted-living facilities and nursing homes, something that is not always clear to people who are faced with often gut-wrenching and financially-draining decisions about elderly family members in need of more care than they can get at home. And it also drives home the point that families must intensely investigate where they are considering placing a family member and what kind of care they can expect for very large sums of money.

This program is sure to anger lots of people. Some will be stirred by what the Frontline/ProPublica spotlight on Emeritus reveals. Others, such as workers in ALFs and family members that have had good experiences in lots of different places, may be upset by what they view as a focus on one company that had some problems to discredit what is actually a huge industry with some 750,000 people living in ALFs around the country, a number with no place else to go but up.

A Cautioning Tale With a Few Gaps

In my view, the Frontline/ProPublica collaborators did the right thing — focus on what its reporting indicated was the metaphorical airliner crash that illustrates what can be a broader problem for many people. And Emeritus is doing the right thing by putting its rebuttals out there.

In a press release prior to the July 30 broadcast, Frontline/ProPublica reporter Thompson, who is also co-producer of the program, said this: "There are, of course, skilled and dedicated individual caregivers working in the assisted living industry — professionals who are absolutely committed to providing our parents and grandparents with the best possible care."

But there is actually none of this sentiment in the hour-long investigative report. I thought that was a mistake. Thompson then goes on to say: "But Emeritus' history — its explosive growth, its move to take in more and more residents with greater and greater health problems, its desire to reward investors — makes for a perfect study of what's taking place in this rapidly expanding corner of the country's health care business." And that is, indeed, what makes the program so important and powerful, in my opinion as a viewer.

The program captures quite well, it seemed to me, the human and business aspects. Elderly patients with declining mental capabilities need special attention. Bad things can, and sometimes do, happen. Thompson reports with depth and persistence in a half-dozen states, gathering documents along the way. The cases with the worst endings are laid out here.

On a personal level, one other thing struck me as I watched that I felt was not dealt with or followed-up adequately. It involved the intense, complex and possibly conflicting emotions of families interviewed on the program who began to understand that their relatives were failing and probably not getting the care they thought would be forthcoming but who did nothing to remove them from the facility.

Later, reading the commentary in Forbes by contributing writer Howard Gleckman, he made a similar point. "Watching the Frontline program, I was struck by the number of adult children who were concerned about the quality of their parent's care well before their tragic deaths. But every time the family members rationalized these fears and did nothing."

Viewer Reactions

There is a lively debate among viewers about this program on the Frontline website. Unfortunately, as I reported in a posting on Wed., July 31, a technical glitch here at PBS late last month resulted in about 10 days of lost feedback from viewers writing to me using the "Submit Your Comments" box on the right-hand side of the ombudsman's page. That outage covered the debut of the Frontline/ProPublica report, so it's likely that many comments about the program were among those lost.

We received a small number of critical emails before the program aired, based on initial previews, two of which are printed below, but only one after our technical problems were resolved.

Here Are the Letters

I watched the Frontline "expose" of assisted living facilities and found it extremely puerile. Short of keeping residents tied down or drugged (or both), which is how nursing homes deal with dementia, there is no way to avoid accidents. Some patients need virtual one-on-one care; families won't provide it, no one should have to pay for it. This is a tough issue that needs to be discussed maturely.

Vienna, VA

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I find it to be very disruptive and irresponsible to present a program that denotes an entire industry in a negative light based on the isolated incidents your reporter used to promote the degradation of the Assisted Living communities and their staff. You will use disgruntled employees and only one company to present an implied state of the industry. You will impact the lives of many residents, families, and employees in a negative manner with a one-sided and narrow minded approach to journalism. I work in a beautiful and respectful ALF and my mother- in-law resides in an ALF community. How dare you use the vindictive nature of a few people to create concern and unease within the lives of my family, my clients and my coworkers. You are basing a complete judgment of this entire environment on one company and a few disgruntled employees. Shame on you for the disruption you will cause by this lack of journalistic professionalism and lack of integrity in the research standard you accepted.

Melisa Hansen, Cleveland, OH

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I would love to see Frontline do a piece on the innovative programmatic enhancements that do exist in assisted living and long term care today versus the piece you will air tonight. I think it may give the public a balanced look at what has been done in elder care in the US.

Don Shulman, Washington, DC
President & CEO, Association of Jewish Aging Services

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